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Prophylactic Mesh Placement During Formation of an End-colostomy: Long-term Randomized Controlled Trial on
Henk-Thijs Brandsma1, Birgitta Me Hansson2, Theo J Aufenacker3
1Department of Surgery, Heelkunde Friesland Group, The Netherlands.
Annals of Surgery
|February 2, 2023
Summary
Prophylactic mesh placement for colostomy does not prevent parastomal hernia (PSH) long-term but delays its onset. This safe procedure is cost-effective, with no significant impact on morbidity, mortality, or quality of life.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Medical Devices
Background:
- Parastomal hernia (PSH) is the most common complication following stoma creation.
- Long-term evidence supporting prophylactic mesh placement to prevent PSH is limited.
Purpose of the Study:
- To evaluate the long-term effectiveness, safety, and cost-effectiveness of prophylactic mesh placement in preventing PSH.
- To assess the impact of mesh reinforcement on PSH incidence, morbidity, mortality, and quality of life.
Main Methods:
- A multicentre superiority trial involving patients undergoing permanent colostomy formation.
- Random assignment to either retromuscular polypropylene mesh reinforcement or conventional colostomy formation.
- Primary endpoint: PSH incidence at 5 years; secondary endpoints: morbidity, mortality, quality of life, cost-effectiveness.
Main Results:
- After a median 60-month follow-up of 113 patients, PSH developed in 27.8% of the mesh group and 37.2% of the non-mesh group (P=0.22).
- The mesh strategy was associated with lower costs (€2,239 less) and no significant difference in quality-adjusted life years.
- No significant differences in morbidity or mortality were observed between the groups.
Conclusions:
- Prophylactic mesh placement is a safe procedure for end-colostomy formation but does not reduce PSH incidence at 5 years.
- Mesh placement appears to delay PSH onset without adversely affecting patient outcomes or quality of life.
- The prophylactic meshing strategy demonstrates cost-effectiveness in the long term.
