Publication
Prophylactic Funnel Mesh to Prevent Parastomal Hernia in Permanent End Colostomy: A Retrospective Cohort Study
Journal Paper/Review - Jul 15, 2021
Ammann Yanic, Widmann Bernhard, Sparn Moritz, Warschkow Rene, Weitzendorfer Michael, Brunner Walter
Units
Keywords
*Hernia, Ventral/etiology/prevention & control/surgery
Humans
*Rectal Neoplasms
Retrospective Studies
Surgical Mesh
*Surgical Stomas/adverse effects
*abdominoperineal rectum resection
*parastomal hernia
*permanent end colostomy
*propensity score
*prophylactic funnel-shaped mesh
PubMed
Doi
Contact
Citation
Type
Journal
Publication Date
Issn Electronic
Pages
Brief description/objective
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.