Prevention of parastomal hernia after abdominoperineal excision with a prophylactic three‐dimensional funnel mesh

Abstract

Aim A prophylactic three‐dimensional (3D) funnel mesh using the keyhole technique (intraperitoneal onlay mesh position) in abdominoperineal excision (APR) may significantly decrease the parastomal hernia (PSH) index without increasing morbidity. The aim of this retrospective observational study was to analyse the incidence of PSH and postoperative complications in patients who underwent permanent colostomy with the use of a prophylactic 3D preformed mesh compared with patients without a mesh. Method Patients who underwent an end‐colostomy after APR for primary or recurrent rectal cancer in a colorectal surgery unit were divided into two groups: group 1 without a prophylactic mesh and group 2 with a prophylactic synthetic mesh. The main end‐point was to analyse the incidence of PSH after a median follow‐up of 2.8 years. Results One hundred and ten patients (64 in group 1 and 46 in group 2, without significant clinical differences) underwent a permanent colostomy after APR. In group 1 70.3% developed a PSH, compared with 13% in group 2 (P < 0.001). Age (especially for patients ≥ 75 years) represented a significant risk factor for PSH. There were no differences in postoperative complications between the groups. Conclusion A prophylactic parastomal 3D mesh using the keyhole technique may reduce the incidence of PSH after permanent colostomy without an increase in postoperative complications.

Prophylactic funnel mesh to prevent parastomal hernia in permanent end colostomy: A retrospective cohort study

“…A structured follow‐up longer than two years is essential. Unlike the study of Lopez et al [17] a statistically significant higher risk of PSH was observed in obese patients and in patients with open surgical access or after conversion, but not in elderly patients.…”

The Role of Mesh Implants in Surgical Treatment of Parastomal Hernia

“…Materials used for non-adhesive coatings include, among others, titanium [73,74], chitosan [75], poly(glycolic acid) (PGA) [76], cellulose [77], and collagen [78]. Another approach for the production of composite meshes is to join filaments with different properties, such as PP, e-PTFE [79], and polyvinylidene fluoride (PVDF) [80,81]. Experience in the use of composite meshes for both repair and prophylactic purposes in parastomal hernia indicates a minimal risk of infection and a low risk of complications [82].…”

Preoperative Progressive Pneumoperitoneum and Botulinum Toxin Type A in Patients With Large Parastomal Hernia

“…Despite recent advances in surgical techniques, repair of parastomal hernia (PSH) is still a huge challenge for surgeons following abdominal ostomy ( 1 ). The reported overall incidence rate of PSH varies widely in the literature effected by many factors, such as the type of stoma.…”