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No reduction in parastomal hernia rate 3 years after stoma construction with prophylactic mesh: Three-year follow-up results from stomamesh-a multicenter double-blind randomized controlled trial
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Sunderby Research Unit, Umeå University, Luleå, Sweden.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Sunderby Research Unit, Umeå University, Luleå, Sweden.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.ORCID iD: 0000-0001-5838-9133
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.ORCID iD: 0000-0002-3806-2114
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2023 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 277, no 1, p. 38-42Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The primary objective was to compare rates of parastomal hernia (PSH) 3 years after stoma construction with prophylactic mesh or no mesh. A secondary objective was to compare complications requiring reintervention within 3 years.

BACKGROUND: Recent studies have shown that a prophylactic mesh does not reduce the rate of PSH contrary to older studies. Long-term data on efficacy and safety is however scarce.

METHODS: A randomized controlled double-blind multicenter trial. Patients planned for permanent end colostomy were randomized to either prophylactic mesh in the retromuscular position around the stoma site or no mesh. They were evaluated for PSH clinically and with computed tomography (CT) 3 years after stoma construction. Medical records of all patients included were also reviewed at 3 years to detect any abdominal or abdominal wall surgery during that period.

RESULTS: A total of 232 patients were randomized. At 3 years, 154 patients were available for clinical evaluation and 137 underwent a CT scan. No significant difference in PSH rates was seen between the treatment allocation arms (clinical: P=0.829 and CT: P=0.761, respectively), nor was there a significant difference in the number of reinterventions, but 2 patients had their mesh removed at emergency surgery.

CONCLUSIONS: Prophylactic mesh does not reduce the rate of PSH and cannot be recommended for routine use.

Place, publisher, year, edition, pages
Wolters Kluwer, 2023. Vol. 277, no 1, p. 38-42
Keywords [en]
parastomal hernia, mesh, prevention, prophylaxis
National Category
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-202661DOI: 10.1097/SLA.0000000000005537ISI: 000905219700014PubMedID: 35837972Scopus ID: 2-s2.0-85145304565OAI: oai:DiVA.org:umu-202661DiVA, id: diva2:1726086
Funder
Swedish Research Council, 214-7196Region Västerbotten, VLL-545001Norrbotten County CouncilAvailable from: 2023-01-12 Created: 2023-01-12 Last updated: 2024-02-08Bibliographically 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, KarinGunnarsson, UlfNäsvall, Pia

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