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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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Zhu X, Liu J, Liu Z, Tang R, Fu C. Establishment and evaluation of rat models of parastomal hernia. Hernia 2024:10.1007/s10029-024-03010-2. [PMID: 38643447 DOI: 10.1007/s10029-024-03010-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/01/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE Parastomal hernia poses a challenging problem in the field of hernia surgery. The high incidence and recurrence rates of parastomal hernia necessitate surgeons to enhance surgical techniques and repair materials. This study aimed to develop a rat model of parastomal hernia by inducing various types of defects on the abdominal wall with colostomy. This established method has potential for future studies on parastomal hernia. METHODS In this study, 32 male rats were included and randomly divided into four groups: the oblique abdominis excision (OE), oblique abdominis dissection (OD), rectus abdominis excision (RE), and rectus abdominis dissection (RD) groups. In each group, colostomy was performed and an abdominal wall defect was induced. The rats were observed for 28 days following surgery. The survival rate, body weight, parastomal hernia model scores, abdominal wall adhesion and inflammation, and collagen level in the hernial sac were compared. RESULTS No significant differences in survival rate and weight were observed among the four groups. The parastomal hernia model scores in the RE and RD groups were significantly higher than those in the OE and OD groups. The ratio of collagen I/III in the RE and RD groups was significantly lower than that in the OE and OD groups. Adhesion and inflammation levels were lower in the RE group than in the RD group. CONCLUSION Based on a comprehensive comparison of the findings, RE with colostomy emerged as the optimal approach for establishing parastomal hernia models in rats.
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Affiliation(s)
- X Zhu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - J Liu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Z Liu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - R Tang
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
| | - C Fu
- Department of Colorectal Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
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Che X, Huang H, Wang W, Zhong L, Yu S, Huang Y, Xi Z. Parastomal Hernia Following Ileal Conduit: Incidence, Risk Factors, and Health-Related Quality of Life. J Wound Ostomy Continence Nurs 2024; 51:126-131. [PMID: 38527321 PMCID: PMC11008435 DOI: 10.1097/won.0000000000001063] [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: 03/27/2024]
Abstract
PURPOSE The purpose of this study was to measure the incidence of parastomal hernia (PH) after radical cystectomy and ileal conduit. Secondary aims were the identification of risk factors for PH and to compare the health-related quality of life (QOL) between patients with and without PH. DESIGN Retrospective review of medical records combined with cross-sectional administration of the QOL instrument and telephone follow-up. SUBJECTS AND SETTING The study sample comprised 219 patients who underwent radical cystectomy and ileal conduit for urothelial cancer between February 2014 and December 2018. The study setting was Peking University First Hospital (Beijing, China). METHODS Demographic and pertinent clinical data, including development of PH, were gathered via the retrospective review of medical records. Participants were also asked to complete the traditional Chinese language version of the City of Hope Quality of Life-Ostomy Questionnaire (C-COH). Multiple linear regression analysis was used to identify the effect of PH on C-COH scores. Logistic regression analysis was used to identify risk factors for PH development. RESULTS At a median follow-up of 34 months (IQR = 21-48), 43 of 219 (19.63%) patients had developed a PH. A body mass index (BMI) indicating overweight (OR = 3.548; 95% CI, 1.562-8.061; P = .002), a prior history of hernia (OR = 5.147; 95% CI, 1.195-22.159; P = .028), and chronic high abdominal pressure postdischarge (CHAP-pd) (OR = 3.197; 95% CI, 1.445-7.075; P = .004) were predictors of PH after operation. There was no significant difference between C-COH scores of patients with or without PH. No significant differences were found when participants with PH were compared to those without PH on 4 factors of the C-COH: physical scores (β= .347, P = .110), psychological scores (β= .316, P = .070), spiritual scores (β=-.125, P = .714), and social scores (β= .054, P = .833). CONCLUSION Parastomal hernia is prevalent in patients undergoing radical cystectomy and ileal conduit urinary diversion. Overweight, hernia history, and CHAP-pd were predictors of PH development. No significant differences in QOL were found when patients with PH were compared to those without PH.
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Affiliation(s)
- Xinyan Che
- Xinyan Che, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Haiwen Huang, MD, Department of Urology, Peking University First Hospital, Beijing, China; Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
- Wei Wang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Lijun Zhong, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Shuhui Yu, RN, Department of Urology and Nursing, Peking University First Hospital, Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China
- Yanbo Huang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Zhijun Xi, MD, PhD, Department of Urology, Peking University First Hospital, Beijing, China
| | - Haiwen Huang
- Xinyan Che, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Haiwen Huang, MD, Department of Urology, Peking University First Hospital, Beijing, China; Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
- Wei Wang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Lijun Zhong, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Shuhui Yu, RN, Department of Urology and Nursing, Peking University First Hospital, Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China
- Yanbo Huang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Zhijun Xi, MD, PhD, Department of Urology, Peking University First Hospital, Beijing, China
| | - Wei Wang
- Xinyan Che, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Haiwen Huang, MD, Department of Urology, Peking University First Hospital, Beijing, China; Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
- Wei Wang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Lijun Zhong, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Shuhui Yu, RN, Department of Urology and Nursing, Peking University First Hospital, Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China
- Yanbo Huang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Zhijun Xi, MD, PhD, Department of Urology, Peking University First Hospital, Beijing, China
| | - Lijun Zhong
- Xinyan Che, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Haiwen Huang, MD, Department of Urology, Peking University First Hospital, Beijing, China; Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
- Wei Wang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Lijun Zhong, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Shuhui Yu, RN, Department of Urology and Nursing, Peking University First Hospital, Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China
- Yanbo Huang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Zhijun Xi, MD, PhD, Department of Urology, Peking University First Hospital, Beijing, China
| | - Shuhui Yu
- Xinyan Che, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Haiwen Huang, MD, Department of Urology, Peking University First Hospital, Beijing, China; Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
- Wei Wang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Lijun Zhong, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Shuhui Yu, RN, Department of Urology and Nursing, Peking University First Hospital, Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China
- Yanbo Huang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Zhijun Xi, MD, PhD, Department of Urology, Peking University First Hospital, Beijing, China
| | - Yanbo Huang
- Correspondence: Yanbo Huang () or Zhijun Xi (), Department of Urology, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing 100034, China
| | - Zhijun Xi
- Xinyan Che, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Haiwen Huang, MD, Department of Urology, Peking University First Hospital, Beijing, China; Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
- Wei Wang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Lijun Zhong, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Shuhui Yu, RN, Department of Urology and Nursing, Peking University First Hospital, Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China
- Yanbo Huang, RN, Department of Urology and Nursing, Peking University First Hospital, Beijing, China
- Zhijun Xi, MD, PhD, Department of Urology, Peking University First Hospital, Beijing, China
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Haskins IN. Hernia Formation: Risk Factors and Biology. Surg Clin North Am 2023; 103:835-846. [PMID: 37709390 DOI: 10.1016/j.suc.2023.04.020] [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: 09/16/2023]
Abstract
The incidence of ventral hernias in the United States is in increasing. Herein, the author details the etiology of congenital and acquired ventral hernias as well as the risk factors associated with the development of each of these types of ventral hernias.
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Affiliation(s)
- Ivy N Haskins
- Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA.
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Denti FC, Brambilla D, De Luca G, Malvone AP, Maglio A, Oliveri M, Scaduto V, Rosati R, Tamburini AM, Villa G. Parastomal hernia: an overview. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S22-S30. [PMID: 37682763 DOI: 10.12968/bjon.2023.32.16.s22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Parastomal hernia (PH) is one of the most frequent ostomy complications, and the reported incidence in the literature is highly variable. As highlighted by the Association of Stoma Care Nurses UK, this complication develops mainly in children and older men over 70, but many predisposing factors are related to the individual patient and surgery. There is no standardised system for assessing PH. The main assessment techniques include objective examination, ultrasound scan and computed tomography. Prevention is based on various interventions by surgeons and stoma care nurses (SCNs). The SCN's primary interventions include accurate patient evaluation, pre-operative ostomy siting, education about body weight management and advice on appropriate exercises. The treatment of PH can be conservative or surgical, and the choice is based on the patient's clinical condition. Ostomy can significantly impact on a patient's quality of life (QoL), and the presence of PH can further aggravate the situation. This overview of PH considers the incidence, aetiology, prevention, treatment and impact on QoL.
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Affiliation(s)
- Francesco Carlo Denti
- Enteral Stoma Nurse, Stoma Care Unit, San Raffaele Scientific Institute, Milan; Adjunct Professor Nursing, Vita Salute San Raffaele University, Milan, Italy
| | - Davide Brambilla
- Enteral Stoma Nurse, Stoma Care Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni De Luca
- Nurse, Gastrointestinal Surgery Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Andrea Maglio
- Enteral Stoma Nurse, Gastrointestinal Surgery Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Oliveri
- Nurse, Gastrointestinal Surgery Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Vitalba Scaduto
- Nurse, Gastrointestinal Surgery Unit, San Raffaele Scientific Institute; Adjunct Professor Nursing, Vita Salute San Raffaele University, Milan, Italy
| | - Riccardo Rosati
- Chief Surgeon, Gastrointestinal Surgery Unit, San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Marco Tamburini
- Surgeon, Gastrointestinal Surgery Unit, San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy
| | - Giulia Villa
- Assistant Professor of Nursing, Center for Nursing Research and Innovation, Vita Salute San Raffaele University, Milan, Italy
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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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Scientific and Clinical Abstracts From WOCNext® 2023: Las Vegas, Nevada ♦ June 4-7, 2023. J Wound Ostomy Continence Nurs 2023; 50:S1-S78. [PMID: 37632270 DOI: 10.1097/won.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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López-Cano M, Adell-Trapé M, Verdaguer-Tremolosa M, Rodrigues-Gonçalves V, Badia-Closa J, Serra-Aracil X. Parastomal hernia prevention with permanent mesh in end colostomy: failure with late follow-up of cohorts in three randomized trials. Hernia 2023; 27:657-664. [PMID: 36966221 DOI: 10.1007/s10029-023-02781-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/14/2023] [Indexed: 03/27/2023]
Abstract
PURPOSE Short-term results have been reported regarding parastomal hernia (PH) prevention with a permanent mesh. Long-term results are scarce. The objective was to assess the long-term PH occurrence after a prophylactic synthetic non-absorbable mesh. METHODS Long-term data of three randomized controlled trials (RCTs) were collected. The primary outcome was the detection of PH based exclusively on a radiological diagnosis by computed tomography (CT) performed during the long-term follow-up. The Kaplan-Meier method was used for the comparison of time to diagnosis of PH according to the presence of mesh vs. no-mesh and the technique of mesh insertion: open retromuscular, laparoscopic keyhole, and laparoscopic modified Sugarbaker. RESULTS We studied 121 patients (87 men, median age 70 years), 82 (67.8%) of which developed a PH. The median overall length of follow-up was 48.5 months [interquartile range (IQR) 14.4-104.9], with a median time until PH diagnosis of 17.7 months (IQR 9.3-49.0). The survival analysis did not show significant differences in the time to development of a PH according to the presence or absence of a prophylactic mesh neither in the overall study population (log-rank, P = 0.094) nor in the groups of each technique of mesh insertion, although according to the surgical technique, a higher reduction in the appearance of PH for the open retromuscular technique was found (log-rank, P = 0.001). CONCLUSION In the long-term follow-up placement of a non-absorbable synthetic prophylactic mesh in the context of an elective end colostomy does not seem effective for preventing PH.
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Affiliation(s)
- M López-Cano
- Abdominal Wall Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Abdominal Wall Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - M Adell-Trapé
- Abdominal Wall Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Verdaguer-Tremolosa
- Abdominal Wall Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V Rodrigues-Gonçalves
- Abdominal Wall Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Badia-Closa
- Department of General and Digestive Surgery, Colorectal Unit, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - X Serra-Aracil
- Department of General and Digestive Surgery, Colorectal Unit, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
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Taylor C, Munro J, Goodman W, Beeken RJ, Dames N, Oliphant R, Watson AJ, Hubbard G. Experiences of wearing support garments by people living with a urostomy. ACTA ACUST UNITED AC 2019; 28:S26-S33. [PMID: 31835944 DOI: 10.12968/bjon.2019.28.22.s26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND support garments are commonly worn by people with a urostomy but there are no published data about their experiences of doing so. AIMS to identify the views of people living with a urostomy on the role of support garments. METHODS a cross-sectional survey of the stoma population's experiences of support garments was conducted in 2018. Recruitment was by social media. The free-text responses provided by a sub-sample of 58 people out of 103 respondents with a urostomy, were analysed. FINDINGS thematic analysis revealed four themes: physical self-management; psychosocial self-management; lifestyle; and healthcare advice and support. There were mixed feelings about the value of support garments. Many cited a sense of reassurance and confidence and being able to be more sociable and active; others reported discomfort and uncertainty about their value. CONCLUSION these findings add new understanding of experiences of support garments and provide novel theoretical insights about life with a urostomy.
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Affiliation(s)
- Claire Taylor
- Macmillan Nurse Consultant in Colorectal Cancer, London North West Healthcare NHS Trust
| | - Julie Munro
- Macmillan Nurse Consultant in Colorectal Cancer, London North West Healthcare NHS Trust
| | | | | | | | - Raymond Oliphant
- Department of Surgery, Raigmore Hospital, NHS Highland, Inverness
| | - Angus Jm Watson
- Department of Surgery, Raigmore Hospital, NHS Highland, Inverness
| | - Gill Hubbard
- Department of Nursing and Midwifery, Centre for Health Science, University of the Highlands and Islands, Inverness
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Parastomal hernias causing symptoms or requiring surgical repair after colorectal cancer surgery-a national population-based cohort study. Int J Colorectal Dis 2019; 34:1267-1272. [PMID: 31147771 DOI: 10.1007/s00384-019-03292-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Parastomal hernia is a complication with high morbidity that affects the patient's quality of life. The aim of this study was to assess the cumulative incidence of parastomal hernia in patients who have undergone colorectal cancer surgery and to identify potential risk factors that could predispose to the development of this type of hernia in a large population-based cohort over a long follow-up period. METHODS The Swedish Colorectal Cancer Registry and the National Patient Register were used to collect study cohort data between January 2007 and September 2013. All patients undergoing colorectal cancer surgery including a permanent stoma were included in the study group. RESULTS A total of 39,984 patients were registered during the study period. Of these, 7649 received a permanent stoma. Multivariate proportional hazard analysis, based on 6329 patients for whom all covariates could be retrieved, showed that the only independent risk factor for developing a parastomal hernia was BMI ≥ 30 (HR 1.49; 95% CI 1.02-2.17; p < 0.037). A slightly elevated hazard ratio was found for preoperative radiotherapy (HR 1.36; 95% CI 0.96-1.91; p < 0.070). The cumulative incidence of patients diagnosed or surgically treated for parastomal hernia over a follow-up period of 5 years was 7.7% (95% CI 6.1-9.2%). CONCLUSIONS The cumulative incidence of parastomal hernia causing symptoms or requiring surgery after 5 years was at least 7.7%. Obesity increases the risk of developing parastomal hernia.
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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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Wang P, Su H, Liang J, Wang Z, Zhou Z, Zhou H. The Longtan Modification: An Effective and Economical Surgical Innovation for Parastomal Hernia Post-Intraperitoneal Sigmoidostomy. J Laparoendosc Adv Surg Tech A 2017; 28:459-463. [PMID: 29028454 DOI: 10.1089/lap.2017.0423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study was designed to introduce a new surgical innovation, referred to as the "Longtan modification," for cases with parastomal hernia (PSH) following intraperitoneal sigmoidostomy, and to assess the safety and feasibility of this procedure. METHODS Between January 2013 and June 2016, a total of 26 consecutive cases with PSH successfully underwent this procedure. The patient demographics, surgical outcomes, stoma-related complications, and the stoma function were collected and analyzed. RESULTS Mean diameter of the hernia ring was 7.6 cm, mean operation time was 94.2 minutes, and mean intraoperative blood loss was 18.0 mL. The mean period of postoperative hospitalization was 4.4 days while the mean hospitalization cost was only $3,750 USD. There were no severe complications such as postoperative hemorrhage, ischemic necrosis, peritoneal infection, or intestinal obstruction, although one case suffered from postoperative infection at the site of incision. None of the cases had a recurrence of PSH during the follow-up period. In addition, the stoma functioned efficiently and appropriately following the Longtan modification. CONCLUSION Overall, the Longtan modification appears to be an effective and economical surgical innovation for cases with PSH following intraperitoneal sigmoidostomy.
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Affiliation(s)
- Peng Wang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Su
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianwei Liang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Wang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhixiang Zhou
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haitao Zhou
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Fox SS, Janczyk R, Warren JA, Carbonell AM, Poulose BK, Rosen MJ, Hope WW. An Evaluation of Parastomal Hernia Repair Using the Americas Hernia Society Quality Collaborative. Am Surg 2017. [DOI: 10.1177/000313481708300841] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this review was to evaluate outcomes relating to parastomal hernia repair. Data from the Americas Hernia Society Quality Collaborative were used to identify patients undergoing parastomal hernia repair from 2013 to 2016. Parastomal hernia repairs were compared with other repairs using Pearson's test and Wilcoxon test with a P value <0.05 considered significant. Parastomal hernia repairs were performed in 311 patients. Techniques of repair include open in 85 per cent and laparoscopic in 15 per cent. Mesh was used in 92 per cent with keyhole in 34 per cent, flat mesh in 33 per cent, and Sugarbaker in 25 per cent. Mesh types were permanent synthetic in 79 per cent, biologic in 13 per cent, absorbable synthetic in 6 per cent, and hybrid synthetic/biologic in 2 per cent. Most common location for mesh was sublay in 84 per cent followed by onlay in 14 per cent and inlay in 2 per cent with 59 per cent of patients undergoing a myofascial release. Ostomy disposition included ostomy left in situ (47%), moved to a new site (18%), taken down (22%), and rematured in same location in (13%). Outcomes related to parastomal hernia repair included 10 per cent surgical site infection, 24 per cent surgical site occurrence, and 12 per cent surgical site occurrences requiring procedural interventions with a 13 per cent readmission rate and 6 per cent reoperation rate. When comparing parastomal hernias with other ventral hernia repairs, parastomal hernias had a significantly higher surgical site infection, surgical site occurrence, surgical site occurrences requiring procedural intervention, readmission, reoperation rate, and length of stay, and were less commonly performed laparoscopically (P < 0.05). Most parastomal hernias are being repaired open with synthetic mesh in the sublay position. Less favorable outcomes of parastomal hernia repair when compared with other ventral hernia repairs are likely related to the complexity of parastomal hernia repair.
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Affiliation(s)
- Sarah S. Fox
- New Hanover Regional Medical Center, Wilmington, North Carolina
| | | | | | | | | | | | - William W. Hope
- New Hanover Regional Medical Center, Wilmington, North Carolina
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Frankl J, Michailidou M, Maegawa F. Parastomal gallbladder hernia in a septic patient. Radiol Case Rep 2017; 12:508-510. [PMID: 28828113 PMCID: PMC5552004 DOI: 10.1016/j.radcr.2017.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 05/20/2017] [Accepted: 05/25/2017] [Indexed: 11/26/2022] Open
Abstract
Parastomal gallbladder herniation is a rare complication of enterostomies with only 6 previously reported cases. Most cases have occurred in elderly women. Patients typically presented with acute abdominal pain and the majority was managed operatively. Here, we report the clinical course of an 88-year-old female who presented with signs of sepsis and minimal abdominal symptoms. She was subsequently found to have a parastomal gallbladder herniation and Klebsiella pneumoniae bacteremia. Given the patient's multiple comorbidities, she was managed nonoperatively with manual reduction of the parastomal hernia and antibiotics.
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Affiliation(s)
- Joseph Frankl
- University of Arizona College of Medicine, 1501 N. Campbell Ave., Tucson, AZ 85724, USA
| | - Maria Michailidou
- Department of Surgery, University of Arizona College of Medicine, 1501 N. Campbell Ave., Tucson, AZ 85724, USA
| | - Felipe Maegawa
- Department of Surgery, University of Arizona College of Medicine, 1501 N. Campbell Ave., Tucson, AZ 85724, USA.,Department of Surgery, Southern Arizona Veterans Affairs Health Care System, Tucson, AZ 85724, USA
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