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Emile SH, Dourado J, Rogers P, Wignakumar A, Horesh N, Garoufalia Z, Gefen R, Wexner SD. Umbrella review of systematic reviews on the efficacy and safety of using mesh in the prevention of parastomal hernias. Hernia 2024:10.1007/s10029-024-03137-2. [PMID: 39177914 DOI: 10.1007/s10029-024-03137-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 08/11/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND This umbrella review aimed to summarize the findings and conclusions of published systematic reviews on the prophylactic role of mesh against parastomal hernias in colorectal surgery. METHODS PRISMA-compliant umbrella overview of systematic reviews on the role of mesh in prevention of parastomal hernias was conducted. PubMed and Scopus were searched through November 2023. Main outcomes were efficacy and safety of mesh. Efficacy was assessed by the rates of clinically and radiologically detected hernias and the need for surgical repair, while safety was assessed by the rates of overall complications. RESULTS 19 systematic reviews were assessed; 7 included only patients with end colostomy and 12 included patients with either ileostomy or colostomy. The use of mesh significantly reduced the risk of clinically detected parastomal hernias in all reviews except one. Seven reviews reported a significantly lower risk of radiologically detected parastomal hernias with the use of mesh. The pooled hazards ratio of clinically detected and radiologically detected parastomal hernias was 0.33 (95%CI: 0.26-0.41) and 0.55 (95%CI: 0.45-0.68), respectively. Six reviews reported a significant reduction in the need for surgical repair when a mesh was used whereas six reviews found a similar need for hernia repair. The pooled hazards ratio for surgical hernia repair was 0.46 (95%CI: 0.35-0.62). Eight reviews reported similar complications in the two groups. The pooled hazard ratio of complications was 0.81 (95%CI: 0.66-1). CONCLUSIONS The use of surgical mesh is likely effective and safe in the prevention of parastomal hernias without an increased risk of overall complications.
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Affiliation(s)
- Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, 33179, FL, United States
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - Justin Dourado
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, 33179, FL, United States
| | - Peter Rogers
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, 33179, FL, United States
| | - Anjelli Wignakumar
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, 33179, FL, United States
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, 33179, FL, United States
- Department of Surgery and Transplantation, Department of General Surgery, Sheba Medical Center, Ramat-Gan, Jerusalem, Israel
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, 33179, FL, United States
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, 33179, FL, United States
- Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, 33179, FL, United States.
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Meng C, Wei Q, Sun L, Zhang X, Liu Y, Gao J, Wei P, Yang Z, Yao H, Zhang Z. Effects of different mesh materials on complications after prophylactic placement for stoma formation: a systematic review and network meta-analysis. Hernia 2024; 28:1039-1052. [PMID: 38878219 PMCID: PMC11297115 DOI: 10.1007/s10029-024-03068-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/01/2024] [Indexed: 08/03/2024]
Abstract
PURPOSE We primary aimed to synthesise the available data, assess the effectiveness of different mesh materials in prophylactic mesh placement, and rank these materials according to the incidence of parastomal hernia (PSH) and other stoma complications. METHOD This network meta-analysis performed a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Four databases were searched for randomised controlled trials of prophylactic mesh placement. The aggregated results were performed in the STATA routine for Bayesian hierarchical random effects models. RESULT Thirteen randomised controlled trials from 1203 articles, met the inclusion criteria, including 681 cases without meshes, 65 cases with mesh material of xenogeneic acellular dermis (porcine/bovine), 27 cases with polypropylene/PG910, 114 cases with polypropylene/polyglecaprone (Monocryl), 117 cases with polypropylene/cellulose (ORC), 233 cases with polypropylene, and 35 cases with polypropylene/PVDF. In network A, compared with no mesh, only polypropylene (RR 0.24, 95% CI 0.04-0.80) were significantly associated with a reduction in the incidence of PSH. In network B, no statistical difference regarding stoma complications was found between mesh and no mesh. CONCLUSION Based on the network meta-analysis and ranking results, the polypropylene mesh material exhibited the best performance. However, this conclusion needs to be confirmed with larger sample sizes and high-quality randomised controlled trials.
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Affiliation(s)
- C Meng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Q Wei
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - L Sun
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - X Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Y Liu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - J Gao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - P Wei
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Z Yang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - H Yao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China.
| | - Z Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China
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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 PMCID: PMC11338312 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 CentreUniversity of Bristol and University Hospitals Bristol and Weston Foundation TrustBristolUK
| | - Charlotte Murkin
- Population Health Sciences and Bristol Biomedical Research CentreUniversity of Bristol and University Hospitals Bristol and Weston Foundation TrustBristolUK
| | - Leila Rooshenas
- Population Health Sciences and Bristol Biomedical Research CentreUniversity of Bristol and University Hospitals Bristol and Weston Foundation TrustBristolUK
| | - Daisy Elliott
- Population Health Sciences and Bristol Biomedical Research CentreUniversity of Bristol and University Hospitals Bristol and Weston Foundation TrustBristolUK
| | - Kerry Avery
- Population Health Sciences and Bristol Biomedical Research CentreUniversity of Bristol and University Hospitals Bristol and Weston Foundation TrustBristolUK
| | - Katy Chalmers
- Population Health Sciences and Bristol Biomedical Research CentreUniversity of Bristol and University Hospitals Bristol and Weston Foundation TrustBristolUK
| | - Sian Cousins
- Population Health Sciences and Bristol Biomedical Research CentreUniversity of Bristol and University Hospitals Bristol and Weston Foundation TrustBristolUK
| | | | - Natalie Blencowe
- Population Health Sciences and Bristol Biomedical Research CentreUniversity of Bristol and University Hospitals Bristol and Weston Foundation TrustBristolUK
| | - Barnaby C. Reeves
- Population Health Sciences and Bristol Biomedical Research CentreUniversity of Bristol and University Hospitals Bristol and Weston Foundation TrustBristolUK
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Paasch C, Kobelt E, Lünse S, Heisler S, Lorenz R, Hunger R, Mantke R. How often is prophylactic parastomal mesh placement performed after rectal resection without sphincter preservation? An analysis of German nationwide hospital discharge data among 41,697 patients. Hernia 2024; 28:9-15. [PMID: 37843603 PMCID: PMC10891180 DOI: 10.1007/s10029-023-02887-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE The European Hernia Society guidelines of parastomal hernias, published in 2017, strongly recommend prophylactic synthetic non-absorbable mesh upon the construction of a permanent end colostomy to reduce the incidence of parastomal hernias. This study aims to evaluate the implementation of the guidelines in Germany. METHODS This is a retrospective multicentric analysis conducted in December 2022 at the University Hospital Brandenburg an der Havel. Anonymous data on rectal resection without sphincter preservation in the period 2010-2020 were extracted from the German nationwide hospital discharge data set. Individuals with a hernia and < 18 years old were excluded. Another exclusion criterion was a performed colectomy or proctocolectomy with an ileoanal pouch and placement of an absorbable mesh. The primary endpoint was the annual rate of prophylactic parastomal mesh placement following rectal resection without sphincter preservation in Germany. Cases reporting both non-absorbable mesh placement and rectal resection without sphincter preservation were considered prophylactic mesh insertions. RESULTS A total of 41,697 patients received a rectal resection without sphincter preservation and without non-absorbable mesh placement. Among these individuals, 27,089 were male and 14,608 were female. The rate of reoperations (3.1%) and the length of hospital stay (25.3 days ± 19.32) remained almost constant during these 10 years. The rate of prophylactic mesh placement was increasing from 0.2% (n = 8) in 2010 to 6.4% (n = 198) in 2020. CONCLUSIONS Currently, only the minority of patients who have undergone rectal resection without sphincter preservation receive prophylactic mesh insertion.
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Affiliation(s)
- C Paasch
- Department of Surgery, Brandenburg Medical School, University Hospital Brandenburg/Havel, 14770, Brandenburg, Germany.
- Clinic for General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Hochstraße 29, 14770, Brandenburg an der Havel, Germany.
| | - E Kobelt
- Faculty of Health Science Brandenburg, Brandenburg Medical School, University Hospital Brandenburg/Havel, 14770, Brandenburg, Germany
| | - S Lünse
- Department of Surgery, Brandenburg Medical School, University Hospital Brandenburg/Havel, 14770, Brandenburg, Germany
| | - S Heisler
- Department of Surgery, Brandenburg Medical School, University Hospital Brandenburg/Havel, 14770, Brandenburg, Germany
| | - R Lorenz
- Department of Surgery, Brandenburg Medical School, University Hospital Brandenburg/Havel, 14770, Brandenburg, Germany
- Hernia Center 3+CHIRURGEN, Berlin, Germany
| | - R Hunger
- Faculty of Health Science Brandenburg, Brandenburg Medical School, University Hospital Brandenburg/Havel, 14770, Brandenburg, Germany
| | - R Mantke
- Department of Surgery, Brandenburg Medical School, University Hospital Brandenburg/Havel, 14770, Brandenburg, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School, University Hospital Brandenburg/Havel, 14770, Brandenburg, Germany
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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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Barranquero AG, Espert JJ, Llompart Coll MM, Maestre González Y, Gas Ruiz C, Olsina Kissler JJ, Villalobos Mori R. Analysis of recurrence and risk factors in laparoscopic sandwich technique for parastomal hernia repair. Surg Endosc 2023; 37:9125-9131. [PMID: 37814164 DOI: 10.1007/s00464-023-10475-2] [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: 07/05/2023] [Accepted: 09/17/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Parastomal hernias are frequent and highly recurrent. The sandwich technique is a combination of the keyhole and Sugarbaker techniques, using a double intraperitoneal mesh. The objective of this study was to assess the outcomes of the sandwich technique, specifically focusing on recurrence rates. MATERIALS AND METHODS Observational retrospective study conducted in two tertiary referral centers in Catalonia, Spain. All consecutive patients who underwent parastomal hernia repair using the sandwich technique between 1st January 2016 and 31st December 2021 were included. RESULTS A total of 38 patients underwent the laparoscopic sandwich technique for parastomal hernia repair. The overall recurrence rate was 7.9% (3/38), with a median follow-up of 39 months (IQR: 12.3-56.5). According to the EHS classification for parastomal hernia, there were 47.4% (18/38) type I defects, 10.5% (4/38) type II defects, 28.9% (11/38) type III defects, and 13.2% (5/38) type IV defects. The used mesh was predominantly TiMesh® (76.3%; 29/38), followed by DynaMesh® IPOM (23.7%; 9/38). Patients with recurrence exhibited higher rates of seroma, hematoma, surgical site infection, and one case of early recurrence attributed to mesh retraction. Consequently, postoperative complications emerged as the primary risk factor for hernia recurrence. CONCLUSION The sandwich technique demonstrated recurrence rates consistent with those reported in the existing literature.
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Affiliation(s)
- Alberto G Barranquero
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Catalonia, Spain.
| | - Juan José Espert
- Abdominal Wall Unit, General and Digestive Surgery Department, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - María Magdalena Llompart Coll
- Abdominal Wall Unit, General and Digestive Surgery Department, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Yolanda Maestre González
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Catalonia, Spain
| | - Cristina Gas Ruiz
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Catalonia, Spain
| | - Jorge Juan Olsina Kissler
- General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Lleida, Catalonia, Spain
| | - Rafael Villalobos Mori
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Catalonia, Spain
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Gordeev SS, Belenkaya YV, Lukmonov SN, Mamedli ZZ. Laparoscopic retroperitoneal end colostomy creation - A video vignette. Colorectal Dis 2023; 25:2467-2469. [PMID: 37926937 DOI: 10.1111/codi.16797] [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: 08/01/2023] [Accepted: 09/11/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Sergey S Gordeev
- N. N. Blokhin National Medical Research Center of Oncology, Moscow, Russia
- Tyumen State Medical University, Tyumen, Russia
| | - Yana V Belenkaya
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - Zaman Z Mamedli
- N. N. Blokhin National Medical Research Center of Oncology, Moscow, Russia
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Hu A, Pauli EM. Management of Parastomal Hernias. SEMINARS IN COLON AND RECTAL SURGERY 2023. [DOI: 10.1016/j.scrs.2023.100956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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