Prevention Of Parastomal Hernia Research Articles

Prosthetic Mesh in Parastomal Hernia Prevention. Laparoscopic Approach

The use of a sublay mesh in open surgery has been probed to be an efficient strategy for the prevention of parastomal hernia. Based on these previous reports, placing a composite mesh (polypropylene/cellulose) in an intraperitoneal fashion seems to be a good technique when a laparoscopic approach is performed. This technique is easy to perform. Mesh is kept in place with the help of tackers, normal intra-abdominal pressure, and the colon itself. We report the description of a laparoscopic technique for placing an intraperitoneal mesh for the prevention of a parastomal hernia.

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

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.

Parastomal hernia prevention using a novel collagen implant: a randomised controlled phase 1 study

Parastomal hernias can be prevented or repaired using synthetic mesh; however, reported complications include infection, fibrosis and potential bowel erosion. The study aim was to assess the safety, feasibility and potential efficacy of using a prophylactic collagen implant. Twenty patients undergoing defunctioning stomas were randomised to a conventional procedure or reinforcement with the implant. Follow-up included regular symptom questionnaires, clinical examination, stoma site ultrasound, and serum inflammatory markers. Ten patients (four males; mean BMI 26.3) had a conventional stoma, and ten (three males; mean BMI 26.3) received the implant. At a median of 6.5 months follow-up, a parastomal hernia was clinically evident in three of ten patients without the implant, and in none of ten patients with the implant. There were no clinical complications, ultrasound evidence of chronic seromas or serological evidence of a systemic inflammatory response. Xenogeneic collagen has been demonstrated to aid soft tissue reinforcement. In this study, in contrast to published data relating to the use of conventional synthetic mesh, there were no complications related to infection or the implant's proximity to the bowel. This trial demonstrates that the implant is safe, feasible to use and has the potential to prevent parastomal herniation.

Prevention of parastomal hernias by prophylactic use of a specially designed intraperitoneal onlay mesh (Dynamesh IPST®)

Hernias around ostomies are a very common complication, exceeding 50%. Only a few studies deal with the prophylactic use of mesh to prevent parastomal hernia revealing promising results. Twenty-two patients undergoing elective rectal surgery with a permanent colostomy--one with an ileostomy and two needing surgical correction of a preexisting colostomy--were enrolled in a prospective study. A specially designed mesh made of polyvinylidene fluoride with a central whole and a funnel arising (Dynamesh IPST) was prophylactically implanted using an intraperitoneal onlay technique. The patients were followed for a median of 11 (range 2-19) months by clinical examination every 3 months. No infection or any other adverse effect was observed, and no parastomal hernia or stoma protrusion could be detected clinically. Twelve patients had a routine computed tomography after 6 months, which also excluded any hernia formation. The prophylactic use of Dynamesh IPST) is a safe and effective procedure preventing stoma complications such as hernia formation or prolapse, at least in the short run.

Prevention of parastomal hernia: a comparison of results 3 years on

Parastomal hernia continues to be a common and distressing problem for patients with stomas and research investigating prevention strategies is scant. In March 2005 Thompson and Trainor reported that the introduction of a prevention programme for 1 year following stoma formation surgery significantly reduced the incidence of parastomal hernia. This follow-up study strengthens the reliability and validity of the findings of the first study by confirming a statistically significant reduction in the incidence of parastomal hernias through the introduction of a simple non-invasive prevention programme.

Prevention of Parastomal Hernia by Placement of a Polypropylene Mesh at the Primary Operation

Parastomal hernias occur frequently after placement of a permanent colostomy. Preliminary reports have shown a beneficial effect of placing a mesh at the primary operation to prevent the formation of a parastomal hernia. We studied the safety and prophylactic effect of placing a newly designed polypropylene mesh in an onlay position at the primary operation. This was a prospective study that included 25 patients scheduled for elective colorectal surgery. Risk factors for development of parastomal hernia were recorded before surgery. A prepared lasercut polypropylene mesh with six "arms" was placed in an onlay position. Immediate and long-term complications were evaluated by an experienced stoma nurse and a surgeon. Abdominal ultrasound was performed at 6 and 12 months follow-up. Parastomal hernia was defined as both clinical and ultrasonographic signs of protrusion in the vicinity of the stoma. The median follow-up time was 12 (range, 2-26) months. One patient died eight days after surgery. Of the 24 patients included, none had infections or immediate complications after surgery. Two patients had minor complications necessitating a local revision of one of the mesh arms. No other long-term complication was found. Two patients had signs of parastomal hernia at 6 and 12 months follow-up, respectively. Placement of a polypropylene mesh in an onlay position at the primary operation is a safe procedure and probably results in a low risk of parastomal hernia occurrence.