Related Experiment Video
Updated: Jul 15, 2026
Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
Effectiveness of prophylactic Sugarbaker mesh during laparoscopic abdominoperineal resection: a cohort study with
Vinh Ngoc Truong Pham1, Triet Minh Le2, Huy Duc Tran2,3
1University Medical Center, Ho Chi Minh City, Vietnam. vinh.pnt@umc.edu.vn.
Background:
Parastomal hernia is a common and time-dependent complication after permanent colostomy following laparoscopic abdominoperineal resection (APR) for rectal cancer. Although prophylactic mesh placement using the Sugarbaker technique has shown favorable short-term results, long-term real-world evidence remains limited.
Methods:
This was an ambispective observational cohort study consisting of a retrospective historical cohort (2018-2021) and a prospectively followed cohort (2021-2025) after the introduction of prophylactic mesh. This study included patients undergoing elective laparoscopic APR with permanent end colostomy between 2018 and 2025. Laparoscopic APR was performed according to a standardized institutional step-by-step protocol that remained unchanged throughout the study period. Patients were categorized into a prophylactic mesh group using the Sugarbaker technique and a non-mesh group, based on study period and patient preference. The primary outcome was the cumulative incidence of parastomal hernia assessed radiologically during follow-up. Time-to-event data were analyzed using the Kaplan-Meier method and compared using the log-rank test.
Results:
A total of 84 patients were included, comprising 40 patients in the mesh group and 44 in the non-mesh group. Baseline demographic and clinical characteristics were comparable between groups. During a follow-up period of up to 4 years, the cumulative incidence of parastomal hernia was consistently lower in the mesh group at all time points. Kaplan-Meier analysis demonstrated a significantly lower incidence of parastomal hernia in the Sugarbaker group compared with the non-mesh group (log-rank p = 0.00018). The absolute risk reduction at 4 years was 47.0%, corresponding to a number needed to treat (NNT) of approximately 2.1. No mesh-related complications were observed during follow-up.
Conclusion:
Prophylactic mesh placement using the Sugarbaker technique during laparoscopic APR was associated with a sustained reduction in PSH risk over 4 years, without evidence of increased perioperative or mesh-related morbidity. These findings suggest that prophylactic mesh may be beneficial in selected patients.
Insights
Prophylactic mesh placement using the Sugarbaker technique significantly reduces parastomal hernia risk after laparoscopic abdominoperineal resection (APR). This method offers long-term protection without increasing complications, suggesting its benefit for selected patients.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Hernia Repair
Background:
- Parastomal hernia is a common complication after laparoscopic abdominoperineal resection (APR) for rectal cancer.
- Long-term data on prophylactic mesh placement using the Sugarbaker technique is limited.
Purpose of the Study:
- To evaluate the long-term effectiveness of prophylactic mesh placement using the Sugarbaker technique in preventing parastomal hernia after laparoscopic APR.
- To compare the incidence of parastomal hernia in patients who received prophylactic mesh versus those who did not.
Main Methods:
- An ambispective observational cohort study included patients undergoing laparoscopic APR between 2018 and 2025.
- Patients were divided into a prophylactic mesh group (Sugarbaker technique) and a non-mesh group.
- The primary outcome was the cumulative incidence of parastomal hernia, assessed radiologically and analyzed using Kaplan-Meier methods.
Main Results:
- A total of 84 patients were analyzed (40 mesh, 44 non-mesh).
- The cumulative incidence of parastomal hernia was significantly lower in the mesh group over 4 years (log-rank p=0.00018).
- Absolute risk reduction was 47.0% at 4 years, with a number needed to treat of 2.1; no mesh-related complications were observed.
Conclusions:
- Prophylactic mesh placement with the Sugarbaker technique significantly reduces parastomal hernia risk over 4 years.
- This approach did not increase perioperative or mesh-related morbidity.
- Prophylactic mesh may be beneficial for selected patients undergoing laparoscopic APR.
