ABSTRACT
Naturally occurring defects in the abdominal wall, such as the oblique inguinal canal or the diaphragmatic hiatus with its surrounding crura, which have specific evolved anatomical features to prevent herniation of adjacent bowel, still remain common sites of herniation. Both patient and technical factors contribute to the risk of parastomal hernia formation and as with other abdominal wall hernias the risks are increased in situations of impaired wound healing found in diabetes, malnutrition and steroid usage; obesity and increasing age are additional independent risk factors. Open parastomal hernia repair may be required when laparoscopy is impractical due to dense adhesions, where parastomal hernia repair is combined with an open procedure to repair other hernias, or as part of an emergency operation due to complications from a parastomal hernia. Open parastomal hernia repair can be by a keyhole technique or the Sugarbaker method and can be augmented by a posterior component separation to further extend the mesh overlap beyond the stoma.
