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AIM
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.

MATERIAL AND METHODS
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.

RESULTS
Twenty-two (28.9%) of the 76 included patients received a prophylactic mesh. The mean follow-up was 39.3 ± 23.8 months. 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 to 0.48, p = 0.001). No reoperations due to parastomal hernia were needed in patients who received a prophylactic mesh, while 9 patients without mesh (16.7%) required parastomal hernia repair (HR = 0.09, 95% CI: 0.00 to 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).

CONCLUSIONS
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.