Contemporary Paradigms in Parastomal Hernia Management: A Comprehensive Review

Parastomal hernia (PSH) is the most frequent late complication after permanent enterostomy creation, exhibiting a cumulative incidence ranging from 30% to over 50% within 24 months. It induces profound functional, economic, and psychological strain while posing substantial risks of incarceration, mechanical obstruction, and strangulation. This comprehensive review assesses the modern paradigms in PSH prevention, diagnostic criteria, and advanced surgical repair techniques based on international consensus statements and clinical data published between 2023 and 2026. A qualitative synthesis was conducted by analyzing multi-society clinical guidelines, systematic reviews, and meta-analyses indexed in major biomedical databases up to 2026. High-certainty data confirm that prophylactic synthetic mesh reinforcement during permanent end-colostomy creation significantly reduces primary PSH incidence without escalating surgical site infections (SSIs) or stoma-specific complications. Regarding surgical repair, conventional non-mesh suture techniques are obsolete due to high recurrence rates. Modern minimally invasive approaches (laparoscopic and robotic) utilizing the Sugarbaker technique or advanced preperitoneal/retromuscular meshes (such as the Pauli or TRAPPIST procedures) deliver low conversion rates (~0.7%) and decreased wound-related morbidity. However, overall postoperative complications in elective and emergency repairs remain substantial (~43%), necessitating meticulous perioperative optimization. PSH management requires strict adherence to evidence-based prevention pathways. Minimally invasive retrorectus or intraperitoneal mesh placement represents the contemporary standard of care for symptomatic cases. An interdisciplinary approach is essential to tailor surgical and non-operative interventions to the patient's individual clinical profile.