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Matsumoto Y, Aisu N, Kajitani R, Nagano H, Yoshimatsu G, Hasegawa S. Complications associated with loop ileostomy: analysis of risk factors. Tech Coloproctol 2024; 28:60. [PMID: 38801595 DOI: 10.1007/s10151-024-02926-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/03/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Loop ileostomy is a common surgical procedure but is associated with complications such as outlet obstruction (OO), parastomal hernia (PH), and high-output stoma (HOS). This study aimed to identify risk factors for these complications, as well as their causal relationships. METHODS The study included 188 consecutive patients who underwent loop ileostomy between April 2016 and September 2021. Clinical factors and postoperative stoma-related complications (OO, HOS, and PH) were analyzed retrospectively. Stoma-related factors were evaluated using specific measurements from computed tomography (CT) scans. The incidence, clinical course, and risk factors for the stoma-related complications were investigated. RESULTS OO was diagnosed in 28 cases (15.7%), PH in 60 (32%), and HOS in 57 (31.8%). A small longitudinal stoma diameter at the rectus abdominis level on CT and a right-sided stoma were significantly associated with OO. Creation of an ileostomy for anastomotic leakage was independently associated with HOS. Higher body weight and a large longitudinal stoma diameter at the rectus abdominis level on CT were significantly associated with PH. There was a significant relationship between the occurrence of OO and HOS. However, the association between OO and PH was marginal. CONCLUSION This study identified key risk factors for OO, HOS, and PH as complications of loop ileostomy and their causal relationships. Our findings provide insights that may guide the prevention and management of complications related to loop ileostomy.
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Affiliation(s)
- Yoshiko Matsumoto
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Naoya Aisu
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Ryuji Kajitani
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Hideki Nagano
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Gumpei Yoshimatsu
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
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Odensten C, Gunnarsson U, Johansson J, Näsvall P. Impact of parastomal hernia on colostomy costs at 1 year: Secondary analysis of a randomized clinical trial (STOMAMESH). Scand J Surg 2024; 113:33-39. [PMID: 37563916 DOI: 10.1177/14574969231188021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
BACKGROUND AND AIMS Parastomal hernia (PSH) is a common complication after the creation of a colostomy, with a prevalence of approximately 50%. Despite the high frequency, little is known how PSH affects the cost of colostomy care.The hypothesis in this study was that PSH increases the cost of colostomy care compared with not having a PSH. METHODS Two groups with (N = 61) and without (n = 147) PSH were compared regarding costs of stoma appliances and visits. The population from a large randomized trial comparing construction of colostomy with or without prophylactic mesh (STOMAMESH) was used and cross-matched with health economic data from the National Pharmaceutical Register, 1 year after initial surgery. RESULTS Patients with and without a PSH were similar in basic demographic data. No difference in cost of stoma appliances (with PSH 2668.3 EUR versus no PSH 2724.5 EUR, p = 0.938) or number of visits to a stoma therapist (p = 0.987) was seen, regardless of the presence or not of a PSH. CONCLUSIONS PSH appears not to affect costs due to colostomy appliances or the need to visit a stoma therapist, in the first year. The lesson to be learnt is that PSHs are not a driver for costs. Other factors may be determinants of the cost of a colostomy, including manufacturers' price and persuasion, means of procurement, and presence of guidelines.
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Affiliation(s)
- Christoffer Odensten
- Division of Surgery Sunderby Hospital Luleå 97180 Sweden Sunderby Research Unit Department of Surgical and Perioperative Sciences Medical Faculty Umeå University Umeå Sweden
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Medical Faculty, Umeå University, Umeå, Sweden
| | - Jeaneth Johansson
- Department of Business Administration and Industrial Engineering, Luleå University of Technology, Luleå, Sweden
| | - Pia Näsvall
- Sunderby Research Unit, Department of Surgical and Perioperative Sciences, Medical Faculty, Umeå University, Umeå, Sweden
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Blazeby JM, Murkin C, Rooshenas L, Elliott D, Avery K, Chalmers K, Cousins S, Pinkney T, Blencowe N, Reeves BC, Smart N. Development and pilot testing of a patient-reported outcome measure to assess symptoms of parastomal hernia. Colorectal Dis 2024; 26:364-370. [PMID: 38177087 DOI: 10.1111/codi.16850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 01/06/2024]
Abstract
AIM The aim was to develop and pilot a patient-reported outcome measure (PROM) to assess symptoms of parastomal hernia (PSH). METHODS Standard questionnaire development was undertaken (phases 1-3). An initial list of questionnaire domains was identified from validated colorectal cancer PROMs and from semi-structured interviews with patients with a PSH and health professionals (phase 1). Domains were operationalized into items in a provisional questionnaire, and 'think-aloud' patient interviews explored face validity and acceptability (phase 2). The updated questionnaire was piloted in patients with a stoma who had undergone colorectal surgery and had a computed tomography scan available for review. Patient-reported symptoms were examined in relation to PSH (phase 3). Three sources determined PSH presence: (i) data about PSH presence recorded in hospital notes, (ii) independent expert review of the computed tomography scan and (iii) patient report of being informed of a PSH by a health professional. RESULTS For phase 1, 169 and 127 domains were identified from 70 PROMs and 29 interviews respectively. In phase 2, 14 domains specific to PSH were identified and operationalized into questionnaire items. Think-aloud interviews led to three minor modifications. In phase 3, 44 completed questionnaires were obtained. Missing data were few: 5/660 items. PSH symptom scores associated with PSH presence varied between different data sources. The scale with the most consistent differences between PSH presence and absence and all data sources was the stoma appearance scale. CONCLUSION A PROM to examine the symptoms of PSH has been developed from the literature and views of key informants. Although preliminary testing shows it to be understandable and acceptable it is uncertain if it is sensitive to PSH-specific symptoms and further psychometric testing is needed.
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Affiliation(s)
- Jane M Blazeby
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Charlotte Murkin
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Leila Rooshenas
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Daisy Elliott
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Kerry Avery
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Katy Chalmers
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Sian Cousins
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Thomas Pinkney
- Birmingham University Hospitals NHS Trust, Birmingham, UK
| | - Natalie Blencowe
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Barnaby C Reeves
- Population Health Sciences and Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Neil Smart
- Royal Devon and Exeter Hospital, Exeter, UK
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Verdaguer-Tremolosa M, Garcia-Alamino JM, Rodrigues-Gonçalves V, Martínez-López MP, López-Cano M. Prophylactic mesh does not prevent parastomal hernia in long-term: Meta-analysis and trial sequential analysis. Surgery 2024; 175:441-450. [PMID: 37949696 DOI: 10.1016/j.surg.2023.09.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/07/2023] [Accepted: 09/26/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Previous randomized clinical trials, systematic reviews, and meta-analyses evaluating parastomal hernia prevention with mesh placement during end colostomy formation have reported contradictory results. This review aimed to assess the efficacy of this strategy in long-term follow-up according to the latest available data. METHODS Medline, EMBASE, Cochrane Library, Web of Science, and Google Scholar were searched. Randomized clinical trials were included if they compared mesh with no mesh during initial end colostomy creation in adult patients to prevent parastomal hernia with a follow-up longer than 2 years. A meta-analysis was performed to evaluate parastomal hernia incidence (primary outcome), parastomal hernia repair rate, and mortality. Subgroup analysis included surgical approach and mesh position, and trial sequential analysis was performed. RESULTS Eight randomized clinical trials involving 537 patients met the inclusion criteria. Based on long-term follow-up, the incidence of parastomal hernia was not reduced when a prophylactic mesh was placed (relative risk = 0.68 [95% confidence interval:0.46-1.02]; I2 = 81%, P =.06). The parastomal hernia repair rate was low; however, no difference was found between the groups (relative risk = 0.90 [95% confidence interval:0.51-1.56]; I2 = 0%; P = .70), and no difference was detected between the groups when mortality was assessed (relative risk = 1.03 [95% confidence interval: 0.77-1.39]; I2 = 21%; P = .83). Subgroup analyses did not show differences according to the surgical approach or mesh position used. Regarding trial sequential analysis, an optimal information size was not achieved. CONCLUSION Prophylactic mesh placement during end colostomy formation does not prevent parastomal hernia in the long term. The parastomal hernia repair rate and mortality rate did not vary between the included groups. Heterogeneity among the included randomized clinical trials might restrict the reliability of the results.
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Affiliation(s)
- Mireia Verdaguer-Tremolosa
- Abdominal Wall Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Josep Maria Garcia-Alamino
- Department of Health Sciences, Universitat Blanquerna-Ramon Llull, Barcelona, Spain. http://www.twitter.com/JosepMGarcia75
| | - Victor Rodrigues-Gonçalves
- Abdominal Wall Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. http://www.twitter.com/VictRodriguesG
| | - Maria Pilar Martínez-López
- Abdominal Wall Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. http://www.twitter.com/Piilaarr
| | - Manuel López-Cano
- Abdominal Wall Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. http://www.twitter.com/ManuelLpezCano1
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Fujimoto N, Ogino T, Miyoshi N, Uemura M, Doki Y, Eguchi H. Avoiding stoma creation due to super-morbid obesity: A report of two surgical cases of colorectal cancer. Int J Surg Case Rep 2024; 114:109171. [PMID: 38113563 PMCID: PMC10772238 DOI: 10.1016/j.ijscr.2023.109171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION A stoma is commonly created in patients with a high risk of anastomotic leakage. However, patients with obesity have a higher incidence of stoma-related complications, and the decision to create a stoma should be carefully considered. We report two cases of patients with colorectal cancer and super-morbid obesity wherein stoma creation was avoided. PRESENTATION OF CASES Case 1 involved a 52-year-old male patient with a body mass index (BMI) of 41.8 kg/m2 who underwent a robotic-assisted laparoscopic low anterior resection after neoadjuvant chemotherapy for lower rectal cancer. Although temporary diverting ileostomy was initially considered, stoma creation was skipped intraoperatively, considering the complication risk-benefit ratio. Case 2 involved a 42-year-old female patient with a BMI of 64 kg/m2 who underwent open partial non-curative colon resection for descending colon cancer complicated by colonic perforation and abscess formation. The patient was considered to be at high risk of stoma-related complications due to high mobility of the subcutaneous fat of abdominal wall; therefore, we decided not to create a stoma preoperatively. DISCUSSION Considering the high risk of stoma-associated complications, avoiding stoma creation and implementing preventive measures against potential complications are alternative options for patients with super-morbid obesity. CONCLUSION We present our experience two cases in which stoma creation was avoided for super-morbid obese patients with BMI over 40.
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Affiliation(s)
- Naoto Fujimoto
- Department of Gastroenterological Surgery, Graduate school of medicine, Osaka University, Suita, Osaka, Japan
| | - Takayuki Ogino
- Department of Gastroenterological Surgery, Graduate school of medicine, Osaka University, Suita, Osaka, Japan; Therapeutics for Inflammatory Bowel Diseases, Graduate school of medicine, Osaka University, Suita, Osaka, Japan.
| | - Norikatsu Miyoshi
- Department of Gastroenterological Surgery, Graduate school of medicine, Osaka University, Suita, Osaka, Japan
| | - Mamoru Uemura
- Department of Gastroenterological Surgery, Graduate school of medicine, Osaka University, Suita, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate school of medicine, Osaka University, Suita, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate school of medicine, Osaka University, Suita, Osaka, Japan
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Hoh SM, Watters DA. The Best Stoma in an Emergency. World J Surg 2023; 47:2865-2866. [PMID: 37668705 PMCID: PMC10545626 DOI: 10.1007/s00268-023-07151-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/06/2023]
Affiliation(s)
- Su Mei Hoh
- School of Medicine and Health Sciences, Deakin University, Geelong, Waurn Ponds, Victoria, Australia
- University Hospital Geelong, Barwon Health, Geelong, Australia
| | - David Allan Watters
- School of Medicine and Health Sciences, Deakin University, Geelong, Waurn Ponds, Victoria, Australia.
- University Hospital Geelong, Barwon Health, Geelong, Australia.
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Brandsma HT, Hansson BM, Aufenacker TJ, de Jong N, V Engelenburg KC, Mahabier C, Donders R, Steenvoorde P, de Vries Reilingh TS, Leendert van Westreenen H, Wiezer MJ, de Wilt JHW, Rovers M, Rosman C. Prophylactic Mesh Placement During Formation of an End-colostomy: Long-term Randomized Controlled Trial on Effectiveness and Safety. Ann Surg 2023; 278:e440-e446. [PMID: 36727747 DOI: 10.1097/sla.0000000000005801] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to determine if prophylactic mesh placement is an effective, safe, and cost-effective procedure to prevent parastomal hernia (PSH) formation in the long term. BACKGROUND A PSH is the most frequent complication after stoma formation. Prophylactic placement of a mesh has been suggested to prevent PSH, but long-term evidence to support this approach is scarce. METHODS In this multicentre superiority trial patients undergoing the formation of a permanent colostomy were randomly assigned to either retromuscular polypropylene mesh reinforcement or conventional colostomy formation. Primary endpoint was the incidence of a PSH after 5 years. Secondary endpoints were morbidity, mortality, quality of life, and cost-effectiveness. RESULTS A total of 150 patients were randomly assigned to the mesh group (n = 72) or nonmesh group (n = 78). For the long-term follow-up, 113 patients were analyzed, and 37 patients were lost to follow-up. After a median follow-up of 60 months (interquartile range: 48.6-64.4), 49 patients developed a PSH, 20 (27.8%) in the mesh group and 29 (37.2%) in the nonmesh group ( P = 0.22; RD: -9.4%; 95% CI: -24, 5.5). The cost related to the meshing strategy was € 2.239 lower than the nonmesh strategy (95% CI: 491.18, 3985.49), and quality-adjusted life years did not differ significantly between groups ( P = 0.959; 95% CI: -0.066, 0.070). CONCLUSIONS Prophylactic mesh placement during the formation of an end-colostomy is a safe procedure but does not reduce the incidence of PSH after 5 years of follow-up. It does, however, delay the onset of PSH without a significant difference in morbidity, mortality, or quality of life, and seems to be cost-effective.
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Affiliation(s)
| | - Birgitta Me Hansson
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Nienke de Jong
- Department of Surgery, Bernhoven Hospital, Uden, The Netherlands
| | | | - Chander Mahabier
- Department of Surgery, Albert Schweitzer Hospital Dordrecht, The Netherlands
| | - Rogier Donders
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pascal Steenvoorde
- Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | | | - Marinus J Wiezer
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Maroeska Rovers
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of operating rooms, Radboud university medical centre, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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Melland-Smith M, Miller B, Petro C, Beffa L, Prabhu A, Krpata D, LaBelle M, Tamer R, Rosen M. Single-staged retromuscular abdominal wall reconstruction with mesh at the time of ostomy reversal: are we crossing the line? An ACHQC Analysis. Surg Endosc 2023; 37:7051-7059. [PMID: 37353652 DOI: 10.1007/s00464-023-10176-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 05/30/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION The most appropriate method of reconstructing the abdominal wall at the site of a simultaneous stoma takedown is controversial. The contaminated field, concomitant GI procedure being performed and presence of a hernia all complicate decision-making. We sought to describe the surgical approaches, mesh type and outcomes of concomitant abdominal wall reconstruction during stoma takedown in a large hernia registry. METHODS AND PROCEDURES All patients who underwent stoma takedown with simultaneous hernia repair with retromuscular mesh placement from January 2014 to May 2022 were identified within the Abdominal Core Health Quality Collaborative (ACHQC). Patients were stratified by mesh type including permanent synthetic (PS), resorbable synthetic (RS) and biologic mesh. Association of mesh type with 30-day wound events and other complications and 1-year outcomes were evaluated. RESULTS There were 368 patients who met inclusion criteria. Eighty-nine patients had ileostomies, 276 colostomies and 3 had both. Two hundred and seventy-nine (75.8%) patients received PS mesh, 46 (12.5%) biologic, and 43 (11.7%) RS. Seventy percent (259/368) had a parastomal hernia, 75% (285/368) had a midline incisional hernia, and 48% (178/368) had both. All groups had similar preoperative comorbidities and the majority had a transversus abdominus release. All mesh groups had similar thirty-day SSI (13.2-14.3%), SSO (10.5-17.8%) and SSOPI (7.9-14.1%), p = 0.6. Three patients with PS mesh developed infected synthetic mesh and one PS mesh required excision. Four patients with PS developed an enterocutaneous fistula. Of these, only one patient was recorded as having both an enterocutaneous fistula and mesh infection. Thirty-day reoperation and readmission were similar across all mesh groups. Recurrence at 1-year was similar between mesh groups. Quality of life measured using HerQLes scores were higher at one year compared to baseline in all groups indicating improvement in hernia-specific quality of life. CONCLUSION Early complication rates associated with simultaneous stoma takedown and abdominal wall reconstruction are significant, regardless of mesh type utilized. Concomitant surgery should be weighed heavily and tailored to individual patients.
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Affiliation(s)
- Megan Melland-Smith
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA.
| | - Benjamin Miller
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | - Clayton Petro
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | - Lucas Beffa
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | - Ajita Prabhu
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | - David Krpata
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | | | | | - Michael Rosen
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
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Manole TE, Daniel I, Alexandra B, Dan PN, Andronic O. Risk Factors for the Development of Parastomal Hernia: A Narrative Review. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2023; 11:187-192. [PMID: 37533654 PMCID: PMC10393091 DOI: 10.4103/sjmms.sjmms_235_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 03/13/2023] [Accepted: 06/07/2023] [Indexed: 08/04/2023]
Abstract
Parastomal hernia is one of the most common late complications after stoma formation, significantly decreasing patient's quality of life and negatively impacting body image and physical functioning. Progress has been made regarding the surgical technique of stoma creation in different categories of patients, but a better understanding of the risk factors is crucial in reducing the likeliness of parastomal hernia formation and in helping develop risk stratification strategies for pre-and post-operation management. However, currently there is limited consensus on the associated risk factors. Accordingly, for this narrative review, the authors conducted a literature review through three databases (PubMed, Web of Science, and Scopus) and categorized the identified risk factors into the following three categories: patient-, surgery-, and disease-related. Within these categories, the following 10 risk factors were identified and discussed: age, gender, waist circumference, type of ostomy, laparoscopic approach, aperture size >3 cm, stoma not passing through the middle of rectus abdominis muscle, BMI >25 kg/m2, altered collagen metabolism, and diabetes.
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Affiliation(s)
- Teodora Elena Manole
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ion Daniel
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- IIIrd Department of General Surgery, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Bolocan Alexandra
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- IIIrd Department of General Surgery, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Păduraru N. Dan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- IIIrd Department of General Surgery, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Octavian Andronic
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- IIIrd Department of General Surgery, University Emergency Hospital of Bucharest, Bucharest, Romania
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10
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Parastomal hernia repair: a five-year experience from a single centre in the UK. Updates Surg 2023; 75:643-648. [PMID: 36882599 DOI: 10.1007/s13304-023-01470-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/20/2023] [Indexed: 03/09/2023]
Abstract
Parastomal hernias can affect significantly quality of life in patients who often had underwent major operations. The incidence and recurrence is still high although many techniques have been introduced to improve outcomes. Hence, there is still no agreement on what procedure has better results when it comes to repairing a parostomal hernia. Our aim is to compare outcomes of laparoscopic and open parastomal hernia repair in terms of recurrence, reoperations, post-operative complications and length of stay. Sixty-three parastomal hernia repairs were performed in a single Colorectal Centre over a period of 4 years. Eighteen procedures were performed laparoscopically and 45 open. All the 7 emergency procedures were approached open. Both the techniques showed to be safe with post-operative major complication rate (Clavien-Dindo III or above) of 9.52%. The laparoscopic group was found to have a shorter length of stay (p = 0.04) and earlier start of stoma function (p = 0.01), more uneventful recoveries (0.02) and less minor post-operative complications (Clavien-Dindo I or II-p = 0.01,) but similar recurrence rate (p = 0.41). In the open group, the placement of a mesh showed to reduce the rate of recurrence (p = 0.0001). However, this was not found in the laparoscopic approach. In conclusion, the laparoscopic approach showed do give less post-operative complications and a shorter length of stay, with no benefit in the recurrence rate. Considering the open technique, the use of a mesh seemed to reduce the rate of recurrence.
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11
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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. Ann Surg 2023; 277:38-42. [PMID: 35837972 PMCID: PMC9762699 DOI: 10.1097/sla.0000000000005537] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Luan L, Liu Q, Cui C, Cheng Y, Zhang G, Li B. Surgical treatment strategy for recurrent parastomal hernia: Experiences from 17 cases. Front Surg 2022; 9:928743. [PMID: 35983552 PMCID: PMC9379134 DOI: 10.3389/fsurg.2022.928743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/15/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose This study aimed to investigate the surgical treatment strategy of recurrent parastomal hernia (PH) and show its safety, feasibility, and outcomes at a mid-term follow-up. Methods A total of 17 cases of recurrent PH treated at our hospital between January 2016 and October 2021 were included in this retrospective analysis. Patient characteristics were recorded, and the classification of PH, operative time, intraoperative blood loss, hernia repair techniques, follow-up times, complications, as well as recurrence were compared and analyzed. Results Altogether, 17 patients with recurrent PH underwent successful hernia repair via surgical treatment at The First Affiliated Hospital of Shandong First Medical University and Shandong University Qilu Hospital. No recurrence or severe complications were noted during follow-ups (mean 32.8 ± 3.77 [range 3–68] months). Conclusions For recurrent PH, selecting a suitable repair approach based on intraperitoneal conditions such as infection, abdominal adhesions, or the length of the bowel loop, can help in achieving better therapeutic results. The lap-redo + Sugarbaker technique is worth recommending when the appropriate conditions are met.
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Affiliation(s)
- Li Luan
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, China
- Postgraduate Department, Shandong First Medical University, Jinan, China
| | - Qiaonan Liu
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, China
- Postgraduate Department, Shandong University, Jinan, China
| | - Changjin Cui
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, China
- Postgraduate Department, Shandong First Medical University, Jinan, China
| | - Yugang Cheng
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, China
| | - Guangyong Zhang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, China
| | - Bo Li
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, China
- Correspondence: Bo Li
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Gao X, Li RF, Sun LX, Liu ZJ, Tian GJ, Qi H, Li XB. Prophylactic Effect of Simultaneous Placement of Mesh on Incidence of Parastomal Hernia After Miles' Surgical Resection of Colorectal Cancer: A Prospective Study. J Surg Res 2022; 277:27-36. [PMID: 35453054 DOI: 10.1016/j.jss.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 02/15/2022] [Accepted: 03/19/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To assess the prophylactic effect of simultaneous placement of mesh and the incidence of parastomal hernia (PSH) after abdominoperineal resection of rectal cancer. METHODS This study included real-world data of 56 surgically resected patients with colorectal cancer who were consecutively assigned to two groups: control (no mesh, n = 32) and experimental (received mesh, n = 24). An artificial patch was placed under the tunica vaginalis of rectus abdominis for patients in the experimental group, whereas those in the control group received routine sigmoidostomy. The median follow-up time was >20 mo. The difference in hazards function was analyzed by cox regression analysis. The Kaplan-Meir analysis was used to determine the survival curves. A P value of <0.05 was considered as significant. RESULTS The postoperative incidence rate of PSH was lower in the experimental (41.7%) group than in the control group (71.9%; P = 0.045). The PSH postoperative time in the experimental group was significantly delayed compared to the control group (48 mo versus 10 mo; P < 0.001). The risk of progression from H1 to H2 was less in the experimental group compared to the control group (49.28% versus 60.86%; P = 0.14). CONCLUSIONS Prophylactic mesh placement significantly prolonged postoperative time for the recurrence of PSH. The incidence of recurrence of H2 (severe PSH) requiring secondary surgical repair was also reduced.
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Affiliation(s)
- Xu Gao
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Ruo-Fan Li
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Li-Xin Sun
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
| | - Zuo-Jun Liu
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Guang-Jian Tian
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Hui Qi
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xiao-Bin Li
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
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Kalev G, Marquardt C, Schiedeck T. Stomaassoziierte Komplikationen – Vermeidungsstrategie und Therapiekonzepte. COLOPROCTOLOGY 2022. [DOI: 10.1007/s00053-022-00600-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zahia S, Garcia-Zapirain B, Anakabe J, Ander J, Jossa Bastidas O, Loizate Totoricagüena A. A Comparative Study between Scanning Devices for 3D Printing of Personalized Ostomy Patches. SENSORS (BASEL, SWITZERLAND) 2022; 22:560. [PMID: 35062521 PMCID: PMC8780182 DOI: 10.3390/s22020560] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
This papers presents a comparative study of three different 3D scanning modalities to acquire 3D meshes of stoma barrier rings from ostomized patients. Computerized Tomography and Structured light scanning methods were the digitization technologies studied in this research. Among the Structured Light systems, the Go!Scan 20 and the Structure Sensor were chosen as the handheld 3D scanners. Nineteen ostomized patients took part in this study, starting from the 3D scans acquisition until the printed ostomy patches validation. 3D mesh processing, mesh generation and 3D mesh comparison was carried out using commercial softwares. The results of the presented study show that the Structure Sensor, which is the low cost structured light 3D sensor, has a great potential for such applications. This study also discusses the benefits and reliability of low-cost structured light systems.
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Affiliation(s)
- Sofia Zahia
- eVIDA Research Group, University of Deusto, 48007 Bilbao, Spain; (B.G.-Z.); (O.J.B.)
| | | | - Jon Anakabe
- LEARTIKER S.COOP, 48270 Markina, Spain; (J.A.); (J.A.)
| | - Joan Ander
- LEARTIKER S.COOP, 48270 Markina, Spain; (J.A.); (J.A.)
| | - Oscar Jossa Bastidas
- eVIDA Research Group, University of Deusto, 48007 Bilbao, Spain; (B.G.-Z.); (O.J.B.)
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Ghoreifi A, Allgood E, Whang G, Douglawi A, Yu W, Cai J, Miranda G, Aron M, Schuckman A, Desai M, Gill I, Daneshmand S, Duddalwar V, Djaladat H. Risk factors and natural history of parastomal hernia after radical cystectomy and ileal conduit. BJU Int 2021; 130:381-388. [PMID: 34837315 DOI: 10.1111/bju.15658] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the incidence, risk factors and natural history of parastomal hernia (PSH). MATERIALS AND METHODS We reviewed the records of patients who underwent radical cystectomy (RC) and ileal conduit (IC) procedure between 2007 and 2020. Patients who had available follow-up computed tomography (CT) imaging were included in this study. All CT scans were re-reviewed for detection of PSH according to Moreno-Matias classification. Patients who developed hernia were followed up and classified into stable or progressive (defined as radiological upgrading and/or need for surgical intervention) groups. Multivariable Cox regression was performed to identify independent predictors of hernia development and progression. RESULTS A total of 361 patients were included in this study. The incidence of radiological PSH was 30%, graded as I (56.5%), II (12%) and III (31.5%). The median (interquartile range [IQR]) time to radiological hernia was 8 (5-15) months. During the median (IQR) follow-up of 27 (13-47) months in 108 patients with a hernia, 26% patients progressed. The median (IQR) time to progression was 12 (6-21) months. On multivariable analysis, female gender (hazard ratio [HR] 1.86), diabetes (HR 1.81), chronic obstructive pulmonary disease (COPD; HR 1.78) and higher body mass index (BMI; HR 1.07 for each unit) were independent predictors for radiological PSH development. No significant factor was found to be associated with hernia progression. CONCLUSION Radiological PSH after RC and IC occurred in 30% of patients, a quarter of whom progressed in a median time of 12 months. Female gender, diabetes, COPD and high BMI were independent predictors for radiological hernia development.
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Affiliation(s)
- Alireza Ghoreifi
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Evan Allgood
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Gilbert Whang
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Antoin Douglawi
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Wenhao Yu
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jie Cai
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Gus Miranda
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Monish Aron
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Anne Schuckman
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Mihir Desai
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Inderbir Gill
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Siamak Daneshmand
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Vinay Duddalwar
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Hooman Djaladat
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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Chegireddy V, Doval AF, Zavlin D, Ellsworth WA, Dinh TA. Parastomal Hernia Repair Using a Silo Biologic Mesh. Ann Plast Surg 2021; 87:e97-e102. [PMID: 33560001 DOI: 10.1097/sap.0000000000002681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A parastomal hernia (PSH) is an enlargement of the stoma's original opening through the abdominal wall's musculature around a colostomy, ileostomy, or urostomy. Its incidence can be up to 48%. The described methods for its repair have high recurrence rate.This article presents a 3-dimensional silo technique for PSH repair (PSH-R). The aims of this technique are to enhance the structural strength of the tunnel wall, to reinforce both the sidewalls and the fascia above and below the muscular opening, and to maintain a stable stoma opening. METHODS All consecutive patients undergoing PSH-R with the silo technique between January 2009 and May 2018 by 2 plastic surgeons were included. The outcome parameters of interest were hernia recurrence and wound-related complications. RESULTS This study reports 22 patients (9 male, 13 female) with a mean age of 66.7 years and an average body mass index of 29.2. The variety of ostomy types included 10 colostomies, 7 ileostomies, and 5 urostomies. Postoperatively, there were 3 surgical site infections, 1 seroma, and 2 wound healing delays. Six patients were readmitted, 3 of those because of small bowel obstruction. These 3 cases all required reoperation, in addition to 1 operative revision for stoma retraction. During our average follow-up of 19.9 months, 3 cases of PSH recurrence were diagnosed for a recurrence rate of 13.6%. CONCLUSIONS This silo technique is associated with favorable complication and low recurrence rates compared with the available techniques in surgical literature. In our practice, it has established itself as a new and safe technique for complex or recurrent PSHs and should be considered in a surgeon's armamentarium. This technique has become our standard for treatment of recurrent PSHs.
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Affiliation(s)
- Vishwanath Chegireddy
- From the Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
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Jakobsson L, Montgomery A, Ingvar J, Löfgren A, Liedberg F. Urostomal ileal conduit complications in association with abdominal wall mesh implantation. Scand J Urol 2021; 56:1-5. [PMID: 34623226 DOI: 10.1080/21681805.2021.1986571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Parastomal hernia (PH) in association with an ileal conduit is a common complication that is difficult to treat. Mesh reinforcement has been suggested to improve outcomes; either as prophylaxis or for treatment of a parastomal hernia during abdominal wall reconstruction. PATIENTS AND METHODS A retrospective study was performed in consecutive patients subjected to mesh implantation between 2000 and 2016 having a concurrent or previous ileal conduit reconstruction. Postoperative and late urostomal complications, as well as hernia occurrence, were ascertained by a chart review of patients' records. RESULTS A total of 25 patients were included of whom 13 (52%) developed either a urostomal complication, a PH, or both. Complications were caused by mesh erosion in four patients, of which three were diagnosed more than five years after surgery. Four patients developed a urostomal stenosis. One out of eight patients with urostomal complications were subjected to a new ileal conduit reconstruction and another four to other types of revisional surgery. CONCLUSIONS Every second patient with an ileal conduit developed either a local urostomal complication, a PH, or both after abdominal wall mesh reconstruction. A careful and cautious attitude towards the use of mesh in patients with an ileal conduit is suggested.
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Affiliation(s)
- L Jakobsson
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - A Montgomery
- Institution of Clinical Sciences Malmö, Surgical Research Unit, Lund University, Malmö, Sweden
| | - J Ingvar
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - A Löfgren
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - F Liedberg
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Institution of Translational Medicine, Lund University, Malmö, Sweden
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19
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Zelga P, Kluska P, Zelga M, Piasecka-Zelga J, Dziki A. Patient-Related Factors Associated With Stoma and Peristomal Complications Following Fecal Ostomy Surgery: A Scoping Review. J Wound Ostomy Continence Nurs 2021; 48:415-430. [PMID: 34495932 DOI: 10.1097/won.0000000000000796] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Ostomy creation is often an integral part of the surgical management of various diseases including colorectal malignancies and inflammatory bowel disease. Stoma and peristomal complications may occur in up to 70% of patients following ostomy surgery. The aim of this scoping literature review was to synthesize evidence on the risk factors for developing complications following creation of a fecal ostomy. DESIGN Scoping literature review. SEARCH STRATEGY Two independent researchers completed a search of the online bibliographic databases PubMed, MEDLINE, Cochrane, Google Scholar, and EMBASE for all articles published between January 1980 and December 2018. The search comprised multiple elements including systematic literature reviews with meta-analysis of pooled findings, randomized controlled trials, cohort studies, observational studies, other types of review articles, and multiple case reports. We screened 307 unique titles and abstracts; 68 articles met our eligibility criteria for inclusion. The methodological rigor of study quality included in our scoping review was variable. FINDINGS/CONCLUSIONS We identified 6 risk factors associated with an increased likelihood of stoma or peristomal complications (1) age more than 65 years; (2) female sex; (3) body mass index more than 25; (4) diabetes mellitus as a comorbid condition; (5) abdominal malignancy as the underlying reason for ostomy surgery; and (6) lack of preoperative stoma site marking and WOC/ostomy nurse specialist care prior to stoma surgery. We also found evidence that persons with a colostomy are at a higher risk for prolapse and parastomal hernia. IMPLICATIONS Health care professionals should consider these risk factors when caring for patients undergoing fecal ostomy surgery and manage modifiable factors whenever possible. For example, preoperative stoma site marking by an ostomy nurse or surgeon familiar with this task, along with careful perioperative ostomy care and education of the patient by an ostomy nurse specialist, are essential to reduce the risk of modifiable risk factors related to creation of a fecal ostomy.
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Affiliation(s)
- Piotr Zelga
- Piotr Zelga, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Piotr Kluska, MD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Marta Zelga, MD, Department of Pediatric Surgery, Urology and Transplantology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Joanna Piasecka-Zelga, PhD, Research Laboratory for Medicine and Veterinary Products in the GMP Quality System, Nofer Institute of Occupational Medicine, Lodz, Poland
- Adam Dziki, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Piotr Kluska
- Piotr Zelga, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Piotr Kluska, MD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Marta Zelga, MD, Department of Pediatric Surgery, Urology and Transplantology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Joanna Piasecka-Zelga, PhD, Research Laboratory for Medicine and Veterinary Products in the GMP Quality System, Nofer Institute of Occupational Medicine, Lodz, Poland
- Adam Dziki, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Marta Zelga
- Piotr Zelga, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Piotr Kluska, MD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Marta Zelga, MD, Department of Pediatric Surgery, Urology and Transplantology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Joanna Piasecka-Zelga, PhD, Research Laboratory for Medicine and Veterinary Products in the GMP Quality System, Nofer Institute of Occupational Medicine, Lodz, Poland
- Adam Dziki, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Joanna Piasecka-Zelga
- Piotr Zelga, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Piotr Kluska, MD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Marta Zelga, MD, Department of Pediatric Surgery, Urology and Transplantology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Joanna Piasecka-Zelga, PhD, Research Laboratory for Medicine and Veterinary Products in the GMP Quality System, Nofer Institute of Occupational Medicine, Lodz, Poland
- Adam Dziki, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Adam Dziki
- Piotr Zelga, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Piotr Kluska, MD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Marta Zelga, MD, Department of Pediatric Surgery, Urology and Transplantology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Joanna Piasecka-Zelga, PhD, Research Laboratory for Medicine and Veterinary Products in the GMP Quality System, Nofer Institute of Occupational Medicine, Lodz, Poland
- Adam Dziki, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
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López-Cano M, Pereira JA, Rodrigues-Gonçalves V, Verdaguer-Tremolosa M, Hernández-Granados P, Bravo-Salvá A. Parestomal hernia repair. Prospective observational study based on the Spanish Registry of Incisional Hernia (EVEREG). Cir Esp 2021; 99:527-534. [PMID: 34253496 DOI: 10.1016/j.cireng.2021.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The results of parastomal hernia (PH) repair based on data from registries are scarce. The objective of this work is to analyze the data collected on PH in the National Registry of Incisional Hernia (EVEREG) and thus evaluate current practices and results in PH repair. METHODS Data from the PH cohort recorded in the period from July 2012 to June 2018 are analyzed. Complications, recurrences and associated factors of the entire PH cohort are analyzed, regardless of the type of stoma they are associated with. Subsequently, the same PH group analysis was performed in relation to a colostomy (larger group). RESULTS 353 PH were studied. Of these, 259 (73%) were PH in the context of a terminal colostomy, 74 (21%) in the context of a terminal ileostomy, and 20 (6%) in the context of a ureteroileostomy (Bricker). The global mean age was 68.7 ± 11.1 years and 135 (38%) patients were female. The open approach and elective surgery were predominant (78% and 92% respectively); 99% were repaired with a non-absorbable synthetic mesh. Global postoperative complications were high (30.6%). As well as, the global recurrence (27.5%) after a mean follow-up of 9.4 months. CONCLUSIONS PH repair is infrequent. PH surgery seems to be associated with a high percentage of postoperative complications and recurrence.
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Affiliation(s)
- Manuel López-Cano
- Unidad de Cirugía de la Pared Abdominal, Servicio de Cirugía General, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - José Antonio Pereira
- Servicio de Cirugía General, Hospital Universitari del Mar, Departament de Cièncias Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Victor Rodrigues-Gonçalves
- Unidad de Cirugía de la Pared Abdominal, Servicio de Cirugía General, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mireia Verdaguer-Tremolosa
- Unidad de Cirugía de la Pared Abdominal, Servicio de Cirugía General, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Alejandro Bravo-Salvá
- Servicio de Cirugía General, Hospital Universitari del Mar, Departament de Cièncias Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
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21
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Tabusa H, Blazeby JM, Blencowe N, Callaway M, Daniels IR, Gunning A, Hollingworth W, McNair AG, Murkin C, Pinkney TD, Rogers CA, Smart NJ, Reeves BC. Protocol for the UK cohort study to investigate the prevention of parastomal hernia (the CIPHER study). Colorectal Dis 2021; 23:1900-1908. [PMID: 33686656 DOI: 10.1111/codi.15621] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 12/13/2022]
Abstract
AIM Abdominal surgery sometimes necessitates the creation of a stoma, which can cause future complications including parastomal hernia (PSH), an incisional hernia adjacent to and related to the stoma. PSH affects approximately 40% of patients within 2 years of stoma formation. Complications of PSH reduce a patient's quality of life and can be severe (e.g. bowel obstruction). PSHs are difficult to manage and can recur after surgical repair. Therefore, it is very important to prevent a PSH. Surgeons create stomas in different ways and both patient and surgical factors are believed to influence the development of PSH. The aim of the CIPHER study is to investigate the influence of different surgical techniques on the development of PSH. METHOD The UK cohort study to investigate the prevention of parastomal hernia (the CIPHER study) aims to recruit 4000 patients undergoing elective or expedited surgery with the intention of forming an ileostomy or colostomy, irrespective of the primary indication for the planned surgery. For each patient, surgeons will describe their methods of trephine formation, mesh reinforcement of the stoma trephine, use of the stoma as a specimen extraction site and wound closure. The primary outcome will be incident PSH during follow-up, defined as symptoms of PSH (custom-designed questionnaire) and anatomical PSH, ascertained by independent reading of usual care CT scans. Secondary outcomes will include surgical site infection, the Comprehensive Complication Index, quality of life (EQ-5D-5L and SF-12), PSH repair and use of NHS resources. RESULTS Results of the study will be submitted for publication in peer-reviewed journals. All publications relating to the results of CIPHER will use a corporate authorship, 'The CIPHER Study Investigators' with named writing committee members. CONCLUSION The CIPHER study will be the first to investigate detailed surgical methods of stoma formation in a large, representative cohort of patients with a range of primary indications, both cancer and noncancer.
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Affiliation(s)
| | | | | | - Mark Callaway
- University Hospitals Bristol and Weston NHS Trust, Bristol, UK
| | - Ian R Daniels
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | | | | | | | | | | | - Neil J Smart
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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22
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Kalev G, Marquardt C, Schiedeck T. [Stoma-associated complications-Prevention strategy and treatment concepts]. Chirurg 2021; 93:415-426. [PMID: 34137906 DOI: 10.1007/s00104-021-01438-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
Postoperative complications after the creation of an intestinal stoma have a considerable impact on the patient's quality of life. The accurate surgical technique is very important for their prevention and requires profound surgical knowledge as well as sufficient experience. The importance of the preoperative consultation as well as the postoperative care by stoma therapists is clearly proven. Depending on the severity of the complication, outpatient conservative treatment is initially indicated. A surgical local revision or laparotomy should only be considered if conservative treatment is no longer sufficient, whereby the indications for surgery should be set very cautiously. This article provides an overview of the current evidence regarding the prevention and treatment of postoperative stoma complications.
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Affiliation(s)
- Georgi Kalev
- Klinik für Allgemein‑, Viszeral‑, Thorax- und Kinderchirurgie Klinikum Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Deutschland
| | - Christoph Marquardt
- Klinik für Allgemein‑, Viszeral‑, Thorax- und Kinderchirurgie Klinikum Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Deutschland
| | - Thomas Schiedeck
- Klinik für Allgemein‑, Viszeral‑, Thorax- und Kinderchirurgie Klinikum Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Deutschland.
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Bloemendaal ALA. Minimally invasive parastomal hernia repair: laparoscopic vs. robot assisted-a video vignette. Colorectal Dis 2021; 23:1279-1280. [PMID: 33539621 DOI: 10.1111/codi.15564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 01/04/2023]
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Ng Z, Tan P, Tan J, Theophilus M. Long-term parastomal hernia occurrence rate following Stapled Mesh stomA Reinforcement Technique. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2021. [DOI: 10.4103/ijawhs.ijawhs_51_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Clinical and Radiologic Predictors of Parastomal Hernia Development After End Colostomy. AJR Am J Roentgenol 2020; 216:94-103. [PMID: 33119406 DOI: 10.2214/ajr.19.22498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Parastomal hernia (PSH) is a common complication that can occur after end colostomy and may result in considerable morbidity. To select the best candidates for prophylactic measures, knowledge of preoperative PSH predictors is important. This study aimed to determine the value of clinical parameters, preoperative CT-based body metrics, and size of the abdominal wall defect created during end colostomy and measured at postoperative CT for predicting PSH development. MATERIALS AND METHODS. Sixty-five patients who underwent permanent end colostomy with at least 1 year of follow-up were included. On preoperative CT, waist circumference, abdominal wall and psoas muscle indexes, rectus abdominis muscle diameter and diastasis, intra- and extraabdominal fat mass, and presence of other hernias were assessed. On postoperative CT, size of the abdominal wall defect and the presence of PSH were determined. To identify independent predictors of PSH development, univariate analysis with the Kaplan-Meier method and multivariate Cox regression analysis were performed. RESULTS. PSH developed after surgery in 30 patients (46%). Three independent risk factors were identified: chronic obstructive pulmonary disease (COPD) as a comorbidity (hazard ratio [HR], 6.4; 95% CI, 1.9-22.0; p = 0.003), operation time longer than 395 minutes (HR, 3.9; 95% CI, 1.5-10.0; p = 0.005), and maximum aperture diameter of more than 34 mm (HR, 5.2; 95% CI, 2.1-12.7; p < 0.001). PSH developed in all nine patients with a maximum abdominal wall defect diameter of more than 50 mm at the ostomy site. CONCLUSION. COPD, longer operation time, and larger abdominal wall defect at the colostomy site can predict PSH development. Intraoperative creation of an abdominal wall ostomy opening that is more than 34 mm in diameter should be avoided.
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Parestomal hernia repair. Prospective observational study based on the Spanish Registry of Incisional Hernia (EVEREG). Cir Esp 2020. [PMID: 32912623 DOI: 10.1016/j.ciresp.2020.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The results of parastomal hernia (PH) repair based on data from registries are scarce. The objective of this work is to analyze the data collected on PH in the National Registry of Incisional Hernia (EVEREG) and thus evaluate current practices and results in PH repair. METHODS Data from the PH cohort recorded in the period from July 2012 to June 2018 are analyzed. Complications, recurrences and associated factors of the entire PH cohort are analyzed, regardless of the type of stoma they are associated with. Subsequently, the same PH group analysis was performed in relation to a colostomy (larger group). RESULTS 353 PH were studied. Of these, 259 (73%) were HP in the context of a terminal colostomy, 74 (21%) in the context of a terminal ileostomy, and 20 (6%) in the context of a ureteroileostomy (Bricker). The global mean age was 68.7±11.1 years and 135 (38%) patients were female. The open approach and elective surgery were predominant (78% and 92% respectively); 99% were repaired with a non-absorbable synthetic mesh. Global postoperative complications were high (30.6%). As well as, the global recurrence (27.5%) after a mean follow-up of 9.4 months. CONCLUSIONS PH repair is infrequent. PH surgery seems to be associated with a high percentage of postoperative complications and recurrence.
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Nagayoshi K, Nagai S, Hisano K, Mizuuchi Y, Fujita H, Nakamura M. Atrophic change of the abdominal rectus muscle significantly influences the onset of parastomal hernias beyond existing risk factors after end colostomy. Hernia 2020; 25:141-148. [PMID: 32399627 DOI: 10.1007/s10029-020-02192-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/08/2020] [Indexed: 01/26/2023]
Abstract
PURPOSE To investigate optimal risk factors, including atrophy of the abdominal rectus muscle (ARM) for postoperative parastomal hernia (PH) in patients who underwent end colostomy at left lower quadrant. METHODS This single-institution retrospective study included 91 patients who underwent end colostomy between April 2004 and December 2015. The surgical and long-term outcomes among patients with or without PH were collected and compared. RESULTS Altogether, 22 (24.2%) patients had a PH including 15 (68.2%) patients with a simultaneous incisional hernia. Univariate analysis showed that older patients (71 ± 11.9 vs. 64 ± 12.2 years, p = 0.03) and those with higher body mass index (BMI) (23.8 ± 3.8 vs. 20.9 ± 3.3 kg/m2, p < 0.001) had a statistically significant relation with having PHs. Relative atrophy of left abdominal rectus muscle was more frequently found in patients with PH (ratio of left side/right side; caudal level and medial side: 0.66 vs. 0.92, p < 0.01, caudal level and lateral side: 0.95 vs. 1.03, p = 0.04). Multivariate analysis revealed that BMI > 25 kg/m2 [odds ratio (OR) 9.05, 95% confidence interval (CI) 2.06-39.76, p = 0.003] and atrophy of the left lower medial portion of the abdominal rectus muscle (OR 12.85, 95% CI 2.49-66.39, p = 0.002) were independent risk factors for PHs. Neither the laparoscopic approach nor the extraperitoneal route of the colostomy was proven to correlate with a lower rate of PHs. CONCLUSIONS High BMI and atrophic change of ARM were significantly associated with PH development. Surgical techniques for prevention of atrophic change of ARM are expected to reduce the incidence of PHs.
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Affiliation(s)
- K Nagayoshi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - S Nagai
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - K Hisano
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Y Mizuuchi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - H Fujita
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - M Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Prophylactic mesh augmentation using permanent synthetic mesh: outcomes of keyhole and Stapled Ostomy Reinforcement with Retromuscular Mesh techniques. Hernia 2020; 25:631-638. [PMID: 32279169 DOI: 10.1007/s10029-020-02176-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/11/2020] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Parastomal hernias (PSH) are the most common complication of stoma creation and can cause significant morbidity. We present a consecutive series of patients receiving prophylactic mesh augmentation (PMA) for prevention of PSH. METHODS This retrospective review evaluates the efficacy and outcomes of PMA for PSH prevention, and retrospectively compares traditional keyhole PMA (tPMA) (n = 28) with a prophylactic Stapled Ostomy Reinforcement with Retromuscular Mesh technique (pSTORRM) (n = 24). RESULTS PMA was performed in 52 cases between January 2015 and July 2018. All cases used a large-pore, non-coated, mid-weight polypropylene mesh placed in the retrorectus space. With a median follow-up of 16 mos, parastomal hernia was confirmed in 11.5% (n = 6), 5 of whom were symptomatic. patient-reported outcomes (PRO) indicated 6 additional patients with symptoms associated with PSH without clinical or radiographic confirmation. Patients had similar comorbidities and operative characteristics between tPMA and pSTORRM techniques, and no difference in a median follow-up. pSTORRM patients had fewer surgical site infections (8.3 vs 32.1%; p = 0.046) and occurrences (12.5 vs 46.4%; p = 0.015), and lower rate of PSH, though not statistically significant (4.2 vs 17.9%; p = 0.195). CONCLUSION Permanent synthetic mesh placed as a sublay in the retromuscular space is safe and appears to decrease the risk of PSH formation after the creation of permanent stomas. A stapled technique may provide advantages over a traditional keyhole technique.
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Preoperative Progressive Pneumoperitoneum Enables Defect Closure and Laparoscopic Repair of Large Parastomal Hernias. Surg Laparosc Endosc Percutan Tech 2020; 30:123-128. [DOI: 10.1097/sle.0000000000000759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Use of Prophylactic Mesh When Creating a Colostomy Does Not Prevent Parastomal Hernia: A Randomized Controlled Trial-STOMAMESH. Ann Surg 2019; 269:427-431. [PMID: 29064900 PMCID: PMC6369967 DOI: 10.1097/sla.0000000000002542] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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López-Borao J, Madrazo-González Z, Kreisler E, Biondo S. Prevention of parastomal hernia after abdominoperineal excision with a prophylactic three-dimensional funnel mesh. Colorectal Dis 2019; 21:1326-1334. [PMID: 31230409 DOI: 10.1111/codi.14738] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/05/2019] [Indexed: 02/08/2023]
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.
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Affiliation(s)
- J López-Borao
- Department of General and Digestive Surgery, Colorectal Unit, IDIBELL, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Z Madrazo-González
- Department of General and Digestive Surgery, Colorectal Unit, IDIBELL, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - E Kreisler
- Department of General and Digestive Surgery, Colorectal Unit, IDIBELL, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - S Biondo
- Department of General and Digestive Surgery, Colorectal Unit, IDIBELL, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
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Etiological analysis of parastomal hernia by computed tomography examination. Wideochir Inne Tech Maloinwazyjne 2019; 14:387-393. [PMID: 31534568 PMCID: PMC6748055 DOI: 10.5114/wiitm.2019.81409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Parastomal hernia is a common complication after stoma formation. The definitive risk factors for parastomal hernia development remain unclear. Aim This study evaluated the risk factors through computed tomography (CT) scan of patients with parastomal hernia. Material and methods All patients who underwent an operation at our institution from January 2008 to February 2014 were included. We recorded patient-related and operation-related variables, and CT scans were checked. All the variables were analyzed with SPSS 19 to identify the risk factors for parastomal hernia formation. Results Of the 128 patients who underwent colostomy, 49 (38.3%) developed a parastomal hernia during a median follow-up period of 20.1 months (range: 4-84 months). Hernia development was significantly associated with the thickness of subcutaneous fat in the abdominal wall, the location of the stoma, anteroposterior diameter and horizontal diameter of the body. The defect size of the abdominal wall is another risk factor. The larger the defect size of the abdominal wall, the larger is the parastomal stoma (3.79 ±1.51 vs. 2.13 ±0.74 cm horizontally and 4.90 ±2.25 vs. 2.94 ±0.73 cm vertically, p < 0.001). The hernia contents protrude into the hernial sac through the path of the inner side more than the outer side (77.6% vs. 12.2%). Conclusions Our findings in Chinese patients with parastomal hernia match those from Western countries: obesity, the location of the stoma, and the defect size of the abdominal wall are significant risk factors for parastomal hernia formation. The mesenteric region is a weak area, which is a site prone to parastomal hernia, and should be protected.
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Zhao F, Chen F, Yuan X, Liu Y, Chen J. Decreased collagen type III synthesis in skin fibroblasts is associated with parastomal hernia following colostomy. Int J Mol Med 2019; 44:1609-1618. [PMID: 31485641 PMCID: PMC6777680 DOI: 10.3892/ijmm.2019.4329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 06/10/2019] [Indexed: 12/14/2022] Open
Abstract
Parastomal hernia (PH) is a common complication following stoma formation. Abnormal collagen synthesis has been suggested to be involved in PH. The aim of the present study is to explore the effect and mechanism of the collagen synthesis on PH. Data from 157 patients with rectal cancer who received permanent colostomy were retrospectively collected and analyzed to identify the risk factors for PH. Primary culture of skin fibroblasts from patients with or without PH were performed. Cell viability, migration and invasion levels were detected by Cell Counting Kit‑8, and wound healing and Transwell assays, respectively. Reverse transcription quantitative polymerase chain reaction and western blot analysis assays were performed to measure the gene and protein expression levels, respectively. The risk factors of sex, body mass index, aperture size and collagen expression were closely associated with the occurrence of PH. α1 (III) procollagen expression levels were significantly increased in patients with PH, while no marked difference in α1 (I) procollagen mRNA expression levels were observed in patients with or without PH. The viability and motility of fibroblasts from the patients with hernia were suppressed. The expression levels of matrix metalloproteinase (MMP)‑2 and MMP‑9 were decreased while the levels of collagen III and metalloproteinase inhibitor 1 (TIMP‑1) were increased in the fibroblasts from the patients with PH. Silencing TIMP‑1 expression promoted fibroblast migration and invasion and reversed the patterns of MMP‑2, MMP‑9 and collagen III expression in fibroblasts from the patients with PH. Decreased collagen III may inhibit the development of PH, potentially through decreases in TIMP‑1 expression. Therefore, the results from the present study may provide a novel target for PH therapy.
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Affiliation(s)
- Fenglin Zhao
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, P.R. China
| | - Fuqiang Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, P.R. China
| | - Xin Yuan
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, P.R. China
| | - Yiting Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, P.R. China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, P.R. China
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Hardt J, Meerpohl JJ, Metzendorf M, Kienle P, Post S, Herrle F. Lateral pararectal versus transrectal stoma placement for prevention of parastomal herniation. Cochrane Database Syst Rev 2019; 4:CD009487. [PMID: 31016723 PMCID: PMC6479206 DOI: 10.1002/14651858.cd009487.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND A parastomal hernia is defined as an incisional hernia related to a stoma, and belongs to the most common stoma-related complications. Many factors, which are considered to influence the incidence of parastomal herniation, have been investigated. However, it remains unclear whether the enterostomy should be placed through, or lateral to the rectus abdominis muscle, in order to prevent parastomal herniation and other important stoma complications. OBJECTIVES To assess if there is a difference regarding the incidence of parastomal herniation and other stoma complications, such as ileus and stenosis, in lateral pararectal versus transrectal stoma placement in people undergoing elective or emergency abdominal wall enterostomy. SEARCH METHODS For this update, we searched for all types of published and unpublished randomized and non-randomized studies in four medical databases: CENTRAL, PubMed, LILACS, Science Ciation Index, and two trials registers: ICTRP Search Portal and ClinicalTrials.gov to 9 November 2018. We applied no language restrictions. SELECTION CRITERIA Randomized and non-randomized studies comparing lateral pararectal versus transrectal stoma placement with regard to parastomal herniation and other stoma-related complications. DATA COLLECTION AND ANALYSIS Two authors independently assessed study quality and extracted data. We conducted data analyses according to the recommendations of Cochrane and the Cochrane Colorectal Cancer Group (CCCG). We rated quality of evidence according to the GRADE approach. MAIN RESULTS Randomized controlled trials (RCT)Only one RCT met the inclusion criteria. The participants underwent enterostomy placement in the frame of an operation for: rectal cancer (37/60), ulcerative colitis (14/60), familial adenomatous polyposis (7/60), and other (2/60).The results between the lateral pararectal and the transrectal approach groups were inconclusive for the incidence of parastomal herniation (risk ratio (RR) 1.34, 95% confidence interval (CI) 0.40 to 4.48; low-quality evidence); development of ileus or stenosis (RR 2.0, 95% CI 0.19 to 20.9; low-quality evidence); or skin irritation (RR 0.67, 95% CI 0.21 to 2.13; moderate-quality evidence). The results were also inconclusive for the subgroup analysis in which we compared the effect of ileostomy versus colostomy on parastomal herniation. The study did not measured other stoma-related morbidities, or stoma-related mortality, but did measure quality of life, which was not one of our outcomes of interest.Non-randomized studies (NRS)Ten retrospective cohort studies, with a total of 864 participants, met the inclusion criteria. The indications for enterostomy placement and the baseline characteristics of the participants (age, co-morbidities, disease-severity) varied between studies. All included studies reported results for the primary outcome (parastomal herniation) and one study also reported data on one of the secondary outcomes (stomal prolapse).The effects of different surgical approaches on parastomal herniation (RR 1.22, 95% CI 0.84 to 1.75; 10 studies, 864 participants; very low-quality evidence) and the occurrence of stomal prolapse (RR 1.23, 95% CI 0.39 to 3.85; 1 study, 145 participants; very low-quality evidence) are uncertain.None of the included studies measured other stoma-related morbidity or stoma-related mortality. AUTHORS' CONCLUSIONS The present systematic review of randomized and non-randomized studies found inconsistent results between the two compared interventions regarding their potential to prevent parastomal herniation.In conclusion, there is still a lack of high-quality evidence to support the ideal surgical technique of stoma formation. The available moderate-, low-, and very low-quality evidence, does not support or refute the superiority of one of the studied stoma formation techniques over the other.
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Affiliation(s)
- Julia Hardt
- University Medical Centre Mannheim, University of HeidelbergDepartment of SurgeryTheodor‐Kutzer‐Ufer 1‐3MannheimBaden‐WürttembergGermany68167
| | - Joerg J Meerpohl
- Medical Center ‐ University of FreiburgInstitute for Evidence in Medicine (for Cochrane Germany Foundation)Breisacher Straße 153FreiburgGermany79110
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | - Peter Kienle
- University Medical Centre Mannheim, University of HeidelbergDepartment of SurgeryTheodor‐Kutzer‐Ufer 1‐3MannheimBaden‐WürttembergGermany68167
| | - Stefan Post
- University Medical Centre Mannheim, University of HeidelbergDepartment of SurgeryTheodor‐Kutzer‐Ufer 1‐3MannheimBaden‐WürttembergGermany68167
| | - Florian Herrle
- University Medical Centre Mannheim, University of HeidelbergDepartment of SurgeryTheodor‐Kutzer‐Ufer 1‐3MannheimBaden‐WürttembergGermany68167
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Aslam MI, Baloch N, Mann C, Nilsson PJ, Maina P, Chaudhri S, Singh B. Simultaneous stoma reinforcement and perineal reconstruction with biological mesh - A multicentre prospective observational study. Ann Med Surg (Lond) 2018; 38:28-33. [PMID: 30595839 PMCID: PMC6308243 DOI: 10.1016/j.amsu.2018.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/07/2018] [Accepted: 12/13/2018] [Indexed: 12/17/2022] Open
Abstract
Introduction The optimal method for perineal reconstruction after extralevator abdominoperineal excision (elAPE) for low rectal cancer remains controversial. This study aimed to assess whether simultaneous perineal reconstruction and parastomal reinforcement with Strattice™ Reconstructive Tissue Matrix after elAPE could prevent hernia formation. Methods In this prospective, multicentre, observational, non-comparative study of consecutive patients undergoing elAPE for low rectal cancer underwent simultaneous perineal reconstruction and colostomy site reinforcement with Strattice™ mesh. All patients underwent long course chemoradiotherapy prior to surgery and had excision of the coccyx. Patients were assessed for perineal wound healing at 7 day, 1, 3, 6 and 12 months, perineal and parastomal hernia defects on clinical and radiological assessment at 1 year following surgery. Results 19 patients (median age = 67 years, median BMI = 26, M:F = 11:8) were entered the study. 10 (52.6%) patients underwent laparoscopic elAPE. The median length of post-operative stay was 9 days. Complete wound healing was observed for 8(42%) patients at 1 month, 12(63%) at 3 months, and 19(100%) patients at 12 months. Median time for radiological and clinical assessment for hernias was 12 months. No perineal hernia was detected in 17 patients following CT assessment. Dynamic MRI was undertaken in 11 patients at 12 months and all showed no evidence of perineal hernia. 3 (16%) patients had a parastomal hernia detected radiologically. No mesh was removed during the 12 months follow up period. Conclusion Perineal and parastomal reconstruction with biological mesh is a feasible approach for parastomal and perineal hernia prevention after laparoscopic and open elAPE. In this case series, consecutive patients underwent simultaneous perineal reconstruction and colostomy site reinforcement with Strattice™ biological mesh. Simultaneous perineal and parastomal reconstruction with Strattice™ mesh is an effective method of hernia prevention after elAPE. High quality prospective RCTs and national/international collaborative audits are required to compare this technique with others for perineal reconstruction.
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Affiliation(s)
- Muhammad Imran Aslam
- Department of Colorectal Surgery, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicestershire, UK
| | - Naseer Baloch
- Center for Digestive Diseases, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Christopher Mann
- Department of Colorectal Surgery, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicestershire, UK
| | - Per J Nilsson
- Center for Digestive Diseases, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Pierre Maina
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - Sanjay Chaudhri
- Department of Colorectal Surgery, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicestershire, UK
| | - Baljit Singh
- Department of Colorectal Surgery, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicestershire, UK
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Odensten C, Strigård K, Dahlberg M, Gunnarsson U, Näsvall P. Parastomal Hernia Repair; Seldom Performed and Seldom Reported: Results From a Nationwide Survey. Scand J Surg 2018; 109:96-101. [DOI: 10.1177/1457496918818984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Parastomal hernia is common, but there are few population-based studies showing the frequency and outcome of parastomal hernia repair in routine surgical practice. The aim of this study was to identify patients undergoing surgery for parastomal hernia in Sweden and to define risk factors for complication and recurrence. Methods: A broad search of the Swedish National Patient Register 1998–2007 for all possible parastomal hernia repairs using surgical procedure codes. Records of all patients identified were reviewed and those with a definite parastomal hernia procedure were included and analyzed. Results: A total of 71 patients were identified after review of the records. The most common reason for surgery was cosmetic and the most frequent method was relocation of the stoma. Parastomal hernia recurrence rate was 18% during follow-up of a minimum 2 years. Overall, a surgical complication occurred in 32%. Possible risk factors were analyzed including emergency surgery versus planned, gender, age, indication for surgery, and method of surgery; none of which was significant. Conclusion: The frequency of parastomal hernia procedures was much lower than suggested by previous studies. The number of procedures per surgeon was even lower than expected. No specific risk factor could be identified. Parastomal hernia auditing in the form of a nationwide quality register should be mandatory. Centralization should be considered.
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Affiliation(s)
- C. Odensten
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
- Sunderby Research Unit, Umeå University, Umeå, Sweden
- Department of Surgery, Sunderby sjukhus, Luleå, Sweden
| | - K. Strigård
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - M. Dahlberg
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
- Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - U. Gunnarsson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - P. Näsvall
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
- Sunderby Research Unit, Umeå University, Umeå, Sweden
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Ho KK, Economou T, Smart NJ, Daniels IR. Radiological progression of end colostomy trephine diameter and area. BJS Open 2018; 3:112-118. [PMID: 30734022 PMCID: PMC6354228 DOI: 10.1002/bjs5.50109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 09/05/2018] [Indexed: 12/30/2022] Open
Abstract
Background Development of a parastomal hernia is common following abdominoperineal excision (APE). The true incidence is difficult to assess fully owing to differing lengths of follow‐up and techniques used to assess herniation; radiological or clinical. The primary aim of this study was to evaluate colostomy diameter by studying the rate of change of axial and sagittal trephine diameters, trephine area, and the ratio of the trephine over time. A secondary aim was to investigate variation in trephine area and variables affecting parasternal hernia over time. Methods Serial CT scans performed after APE from January 2006 to December 2014 were reviewed. Variables analysed included age, sex, trephine position relative to rectus abdominis muscle (RAM), type of incision for stoma creation, and axial and sagittal trephine diameters measured on follow‐up CT. A Bayesian hierarchical modelling framework was used to examine the relationship of trephine diameters, area and ratio over time. Results Of 112 patients undergoing APE, 103 were eligible for analysis; this included 91 colostomies (88·3 per cent) through the RAM and 12 (11·7 per cent) lateral to the RAM. Median age of the patients was 68 years. Sixty patients (58·3 per cent) had a circular and 43 (41·7 per cent) a cruciate incision for stoma creation. The sagittal trephine diameter increased by 0·22 (95 per cent credible interval 0·12 to 0·32) mm/month for both sexes. Women reported a significant increase in axial trephine diameters; the male : female ratio difference was −0·17 (−0·30 to −0·03) mm/month and for trephine areas −6·21 (0·96 to 13·7) mm2/month. Patient age, colostomy trephine location and shape of incision were not statistically significant variables for parasternal hernia. Conclusion Female sex was the only variable affecting the rate of increase in axial trephine diameter and trephine area over time.
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Affiliation(s)
- K K Ho
- University of Exeter Medical School Exeter UK
| | - T Economou
- Department of Mathematics University of Exeter Exeter UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter Hospital Exeter UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter Hospital Exeter UK
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Maciel V, Mata W, Arevalo G, Zeichen M, Glass T. Robotic retro-rectus repair of parastomal hernias. J Robot Surg 2018; 13:483-489. [DOI: 10.1007/s11701-018-0874-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 09/17/2018] [Indexed: 12/27/2022]
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Jones HG, Rees M, Aboumarzouk OM, Brown J, Cragg J, Billings P, Carter B, Chandran P. Prosthetic mesh placement for the prevention of parastomal herniation. Cochrane Database Syst Rev 2018; 7:CD008905. [PMID: 30027652 PMCID: PMC6513624 DOI: 10.1002/14651858.cd008905.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Parastomal herniation is a common problem following formation of a stoma after both elective and emergency abdominal surgery. Symptomatic hernias give rise to a significant amount of patient morbidity, and in some cases mortality, and therefore may necessitate surgical treatment to repair the hernial defect and/or re-site the stoma. In an effort to reduce this complication, recent research has focused on the application of a synthetic or biological mesh, inserted during stoma formation to help strengthen the abdominal wall. OBJECTIVES The primary objective was to evaluate whether mesh reinforcement during stoma formation reduces the incidence of parastomal herniation. Secondary objectives included the safety or potential harms or both of mesh placement in terms of stoma-related infections, mesh-related infections, patient-reported symptoms/postoperative quality of life, and re-hospitalisation/ambulatory visits. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library 2018, Issue 1), Ovid MEDLINE (1970 to 11 January 2018), Ovid Embase (1974 to 11 January 2018), and Science Citation Index Expanded (1970 to 11 January 2018). To identify ongoing studies, we also searched the metaRegister of Controlled Trials (mRCT) on 11 January 2018. SELECTION CRITERIA We considered for inclusion all randomised controlled trials (RCTs) of prosthetic mesh (including biological/composite mesh) placement versus a control group (no mesh) for the prevention of parastomal hernia. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the studies identified by the literature search for potential eligibility. We obtained the full articles for all studies that potentially met the inclusion criteria and included all those that met the criteria. Any differences in opinion between review authors were resolved by consensus. We pooled study data into a meta-analysis. We assessed heterogeneity by calculation of I2 and expressed results for each variable as a risk ratio (RR) with corresponding 95% confidence intervals (CI). We expressed continous outcomes as mean difference (MD) with corresponding 95% CIs. MAIN RESULTS We included 10 RCTs involving a total of 844 participants. The primary outcome was overall incidence of parastomal herniation. Secondary outcomes were rate of reoperation at 12 months, operative time, postoperative length of hospital stay, stoma-related infections, mesh-related infections, quality of life, and rehospitalisation rate. We judged the risk of bias across all domains to be low in six trials. We judged four trials to have an overall high risk of bias.The overall incidence of parastomal hernia was less in participants receiving a prophylactic mesh compared to those who had a standard ostomy formation (RR 0.53, 95% CI 0.43 to 0.66; 10 studies, 771 participants; I2 = 69%; low-quality evidence). In absolute numbers, the incidence of parastomal hernia was 22 per 100 participants (18 to 27) receiving prophylactic mesh compared to 41 per 100 participants having a standard ostomy formation.There were no differences in the need for reoperation (RR 0.90, 95% CI 0.50 to 1.64; 9 studies, 757 participants; I2 = 0%; low-quality evidence); operative time (MD -6.50 (min), 95% CI -18.24 to 5.24; 6 studies, 671 participants; low-quality evidence); postoperative length of hospital stay (MD -0.95 (days), 95% CI -2.03 to 0.70; 4 studies, 500 participants; moderate-quality evidence); or stoma-related infections (RR 0.89, 95% CI 0.32 to 2.50; 6 studies, 472 participants; I2 = 0%; low-quality evidence) between the two groups.We were unable to analyse mesh-related infections, quality of life, and rehospitalisation rate due to sparse data or because the outcome was not reported in the included studies. AUTHORS' CONCLUSIONS This Cochrane Review included 10 RCTs with a total of 844 participants. The review demonstrated a reduction in the incidence of parastomal hernia in people who had a prophylactic synthetic mesh placed at the time of the index operation compared to a standard ostomy formation. However, our confidence in this estimate is low due to the presence of a large degree of clinical heterogeneity, as well as high variability in follow-up duration and technique of parastomal herniation detection. We found the rate of stoma-related infection to be similar in both the intervention and control groups.
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Affiliation(s)
- Huw G Jones
- Singleton Hospital, ABM University NHS TrustDepartment of Colorectal SurgerySketty LaneSwanseaUKSA2 8QA
| | - Michael Rees
- Wrexham Maelor Hospital, BCUHBDepartment of General SurgeryCroesnewydd RdWrexhamUKLL13 7TD
| | - Omar M Aboumarzouk
- NHS Greater Glasgow and ClydeDepartment of UrologyQueen Elizabeth University HospitalGlasgowScotlandUK
| | - Joshua Brown
- Royal Gwent HospitalDepartment of General SurgeryNewportWalesUK
| | - James Cragg
- Wrexham Maelor Hospital, BCUHBDepartment of General SurgeryCroesnewydd RdWrexhamUKLL13 7TD
| | - Peter Billings
- Wrexham Maelor Hospital, BCUHBDepartment of General SurgeryCroesnewydd RdWrexhamUKLL13 7TD
| | - Ben Carter
- King's College London; Institute of Psychiatry, Psychology & NeuroscienceBiostatistics and Health InformaticsDenmark HillLondonUK
| | - Palanichamy Chandran
- Wrexham Maelor Hospital, BCUHBDepartment of General SurgeryCroesnewydd RdWrexhamUKLL13 7TD
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Prevention and treatment of parastomal hernia: a position statement on behalf of the Association of Coloproctology of Great Britain and Ireland. Colorectal Dis 2018; 20 Suppl 2:5-19. [PMID: 30176120 DOI: 10.1111/codi.14249] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/30/2018] [Indexed: 02/08/2023]
Abstract
AIM The Association of Coloproctology of Great Britain and Ireland (ACPGBI) Delphi process identified prevention and treatment of parastomal hernia (PSH) as the second highest priority non-cancer related colorectal pathology. This position statement aims to summarize the current evidence base. METHODS Four broad themes were identified (prevention, diagnosis/classification, management and operative repair). Guidelines are based on evidence from an extensive literature review using organized searches on the PubMed, MEDLINE, Embase and Cochrane databases. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adhered to for classifying the quality of evidence and reporting the strength of recommendations. RESULTS The suture repair of PSH other than for patients in extremis is not recommended. Synthetic non-absorbable mesh can be used safely in the short term in the construction of colostomies post rectal surgery, but longer-term follow-up is needed. Other broad recommendations are made around access to stoma care nurses, prevention classification and management. CONCLUSION There is a lack of high quality evidence for many domains in the prevention and treatment of PSH but the results of several studies are awaited. WHAT DOES THIS PAPER ADD TO THE LITERATURE?: Parastomal hernias are a common and debilitating condition following stoma formation. This position statement from ACPGBI details the current evidence base and ongoing research for the prevention, diagnosis and management of parastomal hernias.
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Rhemtulla IA, Messa CA, Enriquez FA, Hope WW, Fischer JP. Role of Prophylactic Mesh Placement for Laparotomy and Stoma Creation. Surg Clin North Am 2018; 98:471-481. [PMID: 29754617 DOI: 10.1016/j.suc.2018.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Incisional and parastomal hernias are a cause of significant morbidity and have a substantial effect on quality of life and economic costs for patients and hospital systems. Although many aspects of abdominal hernias are understood, prevention is a feature that is still being realized. This article reviews the current literature and determines the utility of prophylactic mesh placement in prevention of incisional and parastomal hernias.
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Affiliation(s)
- Irfan A Rhemtulla
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, South Pavilion - 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Charles A Messa
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, South Pavilion - 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Fabiola A Enriquez
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, South Pavilion - 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - William W Hope
- Department of Surgery, New Hanover Regional Medical Center, 1725 New Hanover Medical Park Drive, Wilmington, NC 28403, USA
| | - John P Fischer
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, South Pavilion - 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Andersen RM, Klausen TW, Danielsen AK, Vinther A, Gögenur I, Thomsen T. Incidence and risk factors for parastomal bulging in patients with ileostomy or colostomy: a register-based study using data from the Danish Stoma Database Capital Region. Colorectal Dis 2018; 20:331-340. [PMID: 28980388 DOI: 10.1111/codi.13907] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/04/2017] [Indexed: 02/08/2023]
Abstract
AIM The aim was to investigate the incidence and risk factors for parastomal bulging, a clinically important complication, in patients with an ileostomy or colostomy. METHOD The Danish Stoma Database Capital Region prospectively collects data on patients with a stoma up to a year after surgery. Stoma care nurses clinically assessed the main outcome, parastomal bulging. We linked data from the Stoma Database to data from the Danish Anaesthesia Database. Cumulative incidence of parastomal bulging over the first year was calculated with death and stoma reversal as competing risks. Risk factors were investigated using an exploratory approach. RESULTS In a study population of 5019, the cumulative incidence (with competing risks) of parastomal bulging was 36.2% at 400 days after surgery. Age, colostomy, male gender, alcohol consumption and laparoscopy were associated with an increased risk of parastomal bulging. Compared with cancer, inflammatory bowel disease was associated with a lower risk of parastomal bulging, and diverticulitis was associated with a higher risk. Peristomal mesh and stomas placed through a separate incision were associated with a reduction in risk. There was neither increased nor decreased risk of parastomal bulging for body mass index, American Society of Anesthesiologists score, smoking status, emergency surgery and preoperative stoma site marking. CONCLUSION Parastomal bulging is a common complication affecting one in three patients within 1 year of surgery. Along with previous findings, there is now considerable evidence for age and colostomy as being risk factors for parastomal bulging.
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Affiliation(s)
- R M Andersen
- Abdominal Centre, Rigshospitalet, Copenhagen.,Department of Gastroenterology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - T W Klausen
- Department of Hematology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - A K Danielsen
- Department of Gastroenterology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - A Vinther
- Department of Rehabilitation, Herlev and Gentofte Hospital, Herlev, Denmark
| | - I Gögenur
- Department of Surgical Gastroenterology, Zealand University Hospital, Koege, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - T Thomsen
- Abdominal Centre, Rigshospitalet, Copenhagen.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Osborne W, North J, Williams J. Using a risk assessment tool for parastomal hernia prevention. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2018. [PMID: 29517333 DOI: 10.12968/bjon.2018.27.5.s15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
All patients with a stoma are at risk of developing some degree of parastomal herniation given enough follow-up time. Based on current evidence, preventive measures are strongly advised to minimise the incidence of a parastomal hernia forming. This article explores the evidence for consistency in care and management of parastomal hernia, focusing on the development of a risk assessment tool, taking into consideration the patient's and the nurse's perspective.
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Affiliation(s)
- Wendy Osborne
- Clinical Nurse Specialist Stoma Care and Clinical Lead, Coloplast Ltd
| | - Jacqui North
- Clinical Nurse Specialist Stoma Care, Hollister Ltd
| | - Julia Williams
- Senior Lecturer (Adult Nursing), PG Dip Programme Lead, Bucks New University, Uxbridge
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Affiliation(s)
- Jacqui North
- Clinical Nurse Specialist Stoma Care, Hollister Ltd
| | - Wendy Osborne
- Educational Officer, ASCN UK, and Clinical Lead Ostomy Division, Coloplast Ltd
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Fitzgerald MJ, Ullrich S, Singh K, Misholy O, Kingham P, Brady MS. Parastomal hernia repair using the "top hat" technique - An initial experience in 30 patients at Memorial Sloan Kettering Cancer Center. Am J Surg 2018; 216:465-470. [PMID: 29499860 DOI: 10.1016/j.amjsurg.2018.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/02/2018] [Accepted: 02/14/2018] [Indexed: 11/19/2022]
Abstract
Parastomal hernia repair remains a significant surgical challenge. Recurrence after standard "keyhole" or primary suture repair is common. We adopted and modified a new technique using a construct shaped like an inverted top hat. We review our experience over the last six years in the first 30 patients (31 consecutive procedures). Of these 31 procedures, six (19%) resulted in a parastomal hernia recurrence with a median follow-up of 31 months (range 0.5-80). Four of the recurrences occurred in our initial experience, when we constructed the top hat of xenograft alone. When the technique was modified, using a synthetic composite mesh for the underlay portion of the hat, there were only two subsequent recurrences in 16 patients (13%) with a median follow-up of 22 months. One of these "recurrences" was secondary to infection of the top hat construct, which had to be removed. This initial success in preventing recurrence of parastomal hernia is probably due to the design of the construct, for it occludes the vulnerable stoma/fascial angle, through which most parastomal hernia recurrences occur.
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Affiliation(s)
- Michael J Fitzgerald
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
| | - Sarah Ullrich
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
| | - Kumar Singh
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
| | - Oren Misholy
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
| | - Peter Kingham
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
| | - Mary S Brady
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
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Abstract
PURPOSE OF REVIEW The review summarizes our current understanding of how obesity impacts diagnostic studies and therapies used in inflammatory bowel disease (IBD) as well as the safety and efficacy of medical and surgical weight loss therapies in the obese IBD patient. RECENT FINDINGS Many of the diagnostic tools we rely on in the identification and monitoring of IBD can be altered by obesity. Obesity is associated with increased acute phase proteins and fecal calprotectin. It can be more difficult to obtain and interpret cross sectional imaging of obese patients. Recent studies have also shown that common therapies used to treat IBD may be less effective in the obese population and may impact comorbid disease. Our understanding of how best to measure obesity is evolving. In addition to BMI, studies now include measures of visceral adiposity and subcutaneous to visceral adiposity ratios. An emerging area of interest is the safety and efficacy of obesity treatment including bariatric surgery in patients with IBD. A remaining question is how weight loss may alter the course of IBD. SUMMARY The proportion of obese IBD patients is on the rise. Caring for this population requires a better understanding of how obesity impacts diagnostic testing and therapeutic strategies. The approach to weight loss in this population is complex and future studies are needed to determine the safety of medical or surgical weight loss and its impact on the course of disease.
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Parastomal hernia - current knowledge and treatment. Wideochir Inne Tech Maloinwazyjne 2018; 13:1-8. [PMID: 29643952 PMCID: PMC5890847 DOI: 10.5114/wiitm.2018.72685] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/17/2017] [Indexed: 11/24/2022] Open
Abstract
Intestinal stoma creation is one of the most common surgical procedures. The most common long-term complication following stoma creation is parastomal hernia, which according to some authors is practically unavoidable. Statistical differences of its occurrence are mainly due to patient observation time and evaluation criteria. Consequently, primary prevention methods such as placement of prosthetic mesh and newly developed minimally invasive methods of stoma creation are used. It seems that in the light of evidence-based medicine, the best way to treat parastomal hernia is the one that the surgeon undertaking therapy is the most experienced in and is suited to the individuality of each patient, his condition and comorbidities. As a general rule, reinforcing the abdominal wall with a prosthetic mesh is the treatment of choice, with a low rate of complications and relapses over a long period of time. The current trend is to use lightweight, large pore meshes.
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Majumder A, Orenstein SB, Miller HJ, Novitsky YW. Stapled Transabdominal Ostomy Reinforcement with retromuscular mesh (STORRM): Technical details and early outcomes of a novel approach for retromuscular repair of parastomal hernias. Am J Surg 2018; 215:82-87. [DOI: 10.1016/j.amjsurg.2017.07.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 07/02/2017] [Accepted: 07/16/2017] [Indexed: 02/07/2023]
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