Comparison of Outcome between Ostomy Closure with Permanent Synthetic Mesh and Conventional Technique without Mesh to Prevent Incisional Hernia

Abstract

Background: Stomal site incisional hernia is a common complication following ostomy closure. Prophylactic mesh reinforcement of the fascial defect is typically not considered due to the contaminated nature of the case. The effectiveness of prophylactic mesh placement at the time of stoma closure is unknown because of fear of mesh infection and subsequent wound complications. Purpose: To compare the results obtained by placing synthetic mesh in the stoma site during closure with conventional technique without mesh to prevent incisional. Patients and Methods: Prospective interventional study had been designed to compare the outcome of permanent synthetic mesh placement at the time of ostomy closure. Total 45 patients were selected purposively who were candidates for ostomy closure and presented at the Department of Colorectal Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU) from April 2019 to September 2020 and divided into two groups (no mesh and mesh). In the mesh group, permanent synthetic mesh (ProleneTM – Polypropylene) was placed. Primary outcome, incisional stomal hernia was assessed at regular follow-up for one year along with associated morbidities. Results: The primary outcome of this study i.e. incisional hernia (stomal site) was observed among 1 (4.8%) patients at 4th week, 3 (14.3%) at 3rd month, 7 (33.3%) at 6th month and 8 (38.1%) at 12th month follow-up in no mesh group. And, only 1 patient at 6th month and 12th month follow-up had hernia in the mesh group (Figure 3). There was no difference statistically between no mesh and mesh groups at 4th week and 3rd month but significant difference found at 6th and 12th month follow-up (p=0.280, p=0.344, p=0.033 and p=0.017, respectively). Conclusion: Prophylactic placement of permanent polypropylene mesh during ostomy closure placement significantly reduced the rate of incisional hernia without any additional morbidity. Placement of mesh was found to be both safe and effective.