Rate Of Parastomal Hernia Research Articles

The Assessment of the Incidence of Parastomal Hernia in End Colostomy Patients Using Lateral Pararectal Approach versus Transrectal Approach; A Retrospective Comparative Study

Abstract Background A colostomy is a surgical procedure by which a stoma is constructed through exteriorization of the large intestine. A colostomy can be a loop colostomy or an end colostomy. Para-stomal hernia (PSH) is the most frequent late complication in patients with a stoma, but its true incidence is still difficult to determine. Since various surgical approaches for stoma placement in cancer colon represents major conflict and may be associated with complications, comparing the lateral pararectal with the transrectal stoma position with regard to parastomal herniation, stoma-related morbidity and quality of life was highlighted as a main point of interest. Objective To compare lateral pararectal and transrectal stoma placement regarding the incidence rate of parastomal hernia and other stoma complications. Methods This retrospective comparative study was conducted at tertiary care hospital at Ain Shams University hospitals from March 2023 till August 2023 and performed on total 50 patients who cases that had undergone end colostomy in Ain Shams University hospitals from January 2020 to January 2022 through either transrectal or pararectal approach regarding incidence of parastomal hernia. Results There was no significant difference between the studied groups regarding baseline demographic (age, sex and BMI) (p values = 0.245, 0.821, 0.578) respectively. Regarding risk factors of hernias, our study results revealed that chronic constipation was the most common risk factor (80%), followed by smoking (66%) and respiratory co-morbidities (28%). Colorectal cancer was the most common cause of surgical indication with no statistically significant differences among the study groups as regards the surgical indications (Colorectal cancer resection, Diverticular resection, IBD and Ischemic colitis) (p values = 0.715, 0.645, 0.913, 0.413) respectively. The presence of a parastomal hernia was confirmed in 21 patients (42%), 14 males and 7 females. In all these patients, clinical examination showed a parastomal mass in the upright position and while making a voluntary increase in abdominal pressure. The mass remained in 10 patients after returning to the prone position. The position of the colostomy, determined by means of clinical examination, was transrectal in 21 patients (42%), pararectal in 24 (48%). Colostomy position was doubtful in 5 (10%) cases; using CT it was possible to establish that the colostomy was in a transrectal position in four of these patients and pararectal in one. The position of the colostomy, therefore, was pararectal in 25 (50%) of the 50 patients studied and transrectal in 25 (50%). There were no statistically significant differences among the study groups as regards the postoperative complications (stoma prolapse, retraction, SSI, stoma stenosis and operative revision). Conclusion Creating colostomies away from the lateral edge of the rectus abdominis muscle i.e., at a “para-rectus” position is associated with a lower risk of having para-stomal hernia and is as effective as, if not better, creating those stomas at the “trans-rectus” site.

Trans Oblique Ileal Conduit Technique Has a Low Risk of Parastomal Hernias

ObjectivesTo outline our surgical technique and outcomes of a ipsilateral "transoblique" ileal conduit performed during pelvic exenteration with a Vertical Rectus Abdominis Myocutaneous flap. We report hernia rates in a transrectus group as reference. MethodsWe identified patients from January 2007 to August 2020. The transoblique conduit is placed on the ipsilateral side as the VRAM, through the internal, external oblique, and transverse abdominis muscles. Stomal hernias were assessed radiologically. Transrectus patients were those undergoing radical cystectomy matched based on surgery date, age, and sex in a 3:1 ratio. We employed a Kaplan-Meier plot to visualize the duration between surgery and hernia. We calculated the hernia rate two years after surgery. Additionally, we present the 30-day postoperative complication rate. Results50 underwent transoblique conduits and we matched them to 190 transrectus patients. 67% were men with a median age of 62. 10/50 patients in the transoblique and 44/190 in the transrectus group developed a hernia, with a median follow-up of 2.2 years (IQR 0.8, 4.0). The two-year KM-estimated parastomal hernia rate was 14% (95% CI 1.6%, 25%) for the transoblique conduits, 21% (95% CI 15%, 28%) for the transrectus and 24% (95% CI 6.5%, 39%) for colostomies. Among the transoblique patients, 22 (44%) experienced at least one postoperative complication. ConclusionsA transoblique ileal conduit is safe in patients undergoing a right VRAM flap during a pelvic exenteration with a low parastomal hernia and complication rates.

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?”

Retroperitoneal end colostomy for hernia prevention after laparoscopic abdominoperineal excision: a retrospective study

AIM: to compare the hernia rate and the post-operative morbidity in patients after retroperitoneal and traditional (direct) colostomy during laparoscopic APR.PATIENTS AND METHODS: the retrospective study included patients with rectal and anal cancer after laparoscopic APE in 2019-2022. Direct or retroperitoneal end colostomy were the surgeon’s choice. Primary endpoints were the hernia rate after ≥ 1 year by abdominal CT and post-operative morbidity (Clavien-Dindo).RESULTS: fifty patients were included in the study (30 patients with retroperitoneal colostomy and 20 patients with direct colostomy). There were no significant differences in parameters that could affect the results. Four (13.3%) vs 8 (40%) patients developed parastomal hernias in the retroperitoneal and direct colostomy group, accordingly (p = 0.045). No post-operative morbidity grade 4–5 and no other complications that could be attributed to retroperitoneal colostomy occurred. Post-operative morbidity grade 3 developed in 3 (10%) patients in the retroperitoneal colostomy group and in 1 (5%) — in the direct one (p = 0.64).CONCLUSION: retroperitoneal colostomy in laparoscopic APE may reduce the parastomal hernia rate. It is important to conduct prospective comparative studies.

Effect of Sublay Preventive Mesh for Terminal Colostomy on Symptoms and Quality of Life in Patients With Parastomal Hernia: A Post Hoc Analysis of the GRECCAR 7 Cohort.

Recent randomized clinical trials and meta-analyses confirm that the use of a prophylactic mesh does not significantly reduce the parastomal hernia rate. Data about the benefits of these meshes concerning the symptoms of parastomal hernia are lacking in the existing literature. The aim of this study was to perform a post hoc analysis of the patients presenting parastomal hernia from the GRECCAR 7 (Groupe de recherche sur la chirurgie du cancer du rectum) randomized clinical trials cohort on whether the presence or the absence of the mesh influenced the symptoms, the quality of life, and complications of patients with parastomal hernias. We studied the parastomal hernia-related symptoms among the 2 groups of the GRECCAR 7 randomized clinical trial, with or without prophylactic mesh at the time of the index surgery. Data were retrospectively extracted and analyzed from the GRECCAR 7 database. Patients diagnosed with a parastomal hernia during the 2 years of the GRECCAR 7 study. Several prospectively collected data about the symptoms were studied among this population. We also studied the average interval between parastomal hernia repair surgery and both index surgery and diagnosis of parastomal hernia. Among the 199 patients included in the GRECCAR study, 36 patients (35.6%) in the nonmesh group and 33 patients (33.7%) in the mesh group were diagnosed with clinical and/or radiological parastomal hernia at 2-year follow-up, without a statistically significant difference ( p = 0.89). None of the studied symptoms showed any statistically significant difference between the groups. This study relies on a relatively small number of patients, and although data were prospectively collected, we lacked some details about the categorization of parastomal hernias. We believe that the use of a prosthetic mesh in a sublay position to prevent parastomal hernia in terminal end colostomy patients should no longer be recommended. See Video Abstract . ANTECEDENTES:Los recientes metaanálisis y ensayos clínicos aleatorizados confirman que el uso de una malla profiláctica no reduce significativamente la tasa de hernia paraestomal. En la literatura existente faltan datos sobre los beneficios de estas mallas en relación con los síntomas de la hernia paraestomal.OBJETIVO:El objetivo de este estudio fue realizar un análisis post-hoc de los pacientes que presentaron hernia paraestomal de la cohorte de 7 ensayos clínicos aleatorizados GRECCAR sobre si la presencia o ausencia de la malla influyó en los síntomas, la calidad de vida y las complicaciones de los pacientes con hernias paraestomales.DISEÑO:Estudiamos los síntomas relacionados con la hernia paraestomal entre los dos grupos del ensayo clínico aleatorizado GRECCAR 7, con o sin malla profiláctica en el momento de la cirugía índice.AJUSTES:Los datos fueron extraídos y analizados de manera retrospectiva de la base de datos GRECCAR 7.PACIENTES:Pacientes diagnosticados con hernia paraestomal durante los dos años del estudio GRECCAR 7.PRINCIPALES MEDIDAS DE RESULTADO:Se estudiaron varios datos recopilados de manera prospectiva sobre los síntomas en esta población. También estudiamos el intervalo promedio entre la cirugía reparadora de la hernia paraestomal así como también la cirugía índice como el diagnóstico de la hernia paraestomal.RESULTADOS:De entre los 199 pacientes incluidos en el estudio GRECCAR, 36 pacientes (35,6%) fueron diagnosticados con hernia paraestomal de manera clínica y/o radiológica en el grupo sin malla a los 2 años de seguimiento y 33 (33,7%) en el grupo con malla, sin diferencia estadísticamente significativa ( p = 0,89). Ninguno de los síntomas estudiados mostró diferencias estadísticamente significativas entre los grupos.LIMITACIONES:Este estudio se basa en un número relativamente pequeño de pacientes y, aunque los datos fueron recopilados de forma prospectiva, nos faltaron algunos detalles sobre la categorización de las hernias paraestomales.CONCLUSIONES:Creemos que ya no se debe recomendar el uso de una malla protésica en posición retromuscular para prevenir la hernia paraestomal en pacientes con colostomía terminal. (Traducción-Dr. Osvaldo Gauto ).

Prophylactic Mesh Reinforcement for Non-Midline Incisions: A Systematic Review.

Many abdominal-pelvic surgeries utilize incisions not along the linea alba, such as transverse, laparoscopic, ostomy reversal, or ostomy formation incisions. The prevalence of ventral incisional hernias (VIH) at these sites and the efficacy of prophylactic mesh in preventing VIH remains unclear. PubMed, Embase, Scopus, and Cochrane databases were systematically reviewed from inception to September 2022. We included published randomized controlled trials (RCTs) that compared prophylactic mesh reinforcement versus no mesh. The primary outcome was the incidence of VIH at postoperative follow-up equal to or greater than 24 months. Secondary outcomes included surgical site infection (SSI) and surgical site occurrence (SSO). Of 3186 screened articles, only 3 RCTs with at least an 80% 2-year follow-up, encompassing a total of 901 patients, were included for analysis of non-midline VIH. Fifteen additional RCTs were included for analysis of secondary outcomes. The rate of parastomal hernias with prophylactic mesh was 21%, while it ranged from 44%-64% in the control group. The rate of incisional hernia after ostomy reversal with prophylactic mesh was 10%, and 16% in the control group. No clear evidence of a difference was found in rates of SSI or SSO between groups. There is limited evidence on the role of prophylactic mesh in preventing non-midline VIH. More studies at low risk for bias are needed to elucidate the balance of the long-term risks and benefits of prophylactic mesh for non-midline incisions.

Validation of Urostomy Parastomal Herniation Incisional Prevention Strategies

ObjectiveTo evaluate simulated parastomal herniation forces in in vitro abdominal fascial models. Our group previously illustrated how incision type may play a consequential role in bowel herniation force generated across an incision using several abdominal fascia models. We sought to 1)Confirm findings in fresh human tissue 2)Assess correlation between herniation force and incision size 3)Determine whether incision type impacts drainage in a simulated ex vivo ileal conduit. Materials and MethodsAxial tension force(N) of herniation was measured using our previously published protocol, pulling a Foley catheter balloon 3.8cm diameter affixed to a dynamometer through silicone/fascial incisions ranging 3cm-5.8cm. We simulated ileal conduits using bovine small intestine with stoma matured through human fascia using 3.0 cm linear or cruciate incisions. The conduit’s caudal end was catheterized and filled at 20mL/minute. Drainage was measured by pad weight change. Two-sided α<0.05 was used to reject the null hypothesis. ResultsMean(±SD) herniation forces in fresh human fascia varied significantly across linear longitudinal, linear transverse, and cruciate incisions (20.9±3.7, 23.3±8.8, and 8.9±3.8N, respectively[p=0.011]). Fresh human fascial linear incisions 3cm in diameter had a herniation force of 22.1±6.3 vs 3.5±0.7N for 5.8cm incisions when herniating a 3.8cm balloon(p=0.002). All observations were similar in silicone. In simulated ileal conduit, mean drainage: 70.8±3.6 vs 82.1±9.7mL (linear vs cruciate) after 100mL instilled, respectively(p=0.05). ConclusionsThis ex-vivo study further suggests incision type has predictable influence on herniation force. These data support standardization of urostomy construction techniques and evaluating the clinical impact of stomal maturation techniques on parastomal hernia rates.

Effectiveness of placing prophylactic mesh with the Sugarbaker technique via laparoscopic abdominoperineal resection for rectal cancer: 1-year results

Abstract Background The aim of this study was to assess the efficacy of parastomal hernia prevention with the Sugarbaker technique via laparoscopic abdominoperineal resection for rectal cancer after a 1-year follow-up at University Medical Center in Ho Chi Minh City, Vietnam. Materials and Methods Prospective study. Between November 2018 and July 2022, 43 patients with low rectal cancer underwent laparoscopic abdominoperineal resection and were divided into 2 groups: study (n = 15) with prophylactic mesh placement with the Sugarbaker technique and control (n = 28). All patients were tracked for at least a year and had an abdominal computed tomography scan. The Kaplan-Meier method was used to calculate the rate of parastomal hernia after 1 year. To compare the rates of parastomal hernia in 2 groups, the log-rank test was used. Results This study included 43 patients, the male-to-female ratio was approximately equal to 1:1, the median age was 62 years, the youngest age was 40 years, and the oldest age was 92 years. Rectal cancer stage III was found in 41.8% of people. Neoadjuvant chemoradiotherapy was used in 27.9% of cases. The average duration of operation was 184 minutes. The average time for mesh placement was 15 minutes. The overall complication rate was 16.4%. There were no issues with mesh placement. At 1 year, the control group had a higher cumulative rate of parastomal hernia than the study group (35.7% vs 0%; log-rank test, 6.4; P = 0.01). Conclusions Prophylactic mesh placement with the Sugarbaker technique via laparoscopic abdominoperineal resection for rectal cancer is safe, does not increase complications, and reduces the cumulative rate of a parastomal hernia at 1 year in patients who have undergone prophylactic mesh placement.

Quality of life amongst patients with diverting umbilical stomas in rectal surgery: a single centre prospective randomized controlled pilot study.

The umbilical stoma (umbistoma) has been proposed as a viable alternative site for a temporary defunctioning stoma. Suggested advantages of the umbistoma include decreased number of surgical incisions required, improved cosmesis and ease of reversal surgery. This study aimed to assess the patient experience of umbilical loop ileostomies in rectal surgery, with the primary outcome being patient reported quality of life (QoL). A total of 20 patients undergoing laparoscopic rectal cancer surgery were randomly allocated to have a defunctioning ileostomy at a conventional site (right iliac fossa) or at the umbilicus. Patient-reported QoL was assessed at 6 weeks using the Stoma-QoL questionnaire. Secondary outcomes were number of stomas reversed, length of time awaiting stoma reversal surgery, duration of operative time for stoma reversal, length of hospital stay following stoma reversal and rate of parastomal or post reversal incisional hernias. Patients who had an umbilical stoma scored significantly lower on the Stoma-QoL questionnaire compared to the conventional group, particularly on questions regarding feelings of tiredness, body insecurity and anxiety. No significant differences were observed between the two groups in relation to secondary outcomes. There may be potential disadvantages to the umbilical stoma with negative impacts on body image and subsequent increased social anxiety. Patient selection and adequate counselling will be important when considering an umbilical stoma. Further larger scale prospective studies are required to further validate the feasibility and longer-term safety of umbilical stomas in both clinical outcomes as well as patient QoL.

EDITORIAL COMMENT

Placement of prophylactic mesh at the time of ileal conduit urinary diversion is a controversial topic. On one hand, prophylactic parastomal hernia mesh has been found to decrease the rate of clinically detected parastomal hernia with no mesh complications in randomized studies 1 Liedberg F. Kollberg P. Allerbo M. et al. Preventing parastomal hernia after ileal conduit by the use of a prophylactic mesh: a randomised study. Eur Urol. 2020; 78: 757-763 Google Scholar and, as the current authors find, the approach has been found to be cost effective. 2 Saha S. Gerdtham U. Bläckberg M. Kollberg P. Liedberg F. Cost effectiveness of the use of prophylactic mesh to prevent parastomal hernia after urinary diversion with an ileal conduit. Eur Urol Open Sci. 2022; 40: 9-15 Google Scholar , 3 Kanabolo D.P.S. Park S. Prophylactic mesh placement with ileal conduit: a cost effectiveness analysis. Urology. 2023; (S0090-4295(23)00368-0)https://doi.org/10.1016/j.urology.2023.03.041 Google Scholar On the other hand, placement of prophylactic parastomal hernia mesh is not widely adopted in clinical practice. One reason for lack of adoption may be because the absolute rate of symptomatic parastomal hernia repairs that require surgical intervention is low because interventions are limited to cases with complications from the parastomal hernia such as bowel or conduit obstruction or skin breakdown from pouching challenges. Consequently, it is unclear how prophylactic mesh placement impacts the span of patient experience with parastomal hernia, which may range from asymptomatic to life threatening. Currently, no urologic studies incorporate patient-reported outcome measures regarding stoma satisfaction or impact on daily functioning, though efforts are underway to address this question in colorectal collaborative groups. 4 Blackwell S. Pinkney T. Quality of life and parastomal hernia repair: the PROPHER study. Hernia. 2020; 24: 429-430 Google Scholar As such, a key question remains unanswered in the urologic literature: Does prophylactic parastomal hernia mesh placement improve long-term patient quality of life and decrease the need for parastomal hernia repair?

The same parastomal hernia repairs rate in the different approaches to colostomy.

This study aimed to compare the parastomal hernia repairs rate in the different approaches to colostomy and investigate the risk factors for parastomal hernia formation in patients with permanent colostomies. Consecutive rectal cancer patients who underwent abdominoperineal resection from June 2014 to July 2020 in West China Hospital were divided into two groups according to their surgical approach for permanent colostomies. The impact of different approaches to colostomy on parastomal hernia repairs was determined by comparing a group of patients receiving an extraperitoneal route to colostomy with a group receiving transperitoneal. Potential variables were evaluated first with univariate and then multivariate analyses to identify the risk factors for the formation of parastomal hernia. Two hundred two subjects in the transperitoneal group and 103 in the extraperitoneal group attended the follow-up visit with a median follow-up period of 33 (25th-75th percentiles, 17-46) months. Clinically and radiologically detectable parastomal hernias were present in 76 of 202 (37.6%) and 14 of 103 (13.6%) subjects in the transperitoneal and extraperitoneal groups during the follow-up period (p＜0.01). Besides, 10 of 76 (13.1%) subjects in the transperitoneal group and 2 of 14 (14.3%) subjects in the extraperitoneal group underwent a parastomal hernia operation during the follow-up (p = 0.82). In addition, the transperitoneal approach of colostomy (p = 0.002), older age (p＜0.001), and higher body mass index (p = 0.013) were identified as independent risk factors for the occurrence of parastomal hernia. Extraperitoneal colostomy decreased the detectable parastomal hernias but did not reduce the surgical repair rate of parastomal hernias.

Comparative study of laparoscopic Keyhole and Sugarbaker technique in the treatment of terminal paracolostomy hernia

Objective: To compare laparoscopic Keyhole repair with Sugarbaker repair in consecutive patients with parastomal hernia. Methods: From January 2015 to December 2021, 117 patients with parastomal hernia were treated with Keyhole or Sugarbaker laparoscopy repairs in the Department of Hernia and Bariatrci Surgery, the First Affiliated Hospital of University of Science and Technology of China, and the clinical data were retrospectively analyzed. There were 45 males and 72 females, aged (68.6±8.6) years (range: 44 to 84 years). Laparoscopic Sugarbaker repair was performed in 89 cases, and Keyhole repair was performed in 28 cases. The t-test, Mann-Whitney U test, χ2 test and Fisher exact test were used to compare the observation indicators between the two groups, such as operation time, incidence of operation-related complications, and postoperative recurrence rate. Results: The follow-up period was (M(IQR)) 33 (36) months (range: 12 to 84 months). Compared to the Sugarbaker group, the hernia ring area of the Keyhole group was bigger (35 (26) cm2 vs. 25 (16) cm2, Z=1.974, P=0.048), length of stay was longer ((22.0±8.0) d vs. (14.1±6.2) d, t=5.485, P<0.01), and the postoperative rate of recurrence was higher (28.6% (8/28) vs. 6.7% (6/89), χ2=7.675, P=0.006). There was no difference in operation time and postoperative complications between the two groups. Conclusions: Laparoscopic Sugarbaker repair is superior to Keyhole repair in the recurrence rate of parastomal hernia treated with compsite mesh (not funnel-shaped mesh). There are no differences in operation time and postoperative complications between the two groups.

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.

Effectiveness of placing prophylactic mesh with the Sugarbaker technique via laparoscopic abdominoperineal resection for rectal cancer

Abstract Introduction: The aim of this study was to assess the efficacy of parastomal hernia prevention with the Sugarbaker technique via laparoscopic abdominoperineal resection for rectal cancer after a one-year follow-up at University Medical Center in Ho Chi Minh City. Patients and methods: Intervention study. Between 11/2018 and 7/2022, 43 patients with low rectal cancer underwent laparoscopic abdominoperineal resection and were divided into two groups: intervention (n = 15) with prophylactic mesh placement using the Sugarbaker technique and control (n = 28). All patients were tracked for at least a year and had an abdominal computed tomography scan. The Kaplan Meier method was used to calculate the rate of parastomal hernia after one year. To compare the rates of parastomal hernia in two groups, the logrank test was used. Results: This study included 43 patients; the male to female ratio was approximately equal to 1:1; the median age was 62; the youngest age was 40; and the oldest age was 92. Rectal cancer stage III was found in 41.8% of people. Neoadjuvant chemoradiotherapy was used in 27.9% of cases. The average duration of operation was 184 minutes. The average time for mesh placement was 15 minutes. The overall complication rate was 16.4%. There were no issues with mesh placement. At one year, the control group had a higher cumulative rate of parastomal hernia than the intervention group (35.7% versus 0%, logrank 6.4, p = 0.01). Conclusions: Prophylactic mesh placement using the Sugarbaker technique during laparoscopic abdominoperineal resection for rectal cacner is safe, does not increase complications, and reduces the cumulative rate of a parastomal hernia at 1 year in patients who have undergone prophylactic mesh placement. Keywords: Prophylactic mesh placement, Sugarbaker technique, Laparoscopic abdominoperineal resection.

Prophylactic funnel mesh to prevent parastomal hernia in permanent end colostomy: A retrospective cohort study.

This study assessed the impact of a prophylactic, 3D funnel-shaped intraperitoneal mesh on the rate of parastomal hernia after abdominoperineal rectum resection with permanent end colostomy. Data from 76 patients receiving permanent end colostomy after abdominoperineal rectum resection between 2013 and 2018 were collected retrospectively. Occurrences of parastomal hernia and reoperation rate due to parastomal hernia in patients with and without a prophylactic mesh were compared by univariate, multivariate, and propensity score-adjusted analyses. Twenty-two (28.9%) of the 76 included patients received a prophylactic mesh. The mean follow-up was 39.3±23.8months. Mesh implantation reduced the incidence of parastomal hernia to 9.1% (n=2) compared to 42.6% (n=23) in patients without a prophylactic mesh. The propensity score-adjusted hazard ratio (HR) was 0.14 (95% confidence interval (CI): 0.04-0.48, p=0.001). No reoperations due to parastomal hernia were needed in patients who received a prophylactic mesh, while nine patients without mesh (16.7%) required parastomal hernia repair (HR=0.09, 95% CI: 0.00-1.76, p=0.015). Mesh implantation was not associated with increased short-term morbidity (Clavien-Dindo grade>2, 31.8% vs. 40.7%, p=0.468) or 30-day mortality (4.5% vs. 3.8%, p=1.000). Prophylactic implantation of a 3D funnel-shaped intraperitoneal mesh is a safe and effective method to prevent parastomal hernia in patients requiring permanent end colostomy. Mesh placement significantly reduces reoperations due to parastomal hernia.

Prophylactic retromuscular mesh placement for parastomal hernia prevention: a retrospective cohort study of permanent colostomies and ileostomies.

Parastomal hernia (PSH) is the most common complication of stoma formation. The safety and efficiency of prophylactically placing mesh to prevent PSH remain controversial. To address this question, we examined the incidence of clinical and radiological PSH when using parastomal prophylactic mesh (PPM). We performed a retrospective, single-center, cohort study that included all patients with permanent stoma creation between 2015 and 2018. Patients were divided into two groups according to the utilization of PPM or not. During the study period, 185 patients had a permanent stoma created, 144 with colostomy and 41 with ileostomy. PPM was placed in 79 patients. There was no difference in the need for early surgical reintervention (p = 0.652) or rehospitalization (p = 0.314) for stoma-related complications in patients with mesh as compared with patients without. Similarly, there was no difference in operative time (p = 0.782) or in length of hospital stay (p = 0.806). No patients experienced infection of the mesh or required prosthesis removal. There was a lower incidence rate of PSH with PPM placement in patients with permanent colostomy [adjusted hazard ratio (HR) 0.50 (95% confidence interval 0.28-0.89); p = 0.018]. In contrast, a higher incidence rate of PSH was observed in patients with ileostomy and PPM [adjusted HR 5.92 (95% confidence interval 1.07-32.65); p = 0.041]. Parastomal prophylactic mesh placement to prevent PSH is a safe and efficient approach to reduce the incidence of PSH in patients requiring a permanent colostomy. However, mesh may increase the rate of PSH after permanent ileostomy.

Perineal reconstruction after extralevator abdominoperineal resection: Differences among minimally invasive, open, or open with a vertical rectus abdominis myocutaneous flap approaches

BackgroundPerineal wound complications after extralevator abdominoperineal resection for cancer are common with no consensus on optimal reconstructive technique. We compared short- and long-term results of laparoscopic abdominoperineal resection with open surgery ± vertical rectus abdominis myocutaneous flap. MethodsThis is a single-institution retrospective observational study of 204 consecutive patients with advanced low rectal cancer who underwent extralevator abdominoperineal resection from January 2010 to August 2020. Main outcome measures were short-term results, wound complications, and incisional, parastomal, and perineal hernia rates. ResultsFifty-five (27%) patients had a laparoscopic approach, 80 (39%) open, and 69 (33%) open + vertical rectus abdominis myocutaneous flap. The groups had similar median length of follow up (P = .75). Patients’ age and radiation, intraoperative and postoperative complications, mortality, and readmission rates were similar among the 3 groups. Perineal wound infection and dehiscence rates were not influenced by surgical approach. Laparoscopy resulted in higher perineal (7.3 vs 2.5 vs 0%; P = .047) and parastomal (23.6 vs 13.8 vs 5.8%; P = .016) hernia rates than did open or open + vertical rectus abdominis myocutaneous flap. Patients who underwent an open approach had a higher body mass index and rate of prior surgeries and preoperative ostomies. Laparoscopic and open approaches had significantly shorter operative times (300 vs 303 vs 404 minutes, respectively; P < .001) and shorter length of stay (7.6 vs 10.8 vs 11.12, respectively; P = .006) compared to open with a flap approach. ConclusionOpen and open + vertical rectus abdominis myocutaneous flap approaches for reconstruction after abdominoperineal resection had lower parastomal and perineal hernias rates but similar postoperative morbidity as did the laparoscopic approach.

Prophylactic mesh placement at index permanent end colostomy creation to prevent parastomal hernia-an updated meta-analysis.

Debate persists regarding the efficacy of prophylactic mesh insertion (PMI) at index permanent stoma creation to reduce the rate of parastomal hernia (PSH). This meta-analysis aimed to appraise all the latest evidence from newly published randomized controlled trials (RCTs) on PMI for PSH prevention. PubMed, EMBASE, and Cochrane databases were searched for relevant articles from inception until November 2020. All RCTs that reported on PMI at end colostomy creation with ≥ 12 months follow-up were included. The primary objective was the rate of clinical and radiological PSH while secondary objectives included number of PSH requiring repair and stoma (or mesh)-related complications. Random effects models were used to calculate pooled effect size estimates. Sensitivity analyses were also performed. Eleven RCTs were included capturing 1097 patients. The mean (SD) age was 67.9 (±9.4) years. On random effects analysis, prophylactic mesh appeared to reduce the rate of both clinical (OR = 0.27, 95% CI = 0.12 to 0.61, p = 0.002) and radiological (OR = 0.39, 95% CI = 0.24 to 0.65, p = 0.0002) PSH. However, there was no difference in number of PSH requiring repair or stoma-related complications. On sensitivity analysis, when focusing on low-risk of bias studies, the benefit of prophylactic mesh in the retrorectus space was lost for both clinical (OR = 0.97, 95% CI = 0.62 to 1.51, p = 0.89) and radiological PSH (OR = 0.74, 95% CI = 0.46 to 1.18, p = 0.20). PMI may reduce the rate of subsequent PSH. However, further studies are required to confirm these findings and to establish the optimal mesh position and shape before definite recommendations can be made.

Stoma-related complications: a report from the Stoma-Const randomized controlled trial.

The impact of construction techniques on the development of stoma complications is partly undiscovered. The aim of this paper was to report and analyse the impact of the three surgical techniques in a randomized controlled trial Stoma-Const on stoma-related complications as well as identifying risk factors and patient-reported stoma function as a planned secondary analysis. This was a randomized, multicenter trial where all patients scheduled to receive an end colostomy were invited to participate. Patients were randomized to one of three techniques for stoma construction; cruciate fascial incision, circular incision or prophylactic mesh. Stoma complications were assessed by a surgeon and stoma care nurses within 1 year postoperatively. Two hundred and nine patients were randomized. Patient demographics were similar in all three groups. Data on stoma-related complications were available for analysis in 201 patients. A total of 127 patients (63%) developed some type of stoma complication within 1 year after surgery. The risk ratio (95% CI) for stoma complications was 0.93 (0.73; 1.2) between cruciate vs. circular incision groups and 1.02 (0.78; 1.34) between cruciate vs. mesh groups. There were no statistically significant differences between the groups regarding parastomal hernia rate and no risk factors could be identified. This randomized trial confirmed a high prevalence of stoma-related complications but could not identify an impact of surgical technique or identify modifiable risk factors for stoma-related complications.

Repair Methods in Parastomal Hernia Surgery

Background-Aim: Parastomal hernias (PSH) are incisional hernias that must be classified separately from the other abdominal wall hernias. The high recurrence rate of PSH is the most important problem after suture repair or relocation of the stoma; whereas open or laparoscopic mesh repair results in much lower recurrence rates. The aim of this study is to investigate PSH predisposing factors, surgical repair methods, postoperative complications and recurrence in surgery practice.&#x0D; Methods: Patient demographics, operation time before the first surgery, operation method, and the recurrence rate seen in patients who underwent PSH surgery in a 10-year time/ period (2008-2018) were investigated from the patient records. Except for emergency cases, 2 years of disease-free time was set for PSH surgery in malignant cases to be sure that no malignancy was present in the time of operation. &#x0D; Results: 14 PSHs were treated surgically using mesh repair in all cases. There were 6 male and 8 female patients with a mean age of 71.7 years (range:45-84;median:78). Open sublay polypropylene mesh placement technique was performed in 12 patients and intraperitoneal composite mesh (using either keyhole or Sugarbaker techniques) was placed laparoscopically in 2 patients. Superficial wound infections were developed in 4 patients (28.5 %) and 2 patients developed recurrence (14.2%).&#x0D; Conclusion: There is no effective method defined for the surgery of PSH but the laparoscopic approach has been proposed as a promising alternative to open technique as it causes less abdominal wall trauma. Whether performed open or laparoscopic; mesh repair is the optimal standard for PSH surgery.