Retrorectus mesh reinforcement of ileostomy site fascial closure: stoma closure and reinforcement (SCAR) trial phase I/II results

Shaw, Robert D.; Goldwag, Jenaya L.; Wilson, L.; Ivatury, Srinivas J.; Tsapakos, Michael J.; Pauli, Eric M.; Wilson, M.G.F.

doi:10.1007/s10029-022-02681-z

Cited by 5 publications

(4 citation statements)

References 37 publications

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“…Shaw et all published a prospective case serie using synthetic prophylactic mesh in rectorectus space for 20 patients. No surgical site occurrence was reported within the mean follow up time of 20 months [ 12 ]. In a recent systematic review, the use of prophylactic mesh was considered safe in terms of SSI, seroma and anastomotic leakage [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Synthetic mesh versus biological mesh to prevent incisional hernia after loop-ileostomy closure: a randomized feasibility trial

et al. 2023

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Background Incisional hernia is a frequent complication after loop-ileostomy closure, rationalizing hernia prevention. Biological meshes have been widely used in contaminated surgical sites instead of synthetic meshes in fear of mesh related complications. However, previous studies on meshes does not support this practice. The aim of Preloop trial was to study the safety and efficacy of synthetic mesh compared to a biological mesh in incisional hernia prevention after loop-ileostomy closure. Methods The Preloop randomized, feasibility trial was conducted from April 2018 until November 2021 in four hospitals in Finland. The trial enrolled 102 patients with temporary loop-ileostomy after anterior resection for rectal cancer. The study patients were randomized 1:1 to receive either a light-weight synthetic polypropylene mesh (Parietene Macro™, Medtronic) (SM) or a biological mesh (Permacol™, Medtronic) (BM) to the retrorectus space at ileostomy closure. The primary end points were rate of surgical site infections (SSI) at 30-day follow-up and incisional hernia rate during 10 months’ follow-up period. Results Of 102 patients randomized, 97 received the intended allocation. At 30-day follow-up, 94 (97%) patients were evaluated. In the SM group, 1/46 (2%) had SSI. Uneventful recovery was reported in 38/46 (86%) in SM group. In the BM group, 2/48 (4%) had SSI (p > 0.90) and in 43/48 (90%) uneventful recovery was reported. The mesh was removed from one patient in both groups (p > 0.90). Conclusions Both a synthetic mesh and biological mesh were safe in terms of SSI after loop-ileostomy closure. Hernia prevention efficacy will be published after the study patients have completed the 10 months’ follow-up.

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Section: Introductionmentioning

confidence: 99%

Synthetic mesh versus biological mesh to prevent incisional hernia after loop-ileostomy closure: a randomized feasibility trial

et al. 2023

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“…A further area that requires consideration is the choice of mesh and the site of placement. A synthetic mesh was used in most studies [4,15,17,19,20] while a biological mesh was used only in the identified RCT [4]. There have been only three small studies to date that used biosynthetic mesh types [14,16,18].…”

Section: Discussionmentioning

confidence: 99%

“…Any disagreement was settled through discussion or referred to a third review author (MB). Of the 46 potentially relevant studies identified by the search strategies, 11 were deemed suitable for inclusion [4,6,[13][14][15][16][17][18][19][20][21]. Figure 1 shows the PRISMA flowchart for the selection process, including reasons for exclusion.…”

Section: Re Sultsmentioning

confidence: 99%

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Reversal of stoma with biosynthetic mesh fascial reinforcement: a systematic review and meta‐analysis

Dewantoro,

Manson,

Brazzelli

et al. 2024

Colorectal Disease

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AimTemporary stoma formation remains a common part of modern‐day colorectal surgical operations. At the time of reversal, a second procedure is required when the bowel is anastomosed and the musculature is closed. The rate of incisional hernia at these sites is 30%–35% with conventional suture closure. Mesh placement at this site is therefore an attractive option to reduce hernia risk, particularly as new mesh types, such as biosynthetic meshes, are available. The aim of this work was to conduct a systematic review and meta‐analysis assessing the use of mesh for prophylaxis of incisional hernia at stoma closure and to explore the outcome measures used by each of the included studies to establish whether they are genuinely patient‐centred.MethodThis is a systematic review and meta‐analysis assessing the published literature regarding the use of mesh at stoma site closure operations. Comprehensive literature searches of major electronic databases were performed by an information specialist. Screening of search results was undertaken using standard systematic review principles. Data from selected studies were input into an Excel file. Meta‐analysis of the results of included studies was conducted using RevMan software (v.5.4). Randomized controlled trial (RCT) and non‐RCT data were analysed separately.ResultsEleven studies with a total of 2008 patients were selected for inclusion, with various mesh types used. Of the included studies, one was a RCT, seven were nonrandomized comparative studies and three were case series. The meta‐analysis of nonrandomized studies shows that the rate of incisional hernia was lower in the mesh reinforcement group compared with the suture closure group (OR 0.21, 95% CI 0.12–0.37) while rates of infection and haematoma/seroma were similar between groups (OR 0.7, 95% CI 0.41–1.21 and OR 1.05, 95% CI 0.63–1.80, respectively). The results of the RCT were in line with those of the nonrandomized studies.ConclusionCurrent evidence indicates that mesh is safe and reduces incisional hernia. However, this is not commonly adopted into current clinical practice and the literature has minimal patient‐reported outcome measures. Future work should explore the reasons for such slow adoption as well as the preferences of patients in terms of outcome measures that matter most to them.

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Risk factors associated to incisional hernia in stoma site after stoma closure: A systematic review and meta-analysis

Ramírez-Giraldo,

Van-Londoño,

Monroy

et al. 2023

Int J Colorectal Dis

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This study aims to identify which risk factors are associated to the appearance of an incisional hernia in a stoma site after its closure. This in the sake of identifying which patients would benefit from a preventative intervention and thus start implementing a cost-effective protocol for prophylactic mesh placement in high-risk patients.Methods: A systematic review of PubMed, Cochrane library and ScienceDirect was performed according to PRISMA guidelines. Studies reporting incidence, risk factors and follow-up time for appearance of incisional hernia after stoma site closure were included. A fixed-effects and random effects models were used to calculate odds ratios' estimates and standardized mean values with their respective grouped 95% confidence interval.This to evaluate the association between possible risk factors and the appearance of incisional hernia after stoma site closure.Results: 17 studies totaling 2899 patients were included. Incidence proportion between included studies was of 17,78% (CI95%: 13,51 -22,50%). Out of the evaluated factors obesity (p<0,001, index (p<0,001, Cohen's d=0.63, SE=011), presence of parastomal hernia (p=0,001, LogOR=1.24, SE=0.38), colostomy (p=0,001 LogOR=-0.71, SE=0.15) and end stoma (p=0,040, LogOR=-0,38, SE=-0,18) were associated to the appearance of incisional hernia in stoma site after stoma closure.Conclusions: Prophylactic mesh placement should be considered as an effective preventative intervention in high-risk patients (obese patients, patients with parastomal hernia, colostomy and end stoma patients) with the goal of reducing incisional hernia rates in stoma site after closure while remaining cost-effective.

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Retrorectus mesh reinforcement of ileostomy site fascial closure: stoma closure and reinforcement (SCAR) trial phase I/II results

Cited by 5 publications

References 37 publications

Synthetic mesh versus biological mesh to prevent incisional hernia after loop-ileostomy closure: a randomized feasibility trial

Synthetic mesh versus biological mesh to prevent incisional hernia after loop-ileostomy closure: a randomized feasibility trial

Reversal of stoma with biosynthetic mesh fascial reinforcement: a systematic review and meta‐analysis

Risk factors associated to incisional hernia in stoma site after stoma closure: A systematic review and meta-analysis

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