Prevention Of Parastomal Hernia Research Articles

Meta-analysis and Systematic Review of the Use of a Prosthetic Mesh for Prevention of Parastomal Hernia.

The primary endpoint of this meta-analysis was the PSH rate at 1 year of follow-up with or without the use of a mesh. European guidelines currently recommend the use of a mesh at the time of a stoma formation for the prevention of PSH. These recommendations are based on the RCT and meta-analyses published before 2017. More recently 2 large RCT found no benefit in the mesh group. We investigated whether these latest results could change the conclusion of a meta-analysis. We conducted a comprehensive literature search and analyzed RCT investigating the use of a mesh to prevent PSH formation. All studies including end colostomies were included in the qualitative analysis no matter the surgical technique or the type of mesh. All studies with a limited risk of bias and presenting with usable data were used in the quantitative analysis. There is a large heterogeneity among the studies, in terms of position of the mesh, surgical technique, and diagnostic method for the PSH.No statistically significant difference was found on the PSH rate at 1 or 2 years between the mesh and non-mesh groups. Based on this meta-analysis including the latest RCT on the prevention of PSH, the use of a mesh should not be recommended.

Permanent end-colostomy parastomal hernia prevention using a novel three-dimensional mesh.

Prophylactic mesh placement has been proposed to reduce the high occurrence of parastomal hernia (PSH) after stoma formation. This is an observational study comparing two cohorts of patients: a mesh prophylaxis group (who received mesh prevention since introduction at our Institution) and a no mesh prophylaxis group (retrospectively selected from our historical series). Same exclusion criteria were applied for both groups. The study was conducted at a tertiary referral center for colorectal surgery. 43 patients were operated with mesh prophylaxis between May 2015 and may 2019. 45 patients underwent end-colostomy formation without prophylaxis between April 2011 and April 2015. The primary outcome measure was PSH development at 12-month follow up. Demographic variables and risk factors for PSH were comparable between the two groups. There was no difference between the two cohorts in terms of operative time and main early postoperative outcomes. 37 patients completed the 12-month follow up in each group. PSH occurrence after 12-months was 11% in the mesh prophylaxis group and 54% in the no mesh prophylaxis group (p < 0.0001). There were no differences in long-term complications. 5% of patients who received mesh prophylaxis underwent emergency surgery for bowel occlusion at 7 and 10months after surgery, with partial or complete mesh removal. At multivariate analysis, mesh prophylaxis was a protective factor for PSH development at 12months (p < 0.0001). Prophylactic intraperitoneal mesh placement appears to be effective in preventing PSH.

Mini-invasive Surgery and Parastomal Hernia: Higher Frequency and No Prophylactic Mesh Effect.

Parastomal hernia (PSH) is very common. Recent reports suggest increased frequency after laparoscopic stoma formation compared with open surgery. A retrospective chart review was designed to appraise the outcomes regarding PSH in open and in laparoscopic procedures. All patients operated by rectal resection and planned end-colostomy in the period from 2004 to 2018 were reviewed. A total of 70 open and 101 laparoscopic operations were identified. A modified retromuscular mesh application through the trephine was used for the prevention of PSH in 42% of patients in the laparoscopic group. The median follow-up was 58 (1 to 167) months in the open group and 43 (0 to 153) months in the laparoscopic group. Patient characteristics were evenly distributed between the groups, except for more male patients and higher American Society of Anesthesiologists Score as well as higher rates of patients with neoadjuvant treatment and mesh prophylaxis, in the laparoscopic group. Clinical PSH occurrences were 2 (3%) in the open group and 18 (18%) in the laparoscopic group (P=0.00). Propensity-weighted analysis estimates increased odds ratio (OR) for PSH in the laparoscopic group [OR=11.8; 95% confidence interval (CI): 1.4-96.6]. PSH repair rates were 0 in the open group and 6/18 (33%) in the laparoscopic group. Mesh prophylaxis in the laparoscopic group did not influence PSH outcome (OR=1.4; 95% CI: 0.5-4.0). Computed tomography scans were assessable in 48 and 66 patients, with median follow-up timepoints of 42 and 30 months in the open and laparoscopic groups, respectively, and 8 (18%) and 21 patients (32%) were diagnosed with PSH. Computed tomography assessment implied an increased risk for PSH in laparoscopy (OR=3.5; 95% CI: 1.1-11.9). Aggregate of chart and computed tomography occurrence of PSH showed an equivalent hazard (OR=3.2; 95% CI: 1.1-9.5). Laparoscopic operations with stoma formation seem to have an increased rate of PSH in comparison with open operations and the results support previous claims. Retromuscular keyhole mesh placement may not be the ideal method of PSH prevention in laparoscopic stoma formation.

Prophylactic mesh augmentation using permanent synthetic mesh: outcomes of keyhole and Stapled Ostomy Reinforcement with Retromuscular Mesh techniques.

Parastomal hernias (PSH) are the most common complication of stoma creation and can cause significant morbidity. We present a consecutive series of patients receiving prophylactic mesh augmentation (PMA) for prevention of PSH. This retrospective review evaluates the efficacy and outcomes of PMA for PSH prevention, and retrospectively compares traditional keyhole PMA (tPMA) (n = 28) with a prophylactic Stapled Ostomy Reinforcement with Retromuscular Mesh technique (pSTORRM) (n = 24). PMA was performed in 52 cases between January 2015 and July 2018. All cases used a large-pore, non-coated, mid-weight polypropylene mesh placed in the retrorectus space. With a median follow-up of 16 mos, parastomal hernia was confirmed in 11.5% (n = 6), 5 of whom were symptomatic. patient-reported outcomes (PRO) indicated 6 additional patients with symptoms associated with PSH without clinical or radiographic confirmation. Patients had similar comorbidities and operative characteristics between tPMA and pSTORRM techniques, and no difference in a median follow-up. pSTORRM patients had fewer surgical site infections (8.3 vs 32.1%; p = 0.046) and occurrences (12.5 vs 46.4%; p = 0.015), and lower rate of PSH, though not statistically significant (4.2 vs 17.9%; p = 0.195). Permanent synthetic mesh placed as a sublay in the retromuscular space is safe and appears to decrease the risk of PSH formation after the creation of permanent stomas. A stapled technique may provide advantages over a traditional keyhole technique.

Principles and parallels of prevention and repair of parastomal hernia with meshes

After formation of a permanent terminal stoma by enterostomy, parastomal hernia (PSH) occurs in up to 80% of cases and leads to a wide variety of symptoms and complications with a high rate of emergency operations due to incarceration (ca. 15%). Consequently, greater consideration should be given to PSH prevention even as early as the time of enterostomy and generously applied indications for elective repair of manifest PSH. The aim of this article is to summarize and evaluate the current evidence for PSH repair and prevention. Poor postoperative results after attempted repair of manifest PSH with slit meshes in different layers of the abdominal wall shift the focus onto stoma lateralization (sandwich and Sugarbaker techniques) or 3‑dimensional tunnel-shaped implants with meshes to cover the stomal edges. To date, the best strategy for PSH prevention has still not been defined and techniques with slit meshes show different results. Nevertheless, 10 prospective randomized trials, meta-analyses, aCochrane review and guidelines from the European Hernia Society (EHS) about various slit-mesh devices in sublay, onlay and intraperitoneal positions confirmed significantly reduced rates of PSH after mesh augmentation compared to conventionally sutured enterostomy without morbidity associated with the implanted material. Despite the positive data situation PSH prevention is seldom performed in daily practice, which is due to uncertainty surrounding the most suitable surgical strategy, the necessity to spend additional time at the end of ademanding operation, the aversion to implanting meshes into acontaminated operative field and the lack of remuneration of preventive surgical procedures. Future trials should, therefore, no longer compare standard enterostomy techniques with one prevention method in general but should have anew focus on techniques providing adequate results in PSH repair (Sugarbaker, sandwich and 3‑Dtunnel meshes), probe the advantages and evaluate the differences in outcome between these strategies.

Practice Patterns and Attitudes of Surgeons on the Use of Prophylactic Mesh to Prevent Parastomal Hernia: A Cross-sectional Survey

A survey was conducted to assess attitudes/beliefs and surgical practice related to PM use for preventing PSH. A cross-sectional email survey was conducted during April 2017 among members (surgeons) of the American Hernia Society, European Hernia Society, and International Hernia Collaboration. Survey items included participant demographic characteristics, knowledge about the incidence of PSH, number of permanent stomas created annually, beliefs/opinions (knowledge/interest) regarding the use of PM, and surgical practices (mesh type and position). Data were collected and tallied using SurveyMonkey. Descriptive statistics were used to analyze the data. Of the 5445 emails sent, 497 responses were received, 235 (47.3%) from the United States and 197 (39.6%) from Europe. The majority of participants were general surgeons (371, 74.6%); a small percentage were colorectal surgeons (37, 7.4%). Most respondents (353, 71.0%) reported at least 11 years of surgical experience, with 37.3% reporting >20 years' experience. The majority of respondents (340, 68.4%) created <15 ostomies per year, more than half (252, 50.7%) consider the incidence of PSH 30% or below, and 107 (22%) use PM. The most common reason for not using mesh was concern about mesh-related complications (141, 41.5%). When asked about type of mesh, most surgeons (153/245, 62.4%) preferred permanent mesh and an open retromuscular approach (97/278, 34.9%). Results of the present survey show ongoing ambiguity regarding the use of PM for PSH prevention. Education to increase awareness about the incidence of PSH and well-designed safety and effectiveness studies of preventive strategies are needed to help surgeons optimize PSH prevention strategies.

Quality Assessment and Risk of Bias of Systematic Reviews of Prophylactic Mesh for Parastomal Hernia Prevention Using AMSTAR and ROBIS Tools.

Systematic reviews play a crucial role in clinical decision making and resource allocation and are expected to be unbiased and consistent. The aim of this study is a review of systematic reviews on the use of prophylactic mesh to prevent parastomal hernia (PH) formation using ROBIS and AMSTAR tools to assess the risk of bias and methodological quality. We included systematic reviews with or without meta-analysis of which the objective was to assess the use of a prophylactic mesh to prevent PH. A systematic search of the literature in five databases from inception until December 2017 was conducted. For each systematic review, methodologic quality and risk of bias were assessed using the AMSTAR and ROBIS tools, respectively. We estimated the inter-rater reliability for individual domains and for the overall methodological quality and risk of bias using Fleiss' k. We identified 14 systematic reviews that met the inclusion criteria. Using the AMSTAR scale with a cutoff value, six reviews showed high methodologic quality and eight were of low quality. Using the ROBIS tool, the overall risk of bias was low in 50% of the reviews analyzed. In the remaining studies, the risk of bias was unclear. The global evidence in favor of the use of a prophylactic mesh for preventing PH is not uniform regarding quality and risk of bias. Surgeons cannot be equally confident in the results of all systematic reviews published on this topic.

Prosthetic Mesh for the Prevention of Parastomal Hernias.

Editor's note: This is a summary of a nursing care-related systematic review from the Cochrane Library. For more information, see http://nursingcare.cochrane.org.

Use of Prophylactic Mesh When Creating a Colostomy Does Not Prevent Parastomal Hernia: A Randomized Controlled Trial-STOMAMESH.

Objective:The aim of this study was to determine whether parastomal hernia (PSH) rate can be reduced by using synthetic mesh in the sublay position when constructing permanent end colostomy. The secondary aim was to investigate possible side-effects of the mesh.Background:Prevention of PSH is important as it often causes discomfort and leakage from stoma dressing. Different methods of prevention have been tried, including several mesh techniques. The incidence of PSH is high; up to 78%.Methods:Randomized controlled double-blinded multicenter trial. Patients undergoing open colorectal surgery, including creation of a permanent end colostomy, were randomized into 2 groups, with and without mesh. A lightweight polypropylene mesh was placed around the colostomy in the sublay position. Follow up after 1 month and 1 year. Computerized tomography and clinical examination were used to detect PSH at the 1-year follow up. Data were analyzed on an intention-to-treat basis.Results:After 1 year, 211 of 232 patients underwent clinical examination and 198 radiologic assessments. Operation time was 36 minutes longer in the mesh arm. No difference in rate of PSH was revealed in the analyses of clinical (P = 0.866) and radiologic (P = 0.748) data. There was no significant difference in perioperative complications.Conclusions:The use of reinforcing mesh does not alter the rate of PSH. No difference in complication rate was seen between the 2 arms. Based on these results, the prophylactic use of mesh to prevent PSH cannot be recommended.

'Hepworth hitch': parastomal hernia prevention by simple modifications of operative techniques.

'Hepworth hitch': parastomal hernia prevention by simple modifications of operative techniques.

Using a risk assessment tool for parastomal hernia prevention.

All patients with a stoma are at risk of developing some degree of parastomal herniation given enough follow-up time. Based on current evidence, preventive measures are strongly advised to minimise the incidence of a parastomal hernia forming. This article explores the evidence for consistency in care and management of parastomal hernia, focusing on the development of a risk assessment tool, taking into consideration the patient's and the nurse's perspective.

Parastomal Hernia Prevention With Mesh in the Context of Laparoscopic Approach: An Opinion Based on Current Literature.

Parastomal Hernia Prevention With Mesh in the Context of Laparoscopic Approach: An Opinion Based on Current Literature.

Preventing parastomal hernia with modified stapled mesh stoma reinforcement technique (SMART) in patients who underwent surgery for rectal cancer: a case–control study

Parastomal hernia is a frequent complication of an abdominal wall stoma. Surgical repairs have high complication and recurrence rates. Several different techniques have been suggested to prevent parastomal hernia during stoma creation. The aim of the present case-control study was to evaluate the efficacy of modified Stapled Mesh stomA Reinforcement Technique (SMART) for prevention of parastomal hernia compared with conventional colostomy formation in patients who underwent open or laparoscopic rectal resection and end colostomy for cancer. Between January 2014 and May 2016, all consecutive patients who underwent open or laparoscopic resection and end colostomy for primary or recurrent rectal cancer were identified from a prospectively collected database. Since January 2014, one surgeon in our team has routinely offered modified SMART procedure to all patients who are candidates for permanent terminal colostomy. In the SMART group patients, while creating an end colostomy, we placed a standard polypropylene mesh in the retromuscular position, fixed and cut the mesh by firing a 31- or 33-mm-diameter circular stapler and constructed the stoma. In the control group, a stoma was created conventionally by a longitudinal or transverse incision of the rectus abdominis sheath sufficiently large for the colon to pass through. Twenty-nine patients underwent parastomal hernia prophylaxis with modified SMART and 38 patients underwent end-colostomy formation without prophylaxis (control group). Groups were similar in terms of age, sex and underlying conditions predisposing to herniation. Median follow-up time is 27 (range 12-41)months. Nineteen patients (28.4%) developed parastomal herniation. In the SMART group, 4 patients (13.8%) developed parastomal herniation which is significantly lower than the control group in which 15 patients (39.5%) developed parastomal herniation (p=0.029). We did not observe mesh infection, stenosis, erosion or fistulation in the SMART group. One patient in the control group underwent surgical correction of stoma stricture, another patient underwent surgery for stoma prolapse and four patients underwent surgery for parastomal herniation. New systemic reviews and meta-analysis support parastomal hernia prevention with the use of a prophylactic mesh. Until more evidence is available, prophylactic mesh should be routinely offered to all patients undergoing permanent stoma formation. SMART is easy to use, safe and effective for paracolostomy hernia prophylaxis.

Syntheticvsbiologic mesh for the repair and prevention of parastomal hernia

Synthetic<i>vs</i>biologic mesh for the repair and prevention of parastomal hernia

European Hernia Society guidelines on prevention and treatment of parastomal hernias.

International guidelines on the prevention and treatment of parastomal hernias are lacking. The European Hernia Society therefore implemented a Clinical Practice Guideline development project. The guidelines development group consisted of general, hernia and colorectal surgeons, a biostatistician and a biologist, from 14 European countries. These guidelines conformed to the AGREE II standards and the GRADE methodology. The databases of MEDLINE, CINAHL, CENTRAL and the gray literature through OpenGrey were searched. Quality assessment was performed using Scottish Intercollegiate Guidelines Network checklists. The guidelines were presented at the 38th European Hernia Society Congress and each key question was evaluated in a consensus voting of congress participants. End colostomy is associated with a higher incidence of parastomal hernia, compared to other types of stomas. Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. Currently available classifications are not validated; however, we suggest the use of the European Hernia Society classification for uniform research reporting. There is insufficient evidence on the policy of watchful waiting, the route and location of stoma construction, and the size of the aperture. The use of a prophylactic synthetic non-absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present. It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, a mesh without a hole is suggested in preference to a keyhole mesh when laparoscopic repair is performed. An evidence-based approach to the diagnosis and management of parastomal hernias reveals the lack of evidence on several topics, which need to be addressed by multicenter trials. Parastomal hernia prevention using a prophylactic mesh for end colostomies reduces parastomal herniation. Clinical outcomes should be audited and adverse events must be reported.

Prophylactic mesh to prevent parastomal hernia after end colostomy: a meta-analysis and trial sequential analysis.

Prevention of parastomal hernia (PSH) formation is crucial, given the high prevalence and difficulties in the surgical repair of PSH. To investigate the effect of a preventive mesh in PSH formation after an end colostomy, we aimed to meta-analyze all relevant randomized controlled trials (RCTs). We searched five databases. For each trial, we extracted risk ratios (RRs) of the effects of mesh or no mesh. The primary outcome was incidence of PSH with a minimum follow-up of 12months with a clinical and/or computed tomography diagnosis. RRs were combined using the random-effect model (Mantel-Haenszel). To control the risk of type I error, we performed a trial sequential analysis (TSA). Seven RCTs with low risk of bias (451 patients) were included. Meta-analysis for primary outcome showed a significant reduction of the incidence of PSH using a mesh (RR 0.43, 95% CI 0.26-0.71; P=0.0009). Regarding TSA calculation for the primary outcome, the accrued information size (451) was 187.1% of the estimated required information size (RIS) (241). Wound infection showed no statistical differences between groups (RR 0.77, 95% CI 0.39-1.54; P=0.46). PSH repair rate showed a significant reduction in the mesh group (RR 0.28 (95% CI 0.10-0.78; P=0.01). PSH prevention with mesh when creating an end colostomy reduces the incidence of PSH, the risk for subsequent PSH repair and does not increase wound infections. TSA shows that the RIS is reached for the primary outcome. Additional RCTs in the previous context are not needed.

Stapled Mesh stomA Reinforcement Technique (SMART) in the prevention of parastomal hernia: a single-centre experience.

Parastomal hernia remains a frequent complication following creation of an abdominal stoma. Previous interests have centred around the exploration of methods to repair; however, prophylactic mesh placement has demonstrated its efficacy in reduction of parastomal hernia. The aim of this retrospective analysis was to evaluate the outcomes of Stapled Mesh stomA Reinforcement Technique (SMART) in terms of parastomal hernia occurrence rate and mesh-related complications. All patients operated with an abdominal perineal resection or Hartmann's procedure with SMART from November 2013 to March 2016 were included. Patient demographics, operative details and stoma-related symptoms were collected. Patients were examined clinically by the medical team and also reviewed independently by a specialist stoma care nurse for signs of stoma-related complications. As part of oncological follow-up, CT scans were available for review for evidence of parastomal herniation. 14 patients (mean age 76 years) were included in the analysis. All the SMART cases were successfully completed with no intraoperative or immediate post-operative complications. No cases of mesh-related complications such as infection, immediate stomal prolapse, stenosis, retraction, stomal obstruction, mesh erosion or fistulation were observed. No mesh removal was required. There were two cases of parastomal hernia detected on CT scan. Both cases have remained asymptomatic no intervention was required at this stage. Median follow-up was 24months. Our medium-term experience has demonstrated the efficacy of SMART in the reduction of parastomal hernia occurrence. With appropriate learning curve, parastomal hernia can be prevented.

Prophylactic meshes in the abdominal wall.

There is ahigh incidence of incisional hernias in specific high-risk patient populations. For these patients, the prophylactic placement of mesh during closure of the abdominal wall incision has been investigated in several prospective studies. This article aims to summarize and synthetize the currently available evidence on prophylactic meshes in anarrative review. Systematic reviews were performed on the use of prophylactic meshes in different indications: midline laparotomies, stoma reversal wounds, and permanent stoma. High-quality data from randomized trials shows that prophylactic synthetic non-absorbable mesh implantation is safe and effective, both in prevention of incisional hernias after midline laparotomies and during construction of an elective end colostomy. It should be considered in patients with a high risk for incisional hernia development, such as those receiving open abdominal aortic aneurysm, obesity, or colorectal cancer surgery. It is strongly recommended for construction of an elective permanent end colostomy. For midline laparotomies, both the retromuscular and onlay positions of aprophylactic mesh seem equally effective and safe. For parastomal hernia prevention, only the retromuscular prophylactic mesh and its use for end colostomies has been proven to be effective and safe. No data support the choice of abiological mesh or asynthetic absorbable mesh over a non-absorbable synthetic mesh, even in clean-contaminated surgical procedures. No data yet support the standard use of prophylactic mesh when closing the wound during closure of atemporary stoma. Prophylactic mesh implantation should be standard of care during construction of an elective end colostomy and will become standard of care for midline laparotomies in patients at a high risk of incisional hernias.

PD39-01 PROPHYLACTIC USE OF AN INTRAPERITONEAL ONLAY MESH DURING ILEAL CONDUIT URINARY DIVERSION FOR THE PREVENTION OF PARASTOMAL HERNIAS. INITIAL EXPERIENCE

You have accessJournal of UrologyBladder Cancer: Invasive VI1 Apr 2016PD39-01 PROPHYLACTIC USE OF AN INTRAPERITONEAL ONLAY MESH DURING ILEAL CONDUIT URINARY DIVERSION FOR THE PREVENTION OF PARASTOMAL HERNIAS. INITIAL EXPERIENCE Itay Sternberg, Daniel Yaffe, Amir Akdam, and Ilan Leibovitch Itay SternbergItay Sternberg More articles by this author , Daniel YaffeDaniel Yaffe More articles by this author , Amir AkdamAmir Akdam More articles by this author , and Ilan LeibovitchIlan Leibovitch More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1507AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Parastomal hernias develop in a quarter of patients within one year after cystectomy and ileal conduit urinary diversion (RC/IC) and half of patients within 2 years. Prophylactic placement of mesh during surgery has been described in colorectal surgery to be safe and effective. METHODS Since October 2013, 20 consecutive patients underwent prophylactic placement of DynaMesh IPST® during RC/IC at our institution. The last 30 consecutive patients treated with RC/IC prior to October 2013 were used as the control group. We compared patient characteristics, operative times and 90-day postoperative complications between the groups. Continuous variables were compared using the Mann-Whitney test and dichotomous variables were compared using Fisher’s exact test. RESULTS Patient characteristics were similar between the groups. Seven of 20 patients in the DynaMesh group and 7 of 30 in the control group had additional procedures done at the time of RC/IC. Median operative times in patients without additional procedures were 301 minutes (IQR 229-474) and 283 (IQR 246-336) in the DynaMesh and control groups, respectively. This difference was not statistically significant (p=0.06). Major complications occurred in 6 of 20 (30%) and 10 of 30 (33%) of patients in the DynaMesh and control groups, respectively. Minor complications were recorded in 10 of 20 (50%) and 16 of 30 (53%) patients in the DynaMesh and control groups, respectively. Both these differences, in major and minor complications, were not statistically significant (p=0.77 and 0.78, respectively). None of the major complications were related to the placement of the mesh. With a median follow up of 13.5 months none of the patients needed removal of the mesh and none developed PSH. CONCLUSIONS Our initial experience suggests that prophylactic placement of mesh during RC/IC for parastomal hernia prevention is effective, safe and does not elongate surgery considerably. A larger trial is needed to validate our results. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e930 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Itay Sternberg More articles by this author Daniel Yaffe More articles by this author Amir Akdam More articles by this author Ilan Leibovitch More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Running marathons with an ileostomy: overcoming all challenges

Gastrointestinal NursingVol. 14, No. 2 Sports + StomaRunning marathons with an ileostomy: overcoming all challengesKate BensonKate BensonSearch for more papers by this authorKate BensonPublished Online:14 Mar 2016https://doi.org/10.12968/gasn.2016.14.2.18AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Cancer Research UK (2015) Are there exercise guidelines for cancer patients? bit.ly/1QRafOf (accessed 4 march 2016) Google ScholarMcCullough DJ, Stabley JN, Siemann DW, Behnke BJ (2014) Modulation of blood flow, hypoxia, and vascular function in orthotopic prostate tumors during exercise. J Natl Cancer Inst 106(4): dju036. doi: https://doi.org/10.1093/jnci/dju036 Crossref, Google ScholarMcGrath A, Porrett T, Heyman B (2006) Parastomal hernia: an exploration of the risk factors and the implications. Br J Nurs 15(6): 317–21 Link, Google ScholarMeyerhardt JA, Giovannucci EL, Holmes MD et al. (2006) Physical activity and survival after colorectal cancer diagnosis. J Clin Oncol 24(22): 3527–34 Crossref, Google ScholarNational Cancer Institute (2009) Physical Activity and Cancer. What is the relationship between physical activity and colon cancer risk? 1.usa.gov/1Uw1vCZ (accessed 1 March 2016) Google ScholarRichbourg L (2012) Food fight: dietary choices made by people after stoma formation. Gastrointestinal Nursing 10(4): 44–50. doi: https://doi.org/10.12968/gasn.2012.10.4.44 Link, Google ScholarThompson M, Trainor B (2007) Prevention of parastomal hernia: a comparison of results 3 years on. Gastrointestinal Nursing 5(3): 22–8. doi: https://doi.org/10.12968/gasn.2007.5.3.23472 Link, Google Scholar FiguresReferencesRelatedDetails 2 March 2016Volume 14Issue 2ISSN (print): 1479-5248ISSN (online): 2052-2835 Metrics History Published online 14 March 2016 Published in print 2 March 2016 Information© MA Healthcare LimitedPDF download