Incidence Of Parastomal Hernia Research Articles

247 Prophylactic Use of 3D Intraperitoneal Mesh in the Prevention of Parastomal Hernia in Permanent Colostomies After Rectal Cancer Resection

Abstract Background Parastomal hernia (PSH) is the most common complication of stomas associated with significant morbidity. Prophylactic mesh in preventing PSH is less well studied, and evidence is conflicting. We compare PSH rates in patients in whom 3D intraperitoneal mesh was and was not used prophylactically in a cohort of rectal cancer patients undergoing elective curative resection. Method Retrospective data from the Somerset Database and Electronic Patient Record were collected on patients under a single consultant surgeon between May 2016 and December 2021. Follow up was for a minimum of 2 years (excluding deaths). Appropriate statistical tests of difference significance were performed for proportions of categorical data, and time to hernia occurrence in patients with and without Dynamesh IPST placement. (Fisher’s Exact test; Kaplan Meier) Results From 397 colorectal cancer patients under the care of a single surgeon, 223 had elective surgery with curative intent, of which 63 (28%) underwent total mesorectal excision (TME) (30 TME & ileostomy, 12 TME Hartmann and 21 APER) - 90% laparoscopic. 16 patients had prophylactic mesh used. Demographics and co-morbidities between groups were similar. PSH incidence was 1 (6%) (radiological) vs.7 (41%) (clinical) in the mesh vs. non-mesh group; P=0.039. Post operative complications and pain scores differed only slightly. Time to hernia development did not differ between groups. Conclusions Use of prophylactic mesh during permanent stoma formation in our practice appears safe, and effective in preventing PSH. Further studies may answer the question “Should 3D collared mesh be routinely placed during the formation of permanent stomas to prevent parastomal hernia?”

Effects of different mesh materials on complications after prophylactic placement for stoma formation: a systematic review and network meta-analysis.

We primary aimed to synthesise the available data, assess the effectiveness of different mesh materials in prophylactic mesh placement, and rank these materials according to the incidence of parastomal hernia (PSH) and other stoma complications. This network meta-analysis performed a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Four databases were searched for randomised controlled trials of prophylactic mesh placement. The aggregated results were performed in the STATA routine for Bayesian hierarchical random effects models. Thirteen randomised controlled trials from 1203 articles, met the inclusion criteria, including 681 cases without meshes, 65 cases with mesh material of xenogeneic acellular dermis (porcine/bovine), 27 cases with polypropylene/PG910, 114 cases with polypropylene/polyglecaprone (Monocryl), 117 cases with polypropylene/cellulose (ORC), 233 cases with polypropylene, and 35 cases with polypropylene/PVDF. In network A, compared with no mesh, only polypropylene (RR 0.24, 95% CI 0.04-0.80) were significantly associated with a reduction in the incidence of PSH. In network B, no statistical difference regarding stoma complications was found between mesh and no mesh. Based on the network meta-analysis and ranking results, the polypropylene mesh material exhibited the best performance. However, this conclusion needs to be confirmed with larger sample sizes and high-quality randomised controlled trials.

Extraperitonealization of the ileal conduit decreases the risk of parastomal hernia: A single-center, randomized clinical trial

Parastomal hernia (PSH) is a common complication in patients receiving ileal conduit urinary diversion after radical cystectomy. In this randomized controlled clinical trial, we validate our previous finding that extraperitonealization of ileal conduit decreases incidence of PSH. In total, 104 consecutive patients undergoing radical cystectomy at Sun Yat-sen University Cancer Center are randomized 1:1 to receive either modified (extraperitonealized) ileal conduit (n= 52) or conventional ileal conduit (n= 52). Primary endpoint is incidence of radiological PSH during follow-up. Incidence of radiological PSH is lower in the modified group than in the conventional group (11.5% vs. 28.8%; p= 0.028) after a median follow-up of 32months, corresponding to a hazard ratio of 0.374 (95% confidence interval: 0.145-0.965, p= 0.034) in the modified conduit group. The results support our previous finding that extraperitonealization of the ileal conduit is effective for reducing risk of PSH in patients receiving ileal conduit diversion.

Parastomal hernias: the current state (review)

Every year there is an increase in the number of patients with intestinal stoma, which leads to an increase in the incidence of parastomal hernias (PSH). More than 50% of ostomy patients develop a parastomal hernia two or more years after radical surgery. To date, there are many surgical options for PSH, however, a unified algorithm for choosing an operational technique has not been evolved.The purpose of this review is to study modern surgical methods for the treatment of PSH and their late results, to determine the optimal approach and benefits.The review of the literature showed that in all cases of surgical treatment of PSH it is necessary to use mesh implants. The optimal technique for PSH hernioplasty is the laparoscopic version of Sugarbaker due to the low risk of recurrence and technical simplicity. In patients with large and giant PSH or hernia recurrence, STORRM is the technique of choice; classical stoma transposition is not used due to the high risk of recurrence. The use of Pauli/ePauli technique demonstrates a low recurrence rate, but there are no late results in this category of patients.

Clinical value of mesh prophylaxis for parastomal hernia based on evidence-based medicine

The incidence of parastomal hernia is substantially high, significantly affecting the quality of life of patients with stoma. How to effectively solve the problem of parastomal hernia is a long-term focus of hernia and abdominal wall surgery and colorectal surgery. The European Hernia Society guidelines on prevention and treatment of parastomal hernia published in 2018 has recommended the use of a prophylactic mesh to prevent parastomal hernia for the first time. In the following 5 years, more randomized controlled trials of multi-center, large-sample, double-blind, long-term follow-up have been published, and no significant effect of mesh prophylaxis has been observed on the incidence of parastomal hernia. However, whether mesh could decrease surgical intervention by limiting the symptoms of parastomal hernias would become a potential value of prophylaxis, which requires further research to elucidate.

The Risk Factors for Parastomal Hernia Development: A 8-year Retrospective Study in Colorectal Surgery

Background: Although parastomal hernia is a common complication of ostomy surgery, the exact risk factors for its development remain unclear. The aim of this study was to determine the incidence and risk factors of parastomal hernia in ostomy patients. 
 Methods: A retrospective study was conducted. The data from a cohort of 952 ostomy patients' hospital records between 2013 and 2020 were extracted and analyzed. Patients’ ostomy-related characteristics, complication notes, and the occurrence of parastomal hernia were retrieved. 
 Results: The patients' mean age was 59.6 years (±14.4 years), and 524 (55%) of them were male. Colorectal cancer (476 patients,50%) was the most common etiology for surgery. Parastomal hernia developed in 100 (10.5%) of patients. Age >65 (OR=1.753; 95%CI=1.071-2.869), BMI >24.9 (OR=2.009; 95%CI=1.201-3.362), co-morbidity (OR=1.773; 95%CI=1.021-3.080), laparoscopic surgery (OR=5.643; 95%CI=3.113-10.230), height of ostomy (OR=1.906; 95%CI=1.122-3.236), left lower quadrant ostomy location (OR=2.252; 95%CI=1.319-3.845), prolapse (OR=7.876; 95%CI=3.571-17.372), and other ostomy-related complications (OR=2.888; 95%CI=1.179-7.074) were risk factors based on logistic regression analysis. 
 Conclusion: The incidence of parastomal hernia was nearly one in ten patients after colorectal surgery with an ostomy. Advanced age, co-morbidity, laparoscopic surgery, the height of the ostomy, the left lower quadrant ostomy location, prolapse, and other ostomy-related complications were independent risk factors.

OC-101 PLACEMENT OF INTRAPERITONEAL PREFORMED PROPHYLACTIC MESH IN END COLOSTOMIES TO REDUCE PARASTOMAL HERNIA AND COMPARING WITH CONTROL GROUP. TECHNIQUE AND ANALYSIS OF OUR RESULTS

Abstract Objective To study the effect of the incidence of parastomal hernia (PSH) through the prophylactic placement of a preformed intraperitoneal mesh in patients who must undergo a definitive colostomy. The comparison is made with a homogeneous control group that did not receive prophylactic mesh. Material and methods Unicentric, prospective, non-randomized and observational study was performed. Patients were divided in two groups: 30 patients with colorectal neoplastic disease, collected consecutively,who underwent an end colostomy with a profilactic preformed intraperitoneal mesh (Dynamesh IPST®) versus a homogeneous control group (30 patients) who also underwent a definitive end colostomy without prophylactic mesh placement. Primary objective is to determine incidence of PSH in both groups. Secondary objectives were mesh related complications. Demographic variables and early postoperative complications, clinical and radiological follow-up (18–24 months) and presence of clinical and/or radiological PSH were registered. The surgical technique performed in our center is described. Results In the Mesh group there were 0 mesh-related complications at 30 days. In the long term, only 6.6% PSH were recorded in mesh group, while in the control group, a 63% of PSH were observed. Conclusions The incidence of PSH is significantly reduced using prophylactic mesh. Our study corroborates what has already been stated in the literature and does not associate complications. The prophylactic placement of the IPST intraperitoneal mesh in patients who require a definitive end colostomy is a technique that is easy to use in the laparoscopic approach, safe, fast, and easily reproducible, without related complications.

MP32-02 SURGICAL TECHNIQUE OF EXTRAPERITONEALIZING ILEAL CONDUIT DECREASE PARASTOMAL HERNIA COMPLICATION: A SINGLE-CENTER, PROSPECTIVE, RANDOMIZED, CONTROLLED CLINICAL TRIAL

You have accessJournal of UrologyCME1 Apr 2023MP32-02 SURGICAL TECHNIQUE OF EXTRAPERITONEALIZING ILEAL CONDUIT DECREASE PARASTOMAL HERNIA COMPLICATION: A SINGLE-CENTER, PROSPECTIVE, RANDOMIZED, CONTROLLED CLINICAL TRIAL Zhaohui Zhou, Zhiyong Li, Zhiling Zhang, Kai Yao, Huali Ma, Shengjie Guo, Pei Dong, Yunlin Ye, Fangjian Zhou, and Zhuowei Liu Zhaohui ZhouZhaohui Zhou More articles by this author , Zhiyong LiZhiyong Li More articles by this author , Zhiling ZhangZhiling Zhang More articles by this author , Kai YaoKai Yao More articles by this author , Huali MaHuali Ma More articles by this author , Shengjie GuoShengjie Guo More articles by this author , Pei DongPei Dong More articles by this author , Yunlin YeYunlin Ye More articles by this author , Fangjian ZhouFangjian Zhou More articles by this author , and Zhuowei LiuZhuowei Liu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003265.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Parastomal hernia (PSH) is a common complication in patients receiving ileal conduit urinary diversion after radical cystectomy. To validate our previous finding that extraperitonealization of ileal conduit (modified ileal conduit) decreases incidence of PSH after ileal conduit diversion. METHODS: This is a single-center, randomized controlled clinical trial (clinicaltrials.gov, NCT03822234). Between January, 2019 and March, 2020, 104 consecutive patients undergoing radical cystectomy at Sun Yat-sen University Cancer Center were randomized 1:1 to receive either modified ileal conduit (n=52) or conventional ileal conduit (n=52). One group received extraperitonealization of ileal conduit, the other received conventional ileal conduit. Primary endpoint was incidence of radiological PSH at 24 months post surgery. Secondary endpoints were incidence of stomal complications (retraction, stenosis, and prolapse) at 24 months. Other complications related to surgery were also recorded. RESULTS: Incidence of radiological PSH was lower in modified ileal conduit patients than in conventional ileal conduit patients (11.5% [6/52] vs. 28.8% [15/52]; p=0.028) after a median follow-up of 32 months, corresponding to a hazard ratio of 0.375 (95% CI: 0.146-0.967, p=0.043) in the modified conduit group. No stomal retraction, stenosis or prolapse complications occurred. Median operating time was comparable between the groups. Early surgery-related complications were less in modified conduit patients; late complications were similar in the two groups. CONCLUSIONS: The results support our previous finding that extraperitonealization of ileal conduit is effective for reducing risk of PSH in ileal conduit diversion patients. Further multicenter controlled clinical trials on large samples (including obese patients) are needed. Source of Funding: Without source of funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e439 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zhaohui Zhou More articles by this author Zhiyong Li More articles by this author Zhiling Zhang More articles by this author Kai Yao More articles by this author Huali Ma More articles by this author Shengjie Guo More articles by this author Pei Dong More articles by this author Yunlin Ye More articles by this author Fangjian Zhou More articles by this author Zhuowei Liu More articles by this author Expand All Advertisement PDF downloadLoading ...

V06-12 PROPHYLACTIC MESH STRIPS: AN EFFECTIVE WAY TO REDUCE HERNIA DURING RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 Apr 2023V06-12 PROPHYLACTIC MESH STRIPS: AN EFFECTIVE WAY TO REDUCE HERNIA DURING RADICAL CYSTECTOMY Noah Frydenlund, Eric Li, Clayton Neill, Gergory Dumanian, and Joshua J. Meeks Noah FrydenlundNoah Frydenlund More articles by this author , Eric LiEric Li More articles by this author , Clayton NeillClayton Neill More articles by this author , Gergory DumanianGergory Dumanian More articles by this author , and Joshua J. MeeksJoshua J. Meeks More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003274.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Postoperative hernia development, especially parastomal hernia (PSH), remains a challenging problem after radical cystectomy (RC). The incidence of incisional hernia (IH) has been reported to range from 5-15%, while PSHs occur between 15-65%. The use of prophylactic mesh sheets during RC has been shown to reduce the incidence of PSH in a recent randomized trial. We present our technique for the prophylactic use of soft polypropylene mesh strips as sutures at the time of RC as a potential alternative to mesh sheets and review our early experience. METHODS: A retrospective review of a single surgeon's experience with RC from January 2017 to July 2022 was performed. The inclusion criteria were the use of prophylactic parastomal and/or ventral mesh strips. Patients that required intra-operative assistance from plastic surgery for complex abdominal closure were excluded. Radiographic hernias were identified by radiology reports. Hernias that were noticeable on physical exam, symptomatic, or required operative repair were classified as clinical hernias. RESULTS: A total of 72 patients with prophylactic mesh strip placement during radical cystectomy were included. The average age was 73.5 years (Range 41-88 years), with an average follow of 10.8 months (range 1.1 – 63 months) and an average BMI of 27.9 (range 16.0 – 39.13). Sixty-one patients underwent RC with ileal conduit (IC), while 11 underwent RC with neobladder (NB) creation. 93% of the cases were performed robotically with extracorporeal diversion, and the remainder were open. In the RC with IC cohort, 54 patients had ventral and stomal mesh strips placed while 4 had ventral only and 3 had stomal only strips. Radiographic IH was reported in 6/69 (8.7%) patients with ventral mesh strips. Clinical IH was reported in 2/69 (2.9%) patients. For the RC/IC cohort, radiographic PSH was identified in 11/57 (19.3%) patients, and clinical PSH occurred in 6/57 (10.5%) patients. 2/57 (3.5%) patients underwent parastomal hernia repair, 2/57 (3.5%) developed stomal stenosis, and one patient underwent incisional hernia repair. No mesh-related complications were identified. CONCLUSIONS: The prophylactic use of mesh strips as sutures during RC may provide a safe and effective method to reduce postoperative hernia. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e512 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Noah Frydenlund More articles by this author Eric Li More articles by this author Clayton Neill More articles by this author Gergory Dumanian More articles by this author Joshua J. Meeks More articles by this author Expand All Advertisement PDF downloadLoading ...

Prophylactic Effect of Simultaneous Placement of Mesh on Incidence of Parastomal Hernia After Miles' Surgical Resection of Colorectal Cancer: AProspective Study.

To assess the prophylactic effect of simultaneous placement of mesh and the incidence of parastomal hernia (PSH) after abdominoperineal resection of rectal cancer. This study included real-world data of 56 surgically resected patients with colorectal cancer who were consecutively assigned to two groups: control (no mesh, n=32) and experimental (received mesh, n=24). An artificial patch was placed under the tunica vaginalis of rectus abdominis for patients in the experimental group, whereas those in the control group received routine sigmoidostomy. The median follow-up time was >20mo. The difference in hazards function was analyzed by cox regression analysis. The Kaplan-Meir analysis was used to determine the survival curves. A P value of <0.05 was considered as significant. The postoperative incidence rate of PSH was lower in the experimental (41.7%) group than in the control group (71.9%; P=0.045). The PSH postoperative time in the experimental group was significantly delayed compared to the control group (48mo versus 10mo; P<0.001). The risk of progression from H1 to H2 was less in the experimental group compared to the control group (49.28% versus 60.86%; P=0.14). Prophylactic mesh placement significantly prolonged postoperative time for the recurrence of PSH. The incidence of recurrence of H2 (severe PSH) requiring secondary surgical repair was also reduced.

TH8.1 Radiological incidence of donor-site incisional hernia and parastomal hernia after Vertical Rectus Abdominus Myocutaneous Flap-based reconstruction following colorectal surgery

Abstract Aims The vertical rectus abdominis myocutaneous (VRAM) flap is commonly used to reconstruct perineal defects for low rectal and anal cancer. The incidence of midline incisional hernias after VRAM reconstruction varies from 3.6% when detected clinically to up to 50% when detected radiologically. The aims of this study is to accurately determine the radiological incidence of donor-site incisional and parastomal hernia following VRAM reconstruction. Methods Retrospective cohort study of patients undergoing colorectal surgery requiring VRAM reconstruction over 10 years. Data were collected on patient demographics, indication for surgery and surgical procedure including details of any hernia repair. Images from surveillance CTs were reviewed for presence and size of midline incisional and/or parastomal hernias. Parastomal hernias were classified based on the European Hernia Society (EHS) classification. Results 173 patients were included in the analysis. The median age was 67 years (range 29 – 88 years) and median length of follow up was 49 months (IQR 24.3 – 71.0 months). The overall radiological incidence of incisional hernia was 27.6%. The radiological incidence of donor-site incisional hernia after VRAM at 1, 2 and 5 years was 16.8%, 25.2% and 18.5%. The parastomal hernia incidence at 1, 2 and 5 years was 37.9%, 44.1% and 29.8% (48.6% overall). Conclusions The majority of patients who develop donor-site incisional hernia and parastomal herniation following VRAM tend to do so within the first two years. Although the use of CT imaging improves the diagnosis of donor-site incisional and parastomal hernias, the clinical significance of this is unknown.

Incidence of parastomal and incisional hernia following emergency surgery for Hinchey III-IV diverticulitis: A systematic review.

The aim of this systematic review was to evaluate the risk of parastomal (PSH) and incisional hernias (IH) after emergency surgery for Hinchey III-IV diverticulitis, with comparison between the Hartmann procedure and other surgical techniques. The Cochrane Library, Embase, PubMed (MEDLINE), Web of Science and Scopus databases were systematically searched. The primary endpoint was parastomal hernia incidence. The secondary endpoint was incisional hernia incidence. Five studies (four randomized controlled trials and one retrospective cohort) with a total of 699 patients were eligible for inclusion. The PSH rate was 15%-46% for Hartmann procedure, 0%-85% for primary anastomosis, 4% for resection, and 2% for laparoscopic lavage. The IH rates were 5%-38% for Hartmann procedure, 5%-27% for primary anastomosis, 9%-12% for primary resection, and 3%-11% for laparoscopic lavage. Both the parastomal and incisional hernia incidences are poorly evaluated and reported, and varied greatly between the studies.

Incidence and risk factors for parastomal hernia with a permanent colostomy.

This study aims to explore the incidence and risk factors for permanent colostomy complicated with a parastomal hernia (PSH) after rectal cancer resection. This was a retrospective study of gastrointestinal surgery performed from January 2013 to December 2017 in patients with colorectal cancer treated at the Affiliated Hospital of Qingdao University. The relevant clinical variables of the patient were analyzed. Kaplan-Meier, univariate, and Cox multivariate analyses were used to evaluate the influencing factors and morbidity of PSH. Among the 211 patients, 65 developed PSH. The cumulative incidence reached 33.5% at 62 months. In the multivariate Cox survival analysis, the results showed that being a woman, aged ≥65 years, having a body mass index(BMI) ≥ 25 kg/m2 , diabetes, and Clavien-Dindo Grade III and IV complications were risk factors for the occurrence of PSH. In our study, the incidence of PSH increased annually and reached a maximum of 33.5% after 62 months. Among the patient-related factors, female sex, age ≥65 years, BMI ≥ 25 kg/m2 , diabetes, and postoperative Clavien-Dindo Grade III and IV complications were significantly associated with the development of PSH. Therefore, intervention measures to prevent patients with this risk factor are advisable.

Cost Effectiveness of the Use of Prophylactic Mesh To Prevent Parastomal Hernia After Urinary Diversion with an Ileal Conduit

BackgroundProphylactic lightweight mesh in the sublay position reduced the cumulative incidence of parastomal hernia (PSH) after cystectomy with ileal conduit diversion in a randomised controlled trial. ObjectiveTo investigate whether the use of prophylactic mesh is cost-effective in comparison to no mesh from the health care provider perspective. Design, setting, and participantsData on health care resource utilisation (outpatient care and inpatient care) were obtained for 159 patients included in a randomised trial. The patients underwent surgery at Skåne University Hospital or Helsingborg County Hospital (80 with a prophylactic mesh and 79 without) and information about care was ascertained from the regional health care register. The patients underwent surgery between 2012 and 2017 and were followed until death or August 2020. Outcome measurements and statistical analysesThe primary outcome measure was the clinical incidence of PSH. Costs are reported in Euro in 2020 prices (€1 = 10.486 Swedish Krona) and presented as the incremental cost-effectiveness ratios (ICERs) with confidence intervals (CIs) calculated using a nonparametric bootstrap procedure. Sensitivity analyses and subgroup analyses were performed to capture the uncertainty for ICERs. Results and limitationsThe mean difference in total costs between the mesh and no-mesh groups was −€2047 (95% CI −€16 441 to €12 348). Seventeen patients (21.5%) in the no-mesh group developed clinical PSH versus six patients (7.5%) in the mesh group (p = 0.001). This indicates that mesh is less costly and more effective compared to no mesh from the health care provider perspective. Subgroup analyses showed that results were more advantageous for women and for patients younger than 71 yr and with less comorbidity than for their counterparts. ConclusionsThe use of prophylactic mesh during ileal conduit reconstruction to prevent PSH is cost-effective from the health care provider perspective. Patient summaryIn patients having their bladder surgically removed, a mesh implant can be inserted when a portion of the intestine is used to create an opening to drain urine from the body. Our results show that mesh use to prevent development of a hernia at the opening where urine exits the body is cost-effective from the perspective of health care providers.

Extraperitonealization of ileal conduit reduces parastomal hernia after cystectomy and ileal conduit diversion.

Parastomal hernia (PSH) is a common complication of ileal conduit diversion after radical cystectomy. Novel surgical techniques for preventing PSH formation are needed. We aimed to evaluate surgical technique of extraperitonealizing the ileal conduit (modified ileal conduit) for preventing PSH. A retrospective analysis of 375 consecutive patients who underwent ileal conduit after cystectomy at the Sun Yat-sen University Cancer Center between January 1, 2000 and June 31, 2019 was conducted. 214 patients had modified ileal conduit diversion and 161 patients conventional ileal conduit (Bricker) diversion. The demographic and clinicopathologic characteristics of patients in the 2 groups were compared using the t test and Chi square test. Univariable and multivariable Cox regression analyses were used to predict the risk of PSH formation. The 2 groups were comparable in regard to all demographic and clinicopathologic variables. The incidence of PSH diagnosed by CT scan was 7.5% in the modified group and 21.1% in the conventional group (P < 0.001). High BMI and history of prior abdominal surgery was identified by univariable analysis as risk factors of PSH formation. Multivariable analyses revealed that technique of extraperitonealizing ileal conduit significantly reduced incidence of PSH in patients with or without risk factors of PSH formation (OR = 0.29, 95% CI 0.16-0.54, P < 0.001). Technique of extraperitonealizing ileal conduit appeared to be effective in reducing PSH formation after ileal conduit diversion.

The incidence of parastomal hernia following the creation of a colostomy, ileostomy or urostomy

The incidence of parastomal hernia following the creation of a colostomy, ileostomy or urostomy

An Analysis of the Risk Factors for the Development of Parastomal Hernia: A Single Institutional Experience.

Objectives: To study the frequency of risk factors affecting the development of parastomal hernias in patients undergoing stoma formation.Study Design: A retrospective descriptive cross-sectional study.Duration of Study: This study was conducted at the Department of General Surgery between January 2017 to December 2020.Methodology: A total of 163 patients aged between 20 and 100 years and who required a stoma formation were included in the study. The patients with incomplete data and those lacking post-operative imaging were excluded. According to this selection criteria, 80 patients were excluded. The data was collected for all patients from the hospital database. This included patient’s demographic information, co-morbidities, pre-surgery patient characteristics, an indication of stoma formation, the location of stoma exit, type of surgery, associated comorbidities, subcutaneous fat thickness, and type of stoma formed. Data were analyzed using IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.Results: The mean age was 68.46 ± 16.50 years, with males in the majority: 48 (57.8%). Most of the patients, 53 (63.8%), had malignant disease. Post-stoma formation, a total of 38 (45.9%) patients developed parastomal hernias, mostly involving the sigmoid colon (n=62, 74.7%). However, there was a statistically significant relationship between paroxysmal sympathetic hyperactivity (PSH) incidence with non-trans-rectus stomas (trans-oblique n=07, junctional n=28) (OR 3.04, CI 1.23-7.5, p=0.014). Furthermore, malignancy was also not an independent predictor of PSH (OR 0.408, CI 0.15-1.2, p=0.056). All other risk factors included in this study were nonsignificant.Conclusion: Our study shows that the incidence of parastomal hernias is rising with a high rate demonstrated in our patients. There was no statistically significant association between patient-related preoperative and operative factors with increased risk of parastomal hernias in our population except for a non-trans-rectus stoma, which was identified as an independent risk factor for parastomal hernias. Based on our findings, we would recommend a trans-rectus stoma over all other stoma sites. However, a much larger study is needed to validate this finding further.

Parastomal hernia repair

Despite significant advances in abdominal wall reconstruction, parastomal hernias remain a complex problem, with a high risk of recurrence following repair. While a number of surgical hernia repair techniques have been proposed, there is no consensus on optimal management. Several clinical variables must be considered when developing a comprehensive repair plan that minimizes the likelihood of hernia recurrence and surgical site occurrences. In this review, we describe the incidence of parastomal hernias and discuss pertinent risk factors, medical history findings, physical examination findings, supplementary diagnostic modalities, parastomal hernia classification systems, surgical indications, and repair techniques. Special consideration is given to the discussion of mesh reinforcement, including available biomaterials, anatomic plane selection, and the extent of mesh reinforcement. Although open repairs are the primary focus of this article, minimally invasive laparoscopic and robotic approaches are also briefly described. It is our hope that the provided surgical outcome data will help guide surgical management and optimize outcomes for affected patients.

P074 PARASTOMAL AND INCISIONAL HERNIAS FOLLOWING EMERGENCY SURGERY FOR HINCHEY III-IV DIVERTICULITIS: A SYSTEMATIC REVIEW

Abstract Aim The aim of this systematic review was to report the risk of parastomal and incisional hernias after emergency surgery for Hinchey III–IV diverticulitis. Material and Methods The Cochrane Library, Embase, PubMed (MEDLINE), Web of Science and Scopus databases were systematically searched. All randomized controlled trials (RCTs) and cohort studies comparing HP with other surgical treatment options for perforated diverticulitis classified as purulent or faecal (Hinchey III–IV) were considered for inclusion. Exclusion criteria were case series and reports, letters, editorials, reviews and conference abstracts. The primary endpoint was parastomal hernia incidence. The secondary endpoint was incisional hernia incidence. Seven studies (six randomized controlled trials and one retrospective cohort) with a total of 831 patients were eligible for inclusion. Results The parastomal hernia incidence was 15.2–46.0% for Hartmann procedure, 0–85.2% for primary anastomosis, 4.3% for resection and 1.6 % for laparoscopic lavage. The incisional hernia incidences were 7.8–38.1% for Hartmann procedure, 4.5–27.2% for primary anastomosis, 3.2–25.5% for primary resection, 2.7–11.1% for laparoscopic lavage and 16.1–45.8% for secondary resection. Due to heterogeneity of follow-up methods, follow-up time and lack of both parastomal and incisional hernia as outcome, no meta-analysis was conducted. Conclusions The hernia incidences reported after surgical treatment for complicated diverticulitis may be biased and underestimated. For future RCTs, researchers are encouraged to pay attention to hernia diagnosis, symptoms and prevention.

163 Morbidity of Presumed Temporary Loop De-Functioning Stomas in Patients with Colorectal Cancer

Abstract Objectives The incidence of parastomal hernia (PSH) can be up to 80% of patients who have a stoma following abdominal surgery (1). Surgical intervention is required in 70% of patients due to pain, obstructive symptoms, or stoma appliance issues (2). This study aims to show the morbidity related to a presumed temporary loop stoma. Method This was a retrospective cohort study of all left-sided colorectal cancer resections undertaken in a single centre. Electronic healthcare records and Picture Archiving and Communication System (PACS) were used to gather data on patient demographics, operative details and details of de-functioning stoma fashioned. Morbidity related to de-functioning stoma was determined based on hospital admissions and length of inpatient stay related to stoma, complications in relation to the stoma, return to theatre, stoma reversal and fate of stoma site. Results 147 patients (87 M; 60 F, median age 69 (23-93)) underwent left sided colorectal cancer resections at a single centre. In total, 50 de-functioning loop stomas were fashioned (49 loop ileostomies and 1 loop colostomy.) At a median follow-up of 23 months (8-44), prior to reversal, 12 PSH were identified. 38 of the de-functioning stomas were reversed at a median time of 11 months (1-44), 5 of which were emergency procedures due to obstruction (n = 3) or high output (n = 2). There were 9 stoma related re-admissions identified in 7 patients. Conclusions Presumed temporary defunctioning loop ileostomies in Low anterior resections is associated with significant morbidity, but low risk in terms of life-threatening complication.