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Is parastomal hernia repair with polypropylene mesh safe?
Scott R Steele1, Patrick Lee, Matthew J Martin
1General Surgery Service, Department of Surgery, Madigan Army Medical Center, Fort Lewis, WA 98431, USA.
Background:
Concern over the safety of polypropylene mesh in parastomal hernia repairs has led some to avoid its use. We reviewed our rate of complications and outcomes with polypropylene mesh.
Methods:
From January 1988 through May 2002, 58 patients underwent parastomal hernia repair with polypropylene mesh. After closure of the fascia, the stoma was pulled through the center of the mesh, which was placed either above or below the fascia. Multivariate analysis was performed to determine independent predictors for the development of complications.
Results:
There were 31 end colostomies, 24 end ileostomies, and 3 loop transverse colostomies. Mean follow-up with 50.6 months. Overall complications related to the polypropylene mesh was 36% (recurrence 26%, surgical bowel obstruction 9%, prolapse 3%, wound infection 3%, fistula 3%, and mesh erosion 2%). None of the patients had extirpation of their mesh. Complications were significantly associated with younger age (59.6 versus 67 years, P = 0.04). Cancer patients with stomas had fewer complications (P = 0.02, odds ratio 0.34). Inflammatory bowel disease, stomal type, mesh location, urgent procedures, steroid use, and surgical approaches were not significantly associated with an increased complication rate. Of the 15 patients with recurrence, 7 underwent successful repair for an overall success rate of 86%.
Conclusions:
Parastomal hernia repair with polypropylene mesh is safe and effective.
Insights
Parastomal hernia repair using polypropylene mesh is safe and effective, with a high success rate even after recurrence. This study reviewed complications and outcomes in 58 patients.
Area of Science:
- Surgical innovation and patient outcomes
- Gastrointestinal surgery and reconstructive procedures
Background:
- Growing concerns regarding polypropylene mesh safety in parastomal hernia repair have prompted re-evaluation.
- This study investigates the complication rates and outcomes associated with polypropylene mesh use in these repairs.
Purpose of the Study:
- To assess the safety and efficacy of polypropylene mesh in parastomal hernia repair.
- To identify predictors of complications following parastomal hernia repair with polypropylene mesh.
Main Methods:
- A retrospective review of 58 patients undergoing parastomal hernia repair with polypropylene mesh between January 1988 and May 2002.
- Mesh placement involved positioning it either above or below the fascia after stoma creation.
- Multivariate analysis was employed to identify independent predictors of complications.
Main Results:
- The overall complication rate related to polypropylene mesh was 36%, with recurrence being the most common (26%).
- Younger age was significantly associated with increased complications (P=0.04), while cancer patients exhibited fewer complications (P=0.02).
- Recurrence occurred in 15 patients, with 7 undergoing successful repair, achieving an overall success rate of 86%.
Conclusions:
- Parastomal hernia repair utilizing polypropylene mesh demonstrates a safe and effective profile.
- The findings support the continued use of polypropylene mesh in parastomal hernia repair, despite potential complications.
