State of the art management of parastomal hernias at the hernia centers.

Parastomal hernia is the most common complication after intestinal stoma creation, with an incidence of up to 50%. In up to 50% of cases, there is a known coincidence with an incisional hernia after laparotomy. Parastomal hernias should be treated using one of the established basic methods (keyhole, funnel mesh, Sugarbaker), or one of the advanced techniques (HyPER, Pauli, sandwich mesh) in the case of complex hernias or redo procedures. Primary suture appears to be completely inadequate and should not be practically used. Within the framework of an elective procedure, reconstruction of the gastrointestinal tract should be prioritized. Replacing of the stoma should only be used exceptionally for altering another section of the abdominal wall and should then be performed using a prophylactic mesh. When suitable, it is to perform our "Zorro" abdominoplasty or panniculectomy. Complex parastomal hernias should be managed similarly to all complex hernias in hernia centers, taking into account the applicable European Hernia Society (EHS) guidelines. This can minimize recurrence and postoperative morbidity. Close cooperation with (not only) colorectal surgeons during the primary procedure appears to be the key (position and closure of laparotomy, placement of stoma, prophylactic mesh). The siphon stoma output seems to be a crucial moment for the long-term uncomplicated function of the intestinal diversion. When performing a permanent terminal colostomy, a non-absorbable prophylactic mesh should be used according to EHS guidelines.