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Prophylactic funnel mesh to prevent parastomal hernia in permanent end colostomy: A retrospective cohort study
Yanic Ammann1, Bernhard Widmann1, Moritz Sparn1
1Department of General, Visceral, Endocrine and Transplant Surgery, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
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.
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): 0.04-0.48, p = 0.001). No reoperations due to parastomal hernia were needed in patients who received a prophylactic mesh, while nine patients without mesh (16.7%) required parastomal hernia repair (HR = 0.09, 95% CI: 0.00-1.76, 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.
Insights
Prophylactic mesh implantation significantly reduces parastomal hernia rates after abdominoperineal rectum resection with end colostomy. This safe and effective method also lowers reoperation rates for hernias.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Medical Devices
Background:
- Parastomal hernia is a common complication following abdominoperineal rectum resection with end colostomy.
- Preventing parastomal hernia is crucial for improving patient outcomes and quality of life.
Purpose of the Study:
- To assess the impact of a prophylactic 3D funnel-shaped intraperitoneal mesh on parastomal hernia rates.
- To evaluate the safety and efficacy of mesh implantation in preventing parastomal hernia and subsequent reoperations.
Main Methods:
- Retrospective analysis of 76 patients undergoing abdominoperineal rectum resection with permanent end colostomy (2013-2018).
- Comparison of parastomal hernia incidence and reoperation rates between patients with and without prophylactic mesh implantation.
- Univariate, multivariate, and propensity score-adjusted analyses were employed.
Main Results:
- Prophylactic mesh implantation reduced parastomal hernia incidence from 42.6% to 9.1% (HR 0.14, p=0.001).
- No reoperations for parastomal hernia were required in the mesh group, versus 16.7% in the non-mesh group (HR 0.09, p=0.015).
- Mesh implantation was not associated with increased short-term morbidity or 30-day mortality.
Conclusions:
- Prophylactic 3D funnel-shaped intraperitoneal mesh is safe and effective in preventing parastomal hernia.
- Mesh placement significantly decreases the need for reoperations due to parastomal hernia in patients with permanent end colostomy.
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