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Badia-Closa J, Comas-Isus J, Centeno-Alvarez A, Arrayás-Valverde A, Subirana-Magdaleno H, Sobrerroca-Porras L, Mullerat-Prat JM, Castellví-Valls J. Parastomal hernia prevention with an intraperitoneal prophylactic 3D-funnel mesh: review of the technique and middle-term results. Hernia 2024; 28:1129-1135. [PMID: 38485812 DOI: 10.1007/s10029-024-02989-y] [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: 12/13/2023] [Accepted: 02/08/2024] [Indexed: 08/03/2024]
Abstract
PURPOSE Parastomal hernia (PH) stands out as a prevalent complication following end colostomies, significantly affecting patients' quality of life. Various surgical strategies, predominantly involving prophylactic mesh deployment, have been explored with variable outcomes. This study details our experience and mid-term outcomes utilizing a funnel-shaped mesh. METHODS A single-center, prospective, non-randomized, observational study examined consecutive patients undergoing colorectal surgery with end colostomy, incorporating a 3D-funnel mesh from January 2019 to December 2021 (PM group). A historical cohort of patients with end colostomy without prophylactic mesh served as the comparison (C group). Postoperative morbidity within 30 days was documented, and clinical examinations and radiological tests were employed for parastomal hernia diagnosis during follow-up. RESULTS Seventy-two patients participated, with thirty-four in the PM group and thirty-eight in the C group. The PM group experienced 16 postoperative complications, unrelated to the mesh, while the C group recorded 20 complications (p = 0.672). Median follow-up was 22.06 months for the PM group and 63.18 months for the C group. The PM group exhibited a lower parastomal hernia incidence during follow-up (8.8%) compared to the C group(68.4%) (p < 0.001). CONCLUSION Prophylactic use of a 3D-funnel mesh appears effective in reducing parastomal hernia incidence in the short and mid-term, without an associated increase in postoperative morbidity.
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Affiliation(s)
- Jesus Badia-Closa
- Colorectal Surgery Unit, General and Digestive Surgery Deparment, Hospital Universitari Moisès Broggi. Sant Joan Despí, Barcelona, Spain.
| | - Jaume Comas-Isus
- Abdominal Wall Surgery Unit, General and Digestive Surgery Deparment, Hospital Universitari Moisès Broggi. Sant Joan Despí, Barcelona, Spain
| | - Ana Centeno-Alvarez
- Colorectal Surgery Unit, General and Digestive Surgery Deparment, Hospital Universitari Moisès Broggi. Sant Joan Despí, Barcelona, Spain
| | - Angela Arrayás-Valverde
- General and Digestive Surgery Deparment, Hospital Universitari Moisès Broggi. Sant Joan Despí, Barcelona, Spain
| | - Helena Subirana-Magdaleno
- Abdominal Wall Surgery Unit, General and Digestive Surgery Deparment, Hospital Universitari Moisès Broggi. Sant Joan Despí, Barcelona, Spain
| | - Laura Sobrerroca-Porras
- Colorectal Surgery Unit, General and Digestive Surgery Deparment, Hospital Universitari Moisès Broggi. Sant Joan Despí, Barcelona, Spain
| | - Jose Maria Mullerat-Prat
- Colorectal Surgery Unit, General and Digestive Surgery Deparment, Hospital Universitari Moisès Broggi. Sant Joan Despí, Barcelona, Spain
| | - Jordi Castellví-Valls
- Colorectal Surgery Unit, General and Digestive Surgery Deparment, Hospital Universitari Moisès Broggi. Sant Joan Despí, Barcelona, Spain
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Calcerrada Alises E, Antón Rodríguez C, Medina Pedrique M, Berrevoet F, Cuccurullo D, López Cano M, Stabilini C, Garcia-Urena MA. Systematic review and meta-analysis of the incidence of incisional hernia in urological surgery. Langenbecks Arch Surg 2024; 409:166. [PMID: 38805110 DOI: 10.1007/s00423-024-03354-4] [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: 01/09/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To evaluate the incidence of incisional hernia in patients undergoing direct access to the abdominal cavity in urological surgery. METHODS We conducted a systematic review in Pubmed, Embase, and Cochrane Central from 1980 to the present according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Eighty-four studies were selected for inclusion in this analysis, and meta-analysis and meta-regression were performed. RESULTS The total incidence in the 84 studies was 4.8% (95% CI 3.7% - 6.2%) I2 93.84%. Depending on the type of incision, it was higher in the open medial approach: 7.1% (95% CI 4.3%-11.8%) I2 92.45% and lower in laparoscopic surgery: 1.9% (95% CI 1%-3.4%) I2 71, 85% According to access, it was lower in retroperitoneal: 0.9% (95% CI 0.2%-4.8%) I2 76.96% and off-midline: 4.7% (95% CI 3.5%-6.4%) I2 91.59%. Regarding the location of the hernia, parastomal hernias were more frequent: 15.1% (95% CI 9.6% - 23%) I2 77.39%. Meta-regression shows a significant effect in reducing the proportion of hernias in open lateral, laparoscopic and hand-assisted compared to medial open access. CONCLUSION The present review finds the access through the midline and stomas as the ones with the highest incidence of incisional hernia. The use of the lateral approach or minimally invasive techniques is preferable. More prospective studies are warranted to obtain the real incidence of incisional hernias and evaluate the role of better techniques to close the abdomen.
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Affiliation(s)
- Enrique Calcerrada Alises
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Sureste, Madrid, Spain.
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain.
| | - Cristina Antón Rodríguez
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain
| | - Manuel Medina Pedrique
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Madrid, Spain
| | - Frederick Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Diego Cuccurullo
- Department of Surgery, Ospedale Monaldi-Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Manuel López Cano
- Abdominal Wall Surgery Unit, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
- Vall d'Hebron Research Institute General and Gastrointestinal Surgery Research Group, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Cesare Stabilini
- Department of Surgery (DiSC), University of Genoa, IRCCS Policlinico San Martino, Genoa, Italy
| | - Miguel Angel Garcia-Urena
- Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Madrid, Spain
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Madrid, Spain
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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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Stabilini C, Muysoms FE, Tzanis AA, Rossi L, Koutsiouroumpa O, Mavridis D, Adamina M, Bracale U, Brandsma HT, Breukink SO, López Cano M, Cole S, Doré S, Jensen KK, Krogsgaard M, Smart NJ, Odensten C, Tielemans C, Antoniou SA. EHS Rapid Guideline: Evidence-Informed European Recommendations on Parastomal Hernia Prevention-With ESCP and EAES Participation. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:11549. [PMID: 38312414 PMCID: PMC10831651 DOI: 10.3389/jaws.2023.11549] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/11/2023] [Indexed: 02/06/2024]
Abstract
Background: Growing evidence on the use of mesh as a prophylactic measure to prevent parastomal hernia and advances in guideline development methods prompted an update of a previous guideline on parastomal hernia prevention. Objective: To develop evidence-based, trustworthy recommendations, informed by an interdisciplinary panel of stakeholders. Methods: We updated a previous systematic review on the use of a prophylactic mesh for end colostomy, and we synthesized evidence using pairwise meta-analysis. A European panel of surgeons, stoma care nurses, and patients developed an evidence-to-decision framework in line with GRADE and Guidelines International Network standards, moderated by a certified guideline methodologist. The framework considered benefits and harms, the certainty of the evidence, patients' preferences and values, cost and resources considerations, acceptability, equity and feasibility. Results: The certainty of the evidence was moderate for parastomal hernia and low for major morbidity, surgery for parastomal hernia, and quality of life. There was unanimous consensus among panel members for a conditional recommendation for the use of a prophylactic mesh in patients with an end colostomy and fair life expectancy, and a strong recommendation for the use of a prophylactic mesh in patients at high risk to develop a parastomal hernia. Conclusion: This rapid guideline provides evidence-informed, interdisciplinary recommendations on the use of prophylactic mesh in patients with an end colostomy. Further, it identifies research gaps, and discusses implications for stakeholders, including overcoming barriers to implementation and specific considerations regarding validity.
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Affiliation(s)
| | - Filip E. Muysoms
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
| | | | - Lisa Rossi
- Department of Surgery, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Ourania Koutsiouroumpa
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Dimitris Mavridis
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Michel Adamina
- Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland
| | - Umberto Bracale
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | | | - Manuel López Cano
- Abdominal Wall Surgery Unit, Val d’ Hebrón University Hospital, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | | | | | | | - Neil J. Smart
- Department of General Surgery, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Christoffer Odensten
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University Educational Unit at Sunderby Hospital, Sunderby, Sweden
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Köhler F, Meir M. [67/f-Bulging around the stoma : Preparation for the medical specialist examination: part 35]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:35-38. [PMID: 37389639 DOI: 10.1007/s00104-023-01915-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 07/01/2023]
Affiliation(s)
- F Köhler
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland.
| | - Michael Meir
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland
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