Trial reportSurgical endoscopy2025
Characterizing a clinically significant radiographic parastomal hernia recurrence: post hoc analysis of a randomized controlled trial.
Trial report in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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16 authors.
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Abstract
introductionParastomal hernia recurrence is common but poorly defined. We aimed to correlate radiographic recurrence and reoperation for parastomal hernia recurrence with patient-reported outcomes (PROs) to determine the clinical significance of radiographic recurrence and identify potential screening tools.
methodsPatient data in the one- and two-year follow-up windows of a registry-embedded randomized controlled trial comparing open retromuscular Sugarbaker and keyhole mesh parastomal hernia repairs (2019-2022) were analyzed. CT scan images were classified using the Moreno-Matias (MM) classification scheme and PROs were analyzed for trends across groups. PROs included stoma-specific quality of life (Colostomy Impact Score - CIS, range 0-38), pain (NIH PROMIS 3a, range 30.7-71.8), abdominal wall-specific quality of life (HerQLes, range 0-100), and the Decision Regret Scale (DRS, range 0-100) in reference to the previous repair.
resultsOf 150 randomized patients, there were 221 cross-sectional images and 5 reoperations for recurrence with time-matched PROs. Radiographic recurrence classification ordinally correlated with worse stoma-specific quality of life (CIS, p = 0.0001), with a significant difference first noted between MM 0 and MM II (p = 0.02). Reoperation for recurrence was associated with both worse stoma-specific quality of life (CIS, p = 0.02) and pain (PROMIS 3a, p = 0.02). Abdominal wall-specific quality of life and decision-regret were not associated with radiographic recurrence or reoperation.
conclusionRadiographic MM classification appears to be clinically meaningful with regard to stoma-specific quality of life. Significant differences were first observed at MM II, supporting the use of MMII as a cutoff to define a clinically significant parastomal hernia recurrence. Additionally, measurements of stoma-specific quality of life and pain are potential screening mechanisms to identify patients that should have cross-sectional imaging and counseling on reoperation.
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