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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. (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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2017 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140Article in journal (Refereed) Epub ahead of print
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, 2017.
Keywords [en]
mesh, parastomal hernia, prophylaxis
National Category
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-142585DOI: 10.1097/SLA.0000000000002542PubMedID: 29064900OAI: oai:DiVA.org:umu-142585DiVA, id: diva2:1163433
Available from: 2017-12-07 Created: 2017-12-07 Last updated: 2018-06-09

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Odensten, ChristofferStrigård, KarinRutegård, JörgenGunnarsson, UlfNäsvall, Pia
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