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Prevention of Parastomal Hernia Using Pre-peritoneal Mesh - Long Term Outcome of a Prospective Study
A Biswas1, K Marimuthu, G Mathew
1George Eliot Hospital, Nuneaton, UK.
Insights
Prophylactic mesh placement in the pre-peritoneal space for stoma formation is a safe and effective method to prevent parastomal hernia. Long-term follow-up showed a 25% incidence of parastomal hernia, with no cases requiring surgical repair.
Area of Science:
- Surgical complications
- Gastrointestinal surgery
- Hernia repair
Background:
- Parastomal hernia is a common complication following stoma creation.
- Preventive strategies are crucial to improve patient outcomes.
Purpose of the Study:
- To evaluate the long-term outcomes of prophylactic mesh placement in the pre-peritoneal space for preventing parastomal hernia.
Main Methods:
- Prospective study including patients undergoing elective permanent stoma formation.
- Polypropylene mesh placed in the pre-peritoneal space without anchoring stitches.
- Follow-up for 5 years with clinical examination and CT scans as needed.
Main Results:
- 42 patients included; 28 completed 5-year follow-up.
- 7 cases (25% incidence) of parastomal hernia detected.
- None of the detected hernias required surgical repair.
Conclusions:
- Pre-peritoneal polypropylene mesh placement is a simple, quick, and cost-effective method for hernia prevention.
- This technique offers better outcomes compared to stoma creation without mesh.
- Further research is needed on mesh types, positioning, and anchoring.
Background:
Parastomal hernia is a frequent complication after stoma formation. The objective of this prospective study was to find long-term outcome of prophylactic mesh placement in the pre-peritoneal space in order to prevent parastomal hernia.
Methods:
Patients undergoing elective formation of permanent stoma were included in the study. A polypropylene mesh was placed in the pre-peritoneal space without any anchoring stitches and bowel was taken out through a central circular hole made in the mesh. These patients were followed up for 5 years-by clinical examination and CT scan when needed.
Results:
A total of 42 patients were included in the study. These patients were followed up for a median period of 60 months (range 32-100 months). Twelve patients died before the 5-year follow up due to causes unrelated to stoma. As two patients were unable to be contacted, 28 patients remained in the long-term follow up. Three cases of parastomal hernia were detected after 5 years. None of these patients required repairing of the parastomal hernia. However, a previous study conducted 3 years ago found 4 cases of parastomal hernia that was treated by resiting the stomas. Therefore the total number of parastomal hernia detected in our series is 7 (incidence 25%).
Conclusions:
Putting a pre-peritoneal polypropylene mesh is an easy, quick and inexpensive method, and easy to learn. The outcome is better than creating stomas without mesh, but further studies are needed to explore potential benefits of different types of mesh and their methods of positioning and anchoring.
