Characterizing a clinically significant radiographic parastomal hernia recurrence: post hoc analysis of a randomized controlled trial.

Introduction: Parastomal 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.

Methods: Patient 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.

Results: Of 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.

Conclusion: Radiographic 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.