Is absorbable mesh useful in preventing parastomal hernia after emergency surgery? The PARTHENOPE study

Area of Science:

• Gastroenterology
• Surgical Oncology
• Medical Devices

Background:

• Colostomy is a common procedure for oncological and inflammatory bowel diseases.
• Parastomal hernia (PH) is a frequent and challenging late complication of colostomy, with high recurrence rates after surgical repair.
• Existing PH repair methods, often involving mesh, have disappointing outcomes.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of using a prophylactic biosynthetic mesh (BIO-A) during colostomy creation to prevent PH.
• To compare the incidence of PH in patients receiving a conventional colostomy versus those with a BIO-A mesh-reinforced colostomy.

Main Methods:

• A prospective, randomized, controlled, double-blind trial was conducted from January 2014 to December 2019.
• 110 patients undergoing colon diversion were randomized into two groups: conventional end-colostomy (Control Group, n=55) and BIO-A mesh-reinforced end-colostomy (Mesh Group, n=55).
• Patients were followed clinically and with CT scans at 3, 6, and 12 months to assess PH incidence, morbidity, and wound events.

Main Results:

• At 12 months, PH incidence was significantly lower in the Mesh Group (12.7%) compared to the Control Group (43.6%) (p < 0.05).
• Postoperative morbidity rates were similar between the groups (12.7% vs 7.3%, p = 0.340).
• Multivariable analysis identified non-mesh use, age >70, diabetes, colon dilation >7cm, and COPD as risk factors for PH.

Conclusions:

• Prophylactic placement of BIO-A mesh during colostomy is an effective strategy for reducing PH incidence within one year.
• This approach is associated with low postoperative morbidity.
• The study provides evidence supporting the use of biosynthetic mesh to prevent parastomal hernias.