Comparison of short-term outcomes between open and minimally invasive surgery for emergent parastomal hernia repair: A retrospective propensity score–matched analysis

Background: Parastomal hernia (PSH) is a common complication after stoma creation and may present emergently with obstruction, incarceration, or ischemia. While minimally invasive surgery (MIS, laparoscopic or robotic) shows benefits in elective PSH repair, data in emergencies are limited. This study compared outcomes following open versus MIS emergent PSH repair. Methods: In this retrospective cohort using ACS-NSQIP, patients undergoing emergent open, laparoscopic, or robotic PSH repair were identified. Surgical approach was categorized as open or MIS. A 3:1 propensity score–matched analysis balanced demographic, comorbidity, physiologic, laboratory, and operative variables. Primary outcome was 30-day overall postoperative complications; secondary outcomes included wound, medical, and surgical complications, return to the operating room (OR), length of stay, and readmission. Multivariate logistic regression identified predictors of complications. Results: Of 303 patients (249 open, 54 MIS), 192 were analyzed after matching (144 open, 48 MIS) with balanced baseline characteristics. MIS repair had lower overall complications than open repair (22.9% vs. 39.6%, p = 0.037), while wound, medical, and surgical complications were similar. Return to the OR tended to be higher after MIS (14.6% vs. 6.3%, p = 0.070), mainly for ostomy-related revisions. Length of stay and readmission were comparable. Higher ASA class independently predicted complications. Robotic repair was associated with reduced odds of overall complications (OR 0.35; 95% CI 0.15–0.79; p = 0.012). Conclusion: MIS repair of emergent PSH was associated with fewer overall complications, though ostomy-related reoperations may be more frequent. MIS is a safe option in selected high-risk patients, with approach guided by patient factors and surgeon experience.