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Prevention of Parastomal Hernia Using Pre-peritoneal Mesh - Long Term Outcome of a Prospective Study
A Biswas1, K Marimuthu1, G Mathew1
1a George Eliot Hospital, Nuneaton , UK.
Insights
Prophylactic pre-peritoneal mesh placement significantly reduces parastomal hernia complications after stoma surgery. This technique offers a better outcome compared to traditional methods, with a 25% incidence of parastomal hernia over 5 years.
Area of Science:
- Surgical Innovation
- Gastroenterology
- Hernia Repair
Background:
- Parastomal hernia is a common post-surgical complication following stoma creation.
- Effective prevention strategies are crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the long-term efficacy of prophylactic pre-peritoneal mesh placement in preventing parastomal hernias.
- To assess the outcomes of patients undergoing stoma formation with mesh reinforcement.
Main Methods:
- Prospective study including patients undergoing elective permanent stoma formation.
- A polypropylene mesh was placed in the pre-peritoneal space, with the stoma created through a central mesh opening.
- Patients were followed for 5 years with clinical examinations and CT scans as needed.
Main Results:
- A total of 42 patients were enrolled; 28 completed the 5-year follow-up.
- Seven cases of parastomal hernia were detected (25% incidence), with none requiring surgical repair.
- Outcomes were favorable compared to historical controls without mesh reinforcement.
Conclusions:
- Pre-peritoneal polypropylene mesh placement is a simple, cost-effective, and easily learned method for parastomal hernia prevention.
- This technique demonstrates improved outcomes compared to stoma creation without mesh.
- Further research is recommended to explore optimal mesh types, positioning, and anchoring techniques.
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%).
Conclusion:
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.
