ESCP leadPROPHER (Patient Reported Outcomes after Parastomal HErnia tReatment) - a prospective international cohort study

Background to project

A significant proportion of stoma patients develop a parastomal hernia (PSH), with reported rates varying widely from 5% to 50% due to heterogeneity in the definition and mode of diagnosis [1]. PSHs are symptomatic in 75% of these patients, causing a significant impact on quality of life due to issues with appliance fitting, leakage, skin excoriation and pain. They can also lead to emergency presentations with strangulation and obstruction.

PROPHER logoThe impact of PSH on patients has been highlighted by the recent ACPGBI Delphi process, and is the subject of an ACPGBI consensus statement [1, 2]. A major prospective NIHR-funded national study, CIPHER, is currently ongoing and aims establish both the incidence and impact of PSH, as well as exploring optimum surgical techniques to try and prevent their initial development after primary stoma creation.

There remains a pressing need to establish the optimum treatment of PSH. In particular, it is always not clear which patients should undergo surgical repair, and in those who do, the best technique of repair is yet to be established. There is wide variability in surgical behaviour when treating PSH, including aspects such as whether a mesh is used to reinforce the repair, and the optimum mesh material, trephine size and shape and plane of placement. Specific and/or new techniques have been published in small series by enthusiasts with promising results, but overall outcomes after surgical repair remain disappointing. The same challenges encountered with the initial definition and diagnosis of PSH also cause issues when trying to assess whether an intervention to treat PSH has been successful.

We propose a unique prospective international cohort study of PSH treatment, including both operative and non-operative interventions. This will utilise our existing global network of surgeons to obtain detailed information on the exact interventions used and short-term outcomes, then empower patients to provide their own medium and long-term outcomes data and to report whether their treatment was successful. This will provide a wealth of contemporaneous information that will improve our ability to counsel patients and facilitate improved selection of appropriate and personalised interventions for those with a PSH.

Download the PROPHER protocol here (PDF)

How to get involved in PROPHER

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  1. ACPGBI Parastomal Hernia Group. Prevention and treatment of parastomal hernia: a position statement on behalf of the Association of Coloproctology of Great Britain and Ireland. Colorectal disease 2018; 20(S2):5-19.
  2. Tiernan J, Cook A, Geh I et al. Use of a modified Delphi approach to develop research priorities for the Association of Coloproctology of Great Britain and Ireland. Colorectal Dis 2014; 16: 965–70.
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