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Use of prophylactic mesh when creating a colostomy does not prevent parastomal hernia: a randomized controlled trial—STOMAMESH
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Sunderby Research Unit, Umeå University, Luleå, Sweden. (Clister)
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. (Clister)
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
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2019 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 269, no 3, p. 427-431Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to determine whether parastomal hernia (PSH) rate can be reduced by using synthetic mesh in the sublay position when constructing permanent end colostomy. The secondary aim was to investigate possible side-effects of the mesh.

Background: Prevention of PSH is important as it often causes discomfort and leakage from stoma dressing. Different methods of prevention have been tried, including several mesh techniques. The incidence of PSH is high; up to 78%.

Methods: Randomized controlled double-blinded multicenter trial. Patients undergoing open colorectal surgery, including creation of a permanent end colostomy, were randomized into 2 groups, with and without mesh. A lightweight polypropylene mesh was placed around the colostomy in the sublay position. Follow up after 1 month and 1 year. Computerized tomography and clinical examination were used to detect PSH at the 1-year follow up. Data were analyzed on an intention-to-treat basis.

Results: After 1 year, 211 of 232 patients underwent clinical examination and 198 radiologic assessments. Operation time was 36 minutes longer in the mesh arm. No difference in rate of PSH was revealed in the analyses of clinical (P = 0.866) and radiologic (P = 0.748) data. There was no significant difference in perioperative complications.

Conclusions: The use of reinforcing mesh does not alter the rate of PSH. No difference in complication rate was seen between the 2 arms. Based on these results, the prophylactic use of mesh to prevent PSH cannot be recommended.

Place, publisher, year, edition, pages
Wolters Kluwer, 2019. Vol. 269, no 3, p. 427-431
Keywords [en]
mesh, parastomal hernia, prophylaxis
National Category
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-142585DOI: 10.1097/SLA.0000000000002542ISI: 000467458600023PubMedID: 29064900Scopus ID: 2-s2.0-85050207106OAI: oai:DiVA.org:umu-142585DiVA, id: diva2:1163433
Available from: 2017-12-07 Created: 2017-12-07 Last updated: 2023-10-31Bibliographically approved
In thesis
1. Aspects of parastomal hernia
Open this publication in new window or tab >>Aspects of parastomal hernia
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Parastomal hernia (PSH) is a common complication to all ostomies, and all too well known to colorectal surgeons. Up to half of all stomates get a PSH. PSH may present itself as a protrusion or a bulge of the stoma that contains bowel or other content of the abdominal cavity. The symptom load varies from none to debilitating. An unknown fraction of patients with PSH receives correctional surgery. The overall aim of this thesis was to investigate prevalence and treatment of PSH in Sweden, explore whether prophylactic mesh when constructing a colostomy is a viable option for prevention, investigate the health economic impact of PSH and probe into the patient’s own experiences of living with a PSH. The thesis is based on both qualitative and quantitative research. Paper I and III are a randomised controlled multicentre trial, paper II is retrospective audit of the treatment of PSH in Sweden, paper IV is a health economic analysis of colostomy costs and paper V is an interview of survivors of colorectal cancer, with a colostomy and PSH.

The conclusions are as follows: The frequency of PSH surgery was much lower than expected, no specific risk factor could be identified, and perhaps centralisation of surgery should be considered. Most common cause for surgery was cosmetic. Prophylactic mesh in a sublay position don’t prevent PSH but doesn’t seem to add significant complications. PSH cost no more than a colostomy with no PSH, regarding appliances and stoma nurse visits. The common theme of long-time rectal cancer survivors with PSH is coping and a deep sense of gratitude being a survivor.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2023. p. 72
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2262
Keywords
parastomal hernia, colostomy, surgical technique, patient experience
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:umu:diva-216046 (URN)978-91-8070-170-9 (ISBN)978-91-8070-171-6 (ISBN)
Public defence
2023-12-01, Aulan, Sunderby sjukhus, Sjukhusvägen 12, Sunderby, 10:00 (English)
Opponent
Supervisors
Available from: 2023-11-10 Created: 2023-10-31 Last updated: 2023-11-01Bibliographically approved

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Odensten, ChristofferStrigård, KarinRutegård, JörgenGunnarsson, UlfNäsvall, Pia

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