1
|
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.
Collapse
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
| |
Collapse
|
2
|
Bellido-Luque J, Scammon-Duran A, Sanchez-Matamoros Martin I, Nogales-Muñoz AL, Morales-Conde S. Easy and reproducible minimally invasive colostomy ischaemia and parastomal hernia prevention after abdominoperineal resection - A video vignette. Colorectal Dis 2024; 26:1087-1088. [PMID: 38503719 DOI: 10.1111/codi.16954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/25/2024] [Accepted: 02/03/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Juan Bellido-Luque
- Hospital Universitario Virgen Macarena, University of Seville, Sevilla, Spain
| | | | | | | | | |
Collapse
|
3
|
Bellido‐Luque J, Scammon‐Duran A, Sanchez‐Matamoros Martin I, Nogales‐Muñoz AL, Morales‐Conde S. Easy and reproducible minimally invasive colostomy ischaemia and parastomal hernia prevention after abdominoperineal resection – A video vignette. Colorectal Dis 2024; 26:1087-1088. [DOI: https:/doi.org/10.1111/codi.16954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/03/2024] [Indexed: 06/11/2024]
Affiliation(s)
- Juan Bellido‐Luque
- Hospital Universitario Virgen Macarena University of Seville Sevilla Spain
| | | | | | | | | |
Collapse
|
4
|
Liu L, Zheng L, Zhang M, Hu J, Lu Y, Wang D. Incidence and risk factors for parastomal hernia with a permanent colostomy. J Surg Oncol 2022; 126:535-543. [PMID: 35608292 DOI: 10.1002/jso.26919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/30/2022] [Indexed: 12/20/2022]
Abstract
AIM This study aims to explore the incidence and risk factors for permanent colostomy complicated with a parastomal hernia (PSH) after rectal cancer resection. METHODS This was a retrospective study of gastrointestinal surgery performed from January 2013 to December 2017 in patients with colorectal cancer treated at the Affiliated Hospital of Qingdao University. The relevant clinical variables of the patient were analyzed. Kaplan-Meier, univariate, and Cox multivariate analyses were used to evaluate the influencing factors and morbidity of PSH. RESULTS Among the 211 patients, 65 developed PSH. The cumulative incidence reached 33.5% at 62 months. In the multivariate Cox survival analysis, the results showed that being a woman, aged ≥65 years, having a body mass index (BMI) ≥ 25 kg/m2 , diabetes, and Clavien-Dindo Grade III and IV complications were risk factors for the occurrence of PSH. CONCLUSION In our study, the incidence of PSH increased annually and reached a maximum of 33.5% after 62 months. Among the patient-related factors, female sex, age ≥65 years, BMI ≥ 25 kg/m2 , diabetes, and postoperative Clavien-Dindo Grade III and IV complications were significantly associated with the development of PSH. Therefore, intervention measures to prevent patients with this risk factor are advisable.
Collapse
Affiliation(s)
- Lei Liu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Longbo Zheng
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Maoshen Zhang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jilin Hu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yun Lu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dongsheng Wang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| |
Collapse
|
5
|
Anandan M, Roberts-Thomson J, Lynch C. Gastric outlet obstruction due to a parastomal hernia: case report of a robotic-assisted laparoscopic surgery and literature review. ANZ J Surg 2020; 90:2135-2136. [PMID: 32100386 DOI: 10.1111/ans.15789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Manoj Anandan
- Department of Surgery, North West Regional Hospital, Burnie, Tasmania, Australia.,Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia
| | - James Roberts-Thomson
- Department of Surgery, North West Regional Hospital, Burnie, Tasmania, Australia.,Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia
| | - Craig Lynch
- Lower Gastrointestinal Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Cancer Specialists, Melbourne, Victoria, Australia.,General Surgery and Gastroenterology, Epworth Healthcare, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
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.
Collapse
|
7
|
Valdés-Hernández J, Díaz Milanés JA, Capitán Morales LC, del Río la Fuente FJ, Torres Arcos C, Cañete Gómez J, Oliva Mompeán F, Padillo Ruiz J. Profilaxis de la hernia paraestomal mediante malla de polipropileno en espacio preperitoneal. Cir Esp 2015; 93:455-9. [DOI: 10.1016/j.ciresp.2014.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/14/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
|
8
|
Abstract
Parastomal hernia is the most common late stomal complication. Its appearance is usually asymptomatic. We report a parastomal hernia containing stomach. A 69-year-old patient with end colostomy arrived at the emergency room presenting with abdominal pain associated with vomiting and functioning stoma. She had a distended and painful abdomen without signs of peritoneal irritation and pericolostomic eventration in the left iliac fossa. X-ray visualized gastric fornix dilatation without dilated intestine bowels, and computed tomography showed parastomal incarcerated gastric herniation. Gastrografin (Bayer Australia Limited, New South Wales, Australia) was administered, showing no passage to duodenum. She underwent surgery, with stomal transposition and placement of onlay polypropylene mesh around the new stoma. Parastomal hernias are a frequent late complication of colostomy. Only four gastric parastomal hernia cases are reported in the literature. Three of these four cases required surgery. The placement of prosthetic mesh in the moment of stoma elaboration should be considered as a potential preventive measure.
Collapse
|
9
|
Mizrahi H, Bhattacharya P, Parker MC. Laparoscopic slit mesh repair of parastomal hernia using a designated mesh: long-term results. Surg Endosc 2011; 26:267-70. [PMID: 21858569 DOI: 10.1007/s00464-011-1866-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 07/25/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Parastomal hernia (PH) is a frequent complication of colorectal surgery, which incidence reaches 55% of all stoma formation. Currently, there is no definitive strategy for its repair. This study was designed to assess the outcome in patients who underwent laparoscopic PH repair using a slit mesh/keyhole technique. METHODS We undertook a retrospective case review of all patients who underwent laparoscopic PH repair with a designed slit mesh/keyhole between 2005 and 2010. Three ports were placed opposite the stoma site, and careful adhesiolysis and hernia content reduction were performed. The parastomal fascial defect was measured and covered with a designated mesh. Fixation of the mesh was achieved with concentric tacks and transcutaneous Prolene suture. Recurrence was diagnosed after examination of patients by two surgeons or by imaging demonstrating an indolent hernia. RESULTS Twenty-nine laparoscopic PH mesh repairs were performed with an average age of 63.5 (range 42-81, median 64) years to treat paracolostomy hernia in 18 of 29 cases (62.1%), para-ileostomy hernia in 10 of 29 cases (34.5%), and for an ileal conduit site hernia in 1 of 29 cases (3.4%). The average operative time was 179 (range, 80-300; median, 180) min. Two operations (6.9%) were converted to an open approach. Early postoperative complications were documented in four patients (13.8%), including one elderly patient with severe comorbidities who died from postoperative sepsis (mortality rate, 3.4%). Only one late complication was recorded (3.4%). The average hospital stay was 4.7 (range, 1-19; median, 3) days. Average follow-up time was 28 (range, 12-53; median, 30) months. Recurrence of the hernia was found in 13 of 28 patients (46.4%). CONCLUSIONS Laparoscopic slit mesh/keyhole repair is feasible, although it is a complex surgery reflected by extended operative time. The high recurrence rate suggests that technical improvement of the method is essential.
Collapse
Affiliation(s)
- H Mizrahi
- Department of Colorectal Surgery, Darent Valley Hospital, Dartford, UK
| | | | | |
Collapse
|
10
|
Laparoscopic slit mesh repair of parastomal hernia using a designated mesh: long-term results. Surg Endosc 2011. [PMID: 21858569 DOI: 10.1007//s00464-011-1866-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Parastomal hernia (PH) is a frequent complication of colorectal surgery, which incidence reaches 55% of all stoma formation. Currently, there is no definitive strategy for its repair. This study was designed to assess the outcome in patients who underwent laparoscopic PH repair using a slit mesh/keyhole technique. METHODS We undertook a retrospective case review of all patients who underwent laparoscopic PH repair with a designed slit mesh/keyhole between 2005 and 2010. Three ports were placed opposite the stoma site, and careful adhesiolysis and hernia content reduction were performed. The parastomal fascial defect was measured and covered with a designated mesh. Fixation of the mesh was achieved with concentric tacks and transcutaneous Prolene suture. Recurrence was diagnosed after examination of patients by two surgeons or by imaging demonstrating an indolent hernia. RESULTS Twenty-nine laparoscopic PH mesh repairs were performed with an average age of 63.5 (range 42-81, median 64) years to treat paracolostomy hernia in 18 of 29 cases (62.1%), para-ileostomy hernia in 10 of 29 cases (34.5%), and for an ileal conduit site hernia in 1 of 29 cases (3.4%). The average operative time was 179 (range, 80-300; median, 180) min. Two operations (6.9%) were converted to an open approach. Early postoperative complications were documented in four patients (13.8%), including one elderly patient with severe comorbidities who died from postoperative sepsis (mortality rate, 3.4%). Only one late complication was recorded (3.4%). The average hospital stay was 4.7 (range, 1-19; median, 3) days. Average follow-up time was 28 (range, 12-53; median, 30) months. Recurrence of the hernia was found in 13 of 28 patients (46.4%). CONCLUSIONS Laparoscopic slit mesh/keyhole repair is feasible, although it is a complex surgery reflected by extended operative time. The high recurrence rate suggests that technical improvement of the method is essential.
Collapse
|
11
|
Abstract
BACKGROUND Parastomal hernia is a major complication after stoma placement. Surgical procedures for repairing parastomal hernia are difficult and their failure rate is high. The use of a mesh implanted at the primary operation has shown promising results. Therefore, we performed a systematic review of the literature to evaluate the results of the placement of mesh at the time of stoma formation with the aim of preventing parastomal hernia. METHODS The Medline, Embase, and Cochrane Library databases were searched using the keywords "parastomal or paracolostomy hernia." Data regarding the incidence of hernia, the operative parameters, including mesh placement and types, and complications, including infection, stoma necrosis, and stenosis, were used and analyzed to evaluate the use of prophylactic mesh at the time of stoma formation. RESULTS Three randomized controlled trials, three prospective observational series, and one retrospective study were selected and summarized. During the follow-up period (observation time of 1-83 months), parastomal hernia was present in 32/58 patients (55%) who did not have mesh placement and in 14/179 patients (7.82%) in whom mesh was used. Meta-analysis of three randomized controlled trials showed that prophylactic use of the mesh significantly diminished the incidence of parastomal hernia (p < 0.0001). Postoperative morbidity levels were similar whether the mesh was placed or not. CONCLUSION Prophylactic use of mesh at the time of stoma formation is a safe procedure and reduces the risk of parastomal hernia. For more detailed evaluation, additional large, double-blinded, randomized controlled trials with long-term follow-up are necessary.
Collapse
|