ASCRS Ch55 - Abdominal Wall Reconstruction and Parastomal Hernia Repair

Fifty-fifth chapter of the ASCRS Textbook of Colon and Rectal Surgery, 4th edition (Petro CC, Prabhu A, Rosen MJ). Book pages 947–959 (PDF pages 937–949 of raw/ASCRS Textbook 4th Ed.pdf, offset +10 — unchanged from Ch54's +10 (both confirmed via the "© Springer Nature Switzerland AG 2022 <page>" copyright-line cross-check; see log.md's offset-correction note — this was previously mislogged as +9); begins immediately at PDF page 937 with no intervening blank page). Despite its title, the chapter's content is almost entirely about parastomal hernia repair specifically — the "abdominal wall reconstruction" techniques it describes (retromuscular repair, transversus abdominis release/TAR) appear only in the context of parastomal defect repair, not as standalone general AWR content. This is the chapter Intestinal Stomas (Ch54) explicitly deferred its parastomal hernia detail to.

Key concepts (chapter's own summary box)

• The precise incidence of parastomal herniation is largely dependent on criteria for diagnosis.
• A selective approach to repair of parastomal hernias is warranted owing to the high recurrence rates associated with surgical repair.
• Repair should generally be restricted to highly symptomatic patients with parastomal hernia.
• Laparoscopic Sugarbaker repair is the procedure of choice for most patients requiring surgery for parastomal hernias.
• Advanced abdominal wall reconstruction techniques may be indicated in complex defects.

Filing

• Parastomal Hernia Repair — entirely new procedure page. Covers incidence by stoma type, risk factors and diagnosis (including the limits of CT imaging vs. patient self-report), classification systems (EHS 2014 as the most pragmatic), operative indications and the evidence for a selective/conservative approach, preoperative optimization targets, and the full repair-technique armamentarium (primary repair, onlay mesh, open and laparoscopic intraperitoneal mesh in keyhole vs. Sugarbaker orientation, open retromuscular repair/TAR) with their respective outcome tables, the chapter's own decision algorithm, and a mesh-selection comparison (synthetic vs. biologic/biosynthetic). Cross-referenced from Intestinal Stomas's complications section, which previously only carried the bare incidence range.

Relevance

An unusually self-aware chapter about the limits of its own evidence base: no randomized trial compares parastomal hernia repair techniques with mesh reinforcement — every recommendation here rests on case series and pooled/meta-analyses. The chapter's own authors also candidly report their institution's less favorable, less-published experience with a technique (the Pauli TAR/Sugarbaker variant) that looked excellent in its originating multi-surgeon report — a useful methodological caution about single-center series in this literature, preserved rather than smoothed over in Parastomal Hernia Repair's "Open items" section. The two most load-bearing sources for the page's central recommendations are the DeAsis laparoscopic meta-analysis (the direct evidentiary basis for "laparoscopic Sugarbaker is the procedure of choice") and the Warren et al. 2020 contaminated-field synthetic mesh series (the largest series of its kind, at 402 patients).

Open items / gaps

• All content is textbook-level/secondary, itself drawn from case series/meta-analyses rather than RCTs (an explicit evidence gap in the underlying field, not just this wiki). 81 references total.
• An ongoing RCT (NCT03972553, open retromuscular keyhole/cruciate vs. Sugarbaker mesh reinforcement) is mentioned as in progress at time of writing — worth checking for published results in a future ingest or lint pass.
• Chapter 56 ("Functional Disorders After Colorectal Surgery/IBS," Kunitake H, Staller K) begins immediately at PDF page 951 (after a "Part V: Pelvic Floor Disorders" section-divider page at PDF page 950) — next in the sequential ingest. Note the section divider: this marks the start of a new textbook part, not necessarily a new page-offset regime — offset should be reconfirmed against printed folio when Ch56 is read.