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Published on: September 11, 2021
Association of Mesenteric Molding Suturing on Parastomal Hernia Incidence: Retrospective Study
Junwei Tang1, Lu Wang1, Dongjian Ji1
1Department of General Surgery, Colorectal Institute of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China.
Introduction:
Parastomal hernia (PSH) is a common complication following colostomy, with reported incidence rates of 30-50%. Prophylactic mesh reinforcement is effective but associated with long-term risks such as infection and erosion, particularly concerning in elective settings. Mesenteric molding suturing (MMS) is an emerging mesh-free technique that stabilizes the stoma by shaping the mesentery through suturing, potentially reducing PSH risk without implant-related complications. We aimed to assess the association of MMS with PSH incidence compared with conventional end-colostomy.
Methods:
This single-center, retrospective cohort study included patients who underwent elective end-colostomy between January 2016 and December 2022. Exclusion criteria were emergency surgery, prior major abdominal surgery, concomitant malignancies, preoperative abdominal wall hernia, severe cardiopulmonary disease, or incomplete follow-up. The primary endpoint was PSH incidence within 2 y, confirmed by clinical examination and/or computed tomography.
Results:
The PSH rate was significantly lower in the MMS group (19.8%, 125/630) than in the control group (27.6%, 199/720) (P < 0.001). Multivariable Cox regression showed MMS was associated with reduced PSH risk (hazard ratio = 0.68, 95% confidence interval: 0.21-0.97, P = 0.02). Kaplan-Meier analysis demonstrated significantly lower cumulative PSH incidence in the MMS group over 3 y (log-rank P = 0.0017). MMS was associated with slightly longer operative time but not with increased blood loss, postoperative hospital stay, 30-d readmission, or stoma-related complications.
Conclusions:
In elective, nonemergent colostomy, MMS was associated with reduced PSH incidence without being associated with increased surgical complexity, representing a safe and cost-effective alternative worthy of further validation in prospective studies.
Insights
Mesenteric molding suturing (MMS) significantly reduces parastomal hernia (PSH) risk after elective colostomy compared to conventional methods. This mesh-free technique offers a safe and effective alternative for preventing PSH complications.
Area of Science:
- Colorectal Surgery
- Surgical Innovation
- Hernia Prevention
Background:
- Parastomal hernia (PSH) is a frequent complication post-colostomy, affecting 30-50% of patients.
- While mesh reinforcement is effective, it carries risks like infection and erosion.
- Mesenteric molding suturing (MMS) is a novel mesh-free technique for stoma stabilization.
Purpose of the Study:
- To evaluate the association between mesenteric molding suturing (MMS) and the incidence of parastomal hernia (PSH).
- To compare PSH rates in patients undergoing MMS versus conventional end-colostomy.
- To assess the safety and efficacy of MMS as a prophylactic measure for PSH.
Main Methods:
- Retrospective cohort study of elective end-colostomy patients (January 2016 - December 2022).
- Exclusion criteria included emergency surgery, prior abdominal surgery, and other specific conditions.
- Primary endpoint: PSH incidence within 2 years, confirmed clinically or via CT scan.
Main Results:
- PSH incidence was lower in the MMS group (19.8%) compared to the control group (27.6%) (P < 0.001).
- MMS was associated with a reduced PSH risk (Hazard Ratio = 0.68, P = 0.02).
- Kaplan-Meier analysis showed significantly lower cumulative PSH incidence with MMS over 3 years (P = 0.0017). MMS did not increase operative time, blood loss, or hospital stay.
Conclusions:
- Mesenteric molding suturing (MMS) is associated with reduced PSH incidence in elective colostomy.
- MMS presents a safe, cost-effective alternative to mesh, without increased surgical complexity.
- Further prospective studies are warranted to validate these findings.
