umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Preventing parastomal hernia with a prosthetic mesh
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
Department of Surgery, Sundsvalls sjukhus, Sundsvall.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
2004 (English)In: Archives of surgery (Chicago. 1960), ISSN 0004-0010, E-ISSN 1538-3644, Vol. 139, no 12, 1356-1358 p.Article in journal (Refereed) Published
Abstract [en]

HYPOTHESIS: Parastomal hernia is a common complication following colostomy. The lowest recurrence rate has been produced when repair is with a prosthetic mesh. This study evaluated the effect on stoma complications of using a mesh during the primary operation. DESIGN: Randomized clinical study. METHODS: Patients undergoing permanent colostomy were randomized to have either a conventional stoma or the addition of a mesh placed in a sublay position. The mesh used was a large-pore lightweight mesh with a reduced polypropylene content and a high proportion of absorbable material. RESULTS: Twenty-seven patients had a conventional stoma, and in 27 patients the mesh was used. No infection, fistula formation, or pain occurred (observation time, 12-38 months). At the 12-month follow-up, parastomal hernia was present in 13 of 26 patients without a mesh and in 1 of 21 patients in whom the mesh was used. CONCLUSIONS: A lightweight mesh with a reduced polypropylene content and a high proportion of absorbable material placed in a sublay position at the stoma site is not associated with complications and significantly reduces the rate of parastomal hernia.

Place, publisher, year, edition, pages
2004. Vol. 139, no 12, 1356-1358 p.
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-22715DOI: 10.1001/archsurg.139.12.1356PubMedID: 15613293OAI: oai:DiVA.org:umu-22715DiVA: diva2:217686
Available from: 2009-05-15 Created: 2009-05-15 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Parastomal hernia: clinical studies on definitions and prevention
Open this publication in new window or tab >>Parastomal hernia: clinical studies on definitions and prevention
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aims of the studies was to evaluate the short and long term effects on the development of parastomal hernia and stoma complications of a prophylactic prosthetic mesh placed in a sublay position at the index operation.  Also the purpose was to validate a definition of parastomal hernia at clinical examination and a method and a definition of parastomal hernia at CT-scan.

In the first two studies 27 patients were randomized to a conventional stoma or to a stoma with the addition of a partly absorbable low weight large pore mesh in sublay position. Patients were examined after one and five years.  After five years the rate of parastomal hernia was 80% with a conventional stoma and 14% with the addition of a mesh.  A prophylactic mesh did not increase the rate of complications. In the third study a prophylactic mesh was intended at stoma formation in 93 consecutive patients in routine surgery. In 75 patients provided with a mesh the rate of parastomal hernia after one year was 13%. Complication rates were not increased in 19 severely contaminated wounds. In the fourth study 27 patients with ostomies were examined by tree surgeons and parastomal hernia was defined as any protrusion in the vicinity of the stoma. CT-scans with patients examined in the supine and prone positions were assessed by three radiologists. Herniation was then defined as any intra abdominal content protruding beyond peritoneum or the presence of a hernia sac. Kappa was 0.85 for surgeons and 0.85 for radiologists with CT-scan in the prone position. Kappa was 0.80 for surgeons and radiologists collectively, with CT-scan in the prone position. Four parastomal hernias detected at CT-scan in the prone position could not be detected in the supine position. A parastomal hernia diagnosed at clinical examination was always detected at CT-scan in the prone position.

Conclusions: A prophylactic mesh placed in a sublay position at the index operation reduces the rate of parastomal hernia without increasing the rate of complications. Parastomal hernia should at clinical examination be defined as any protrusion in the vicinity of the stoma with the patient straining in the supine and erect positions.  At CT-scan, with the patient examined in the prone position, herniation should be defined as any intra abdominal content protruding beyond peritoneum or the presence of a hernia sac.

Place, publisher, year, edition, pages
Umeå: Umeå university, 2010. 59 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1362
Keyword
Parastomal hernia, stoma complications, prosthetic mesh, mesh complications, sigmoid stoma, ileostomy, laparoscopic stoma, CT-scan
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:umu:diva-36142 (URN)978-91-7459-052-4 (ISBN)
Public defence
2010-11-19, Aulan, Utbildningsavdelningen 1 tr Länssjukhuset Sundsvall-Härnösand, Länssjukhuset Sundsvall-Härnösand, Sundsvall, 13:00 (Swedish)
Opponent
Supervisors
Note
Embargo, publiceras 2011-05-01Available from: 2010-11-01 Created: 2010-09-20 Last updated: 2010-11-01Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Jänes, ArthurIsraelsson, Leif A
By organisation
Surgery
In the same journal
Archives of surgery (Chicago. 1960)
Surgery

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 94 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf