Prophylactic placement of permanent synthetic mesh at the time of ostomy closure prevents formation of incisional hernias

Warren, Jeremy A.; Beffa, Lucas; Carbonell, Alfredo M.; Cull, Jennifer; Sinopoli, Brent; Ewing, Joseph A.; McFadden, Cedrek; Crockett, Jay; Cobb, William S.

doi:10.1016/j.surg.2017.09.041

Cited by 43 publications

(58 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A number of prospective trials have already shown the safety, efficacy and benefit of using prophylactic meshes. A recent, larger, matched-case series used a non-absorbable synthetic mesh on the posterior rectus sheath with very promising results (IH rate of 1% vs. 17%, [14]). Based on our institutional data, a randomised controlled trial to further test prophylactic mesh implantation should only be undertaken on a multicentre level lest it be underpowered.…”

Section: Discussionmentioning

confidence: 99%

Incisional hernia at the site of stoma reversal—incidence and risk factors in a retrospective observational analysis

Lorenz

Kogler

Kafka-Ritsch

et al. 2019

Int J Colorectal Dis

View full text Add to dashboard Cite

Background The closure of a stoma site has a high incidence of incisional hernia (IH) development, reaching 30% in some studies. Location and defect size in the abdominal wall depend on the type of stoma formed, most commonly a loop ileostomy or terminal sigmoid colostomy. Methods The retrospective single-centre study includes all consecutive patients who underwent stoma reversal between 2010 and 2016 at the Department of Visceral, Transplant and Thoracic Surgery in Innsbruck. Patient characteristics and follow-up examinations were evaluated for IH at both the stoma reversal site and at any other surgical access sites. Results A total of 181 patients (49% female, 51% male) had a stoma reversal operation. A parastomal hernia was present in 5% (n = 9). Follow-up data was available for 140 patients (77%). A postoperative IH at the stoma reversal site developed in 15.7% (n = 22) and in 18.6% (n = 26) at other surgical wounds to the abdominal wall during a median follow-up of 136 weeks. The combination of a preoperative parastomal hernia and a postoperative IH was observed in 2.8% (n = 5). Parastomal herniation, male sex, body mass index over 25, arterial hypertension and concomitant ventral hernia were associated with IH formation at the stoma reversal. Conclusion The rate of IH at the stoma reversal site was lower than expected from the literature, whereas the rate of IH at other surgical wounds to the abdominal wall was within the expected range.

show abstract

Section: Discussionmentioning

confidence: 99%

Incisional hernia at the site of stoma reversal—incidence and risk factors in a retrospective observational analysis

Lorenz

Kogler

Kafka-Ritsch

et al. 2019

Int J Colorectal Dis

View full text Add to dashboard Cite

show abstract

“…The incidence of stoma site hernia has been reported between 9.6% and 34.6% [11][12][13][14][15][16][17][18][19] (Appendix Table 5). Differences may be explained by mixed populations with both colostomies and ileostomies [11,12,[15][16][17], and different methods for diagnosis, either computer tomography (CT) scan alone [13,19] or combined with patient evaluation [17,20]. Some previous studies have few patients [11,14] or use old surgical techniques [14].…”

Section: Introductionmentioning

confidence: 99%

Hernia at the stoma site after loop ileostomy reversal

Eklöv

Viktorsson

Frosztega

et al. 2020

Int J Colorectal Dis

View full text Add to dashboard Cite

Purpose To estimate the incidence of and risk factors for stoma site hernia after closure of a temporary diverting ileostomy. Method In a non-comparative cohort study, charts (n = 216) and CT-scans (n = 169) from patients who had undergone loop ileostomy closure following low anterior resection for rectal cancer 2010-2015 (mainly open surgery) at three hospitals were evaluated retrospectively. Patients without hernia diagnosis were evaluated cross-sectionally through a questionnaire (n = 158), and patients with symptoms of bulging or pain were contacted and offered a clinical examination or a CT scan including Valsalva maneuver. Results In the chart review, five (2.3%) patients had a diagnosis of incisional hernia at the previous stoma site after 8 months (median). In 12 patients, the CT scan showed a hernia, of which 8 had not been detected previously. The questionnaire was returned by 130 (82%) patients, of which 31% had symptoms of bulging or pain. Less than one in five of patients who reported bulging were diagnosed with hernia, but the absolute majority of the radiologically diagnosed hernias reported symptoms. By combining clinical and radiological diagnosis, the cumulative incidence of hernia was 7.4% during a median follow up time of 30 months. Risk factors for stoma site hernia were male sex and higher BMI. Conclusion Hernia at the previous stoma site was underdiagnosed. Less than a third of symptomatic patients had a hernia diagnosis in routine follow up. Randomized studies are needed to evaluate if prophylactic mesh can be used to prevent hernias, especially in patients with risk factors.

show abstract

“…Based on current data, the ‘true’ rate of herniation at the ileostomy site remains unclear and is still a subject of discussion among surgeons . Neither different surgical techniques nor prophylactic mesh implantation could demonstrate strong and reproducible data on incidence and effective prevention of SSIH.…”

Section: Discussionmentioning

confidence: 99%

“…This could be one explanation for the observed trend in favour of lateral rectal stoma positioning compared with transrectal placement with regard to the development of an incisional hernia after stoma closure in our study. Based on current data, the 'true' rate of herniation at the ileostomy site remains unclear and is still a subject of discussion among surgeons [2,9,13]. Neither different surgical techniques nor prophylactic mesh implantation could demonstrate strong and reproducible data on incidence and effective prevention of SSIH.…”

Section: Discussionmentioning

confidence: 99%

Incisional hernia rate after ileostomy closure in lateral pararectal stoma versus transrectal stoma placement: follow‐up of the randomized PATRASTOM trial

et al. 2019

View full text Add to dashboard Cite

Aim Because damage to the rectus abdominis muscle during ileostomy placement and reversal might be a risk factor for the development of stoma‐site incisional hernia (SSIH), we hypothesized that positioning of the stoma lateral to the rectus abdominis muscle might prevent SSIH. Method To investigate whether a lateral pararectal stoma position lowers the incidence of SSIH in comparison with a transrectal position, a follow‐up study of the PATRASTOM trial, which had randomized stoma placement (lateral pararectal versus transrectal), was conducted. All former participants were invited simultaneously for a follow‐up visit in September 2016, 2 years after database closure of the PATRASTOM trial. For patients who were not able to attend the follow‐up, the electronic chart as well as MRI/CT scans were reviewed with regard to the presence of SSIH. Results Follow‐up – either clinical or radiological – was available for 47 of the 60 PATRASTOM participants. The median duration of follow‐up was 3.4 years (interquartile range 3.0–4.1 years). SSIH occurred in 3 of 23 patients (13.0%) in the lateral pararectal group compared with 7 of 24 patients (29.2%) in the transrectal group (P = 0.287). Four of the 10 patients diagnosed with SSIH had already undergone or were scheduled for hernia repair. Of the patient and procedure characteristics which may have an impact on the development of incisional hernia none was a significant risk factor for SSIH. Conclusion In the present follow‐up study, no difference in the incidence of SSIH was found between lateral pararectal and transrectal stoma construction in an elective setting.

show abstract

Prophylactic placement of permanent synthetic mesh at the time of ostomy closure prevents formation of incisional hernias

Cited by 43 publications

References 44 publications

Incisional hernia at the site of stoma reversal—incidence and risk factors in a retrospective observational analysis

Incisional hernia at the site of stoma reversal—incidence and risk factors in a retrospective observational analysis

Hernia at the stoma site after loop ileostomy reversal

Incisional hernia rate after ileostomy closure in lateral pararectal stoma versus transrectal stoma placement: follow‐up of the randomized PATRASTOM trial

Contact Info

Product

Resources

About