Prevention of parastomal hernia by the placement of a mesh at the primary operation

Abstract

Parastomal hernia is a well known clinical problem, and up to 50% of all patients having a stoma will eventually develop a parastomal hernia. There are many surgical options available for the repair of a parastomal hernia, but the prevention of hernia development has only recently received scientific attention. The most encouraging results have included the use of a mesh inserted at the primary operation. We have, therefore, chosen to review the literature regarding the results of operative techniques, including mesh placement, for the prevention of a parastomal hernia. We performed a systematic literature search and found five publications which, in total, included 112 patients having a prophylactic mesh during their stoma formation. One study was a randomized controlled trial which included 54 patients, of which, 21 patients had a prophylactic mesh. The remaining four studies were prospective observational series. Three of the 112 patients had a hernia recurrence within the follow-up period, which ranged from 2 to 48 months. One of the 52 patients that had a sublay mesh placed at the primary operation and two of 60 patients that had an onlay mesh developed a hernia. There were no infections or other serious complications related to the mesh in any of the studies. The results of placing a prophylactic mesh when performing a permanent stoma in the elective situation are very promising. However, the data are preliminary and with relatively short follow-up times. Therefore, it should be confirmed in larger, double-blinded, controlled randomized clinical trials whether there are short- and long-term advantages of placing a mesh at the primary operation, and where the mesh should be placed in the abdominal wall.