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Mäkäräinen EJ, Wiik HT, Kössi JAO, Pinta TM, Mäntymäki LMJ, Mattila AK, Nikki MJ, Järvinen JE, Ohtonen PP, Rautio TT. Prevention of incisional hernia with retrorectus synthetic mesh versus biological mesh following loop ileostomy closure (Preloop trial). Br J Surg 2024; 111:znad362. [PMID: 37944025 DOI: 10.1093/bjs/znad362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/04/2023] [Accepted: 10/14/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The rate of incisional hernia after closure of a temporary loop ileostomy is significant. Synthetic meshes are still commonly avoided in contaminated wounds. The Preloop trial was a multicentre RCT designed to evaluate the benefits of synthetic mesh in incisional hernia prevention, and its safety for use in a contaminated surgical site compared with biological mesh. METHODS Study patients who underwent closure of a loop ileostomy after anterior resection for rectal cancer were assigned to receive either retrorectus synthetic or biological mesh to prevent incisional hernia. The primary outcomes were surgical-site infections within 30 days, and clinical or radiological incisional hernia incidence at 10 months. Secondary outcomes were reoperation rate, operating time, duration of hospital stay, other complications within 30 days of surgery, 5-year quality of life measured by RAND-36, and incisional hernia incidence within 5 years of follow-up. RESULTS Between November 2018 and September 2021, 102 patients were randomised, of whom 97 received the intended allocation. At 10-month follow-up, 90 patients had undergone clinical evaluation and 88 radiological evaluation. One patient in each group (2 per cent) had a clinical diagnosis of incisional hernia (P = 0.950) and one further patient in each group had a CT-confirmed incisional hernia (P = 0.949). The number of other complications, reoperation rate, operating time, and duration of hospital stay did not differ between the study groups. CONCLUSION Synthetic mesh appeared comparable to biological mesh in efficacy and safety for incisional hernia prevention at the time of loop ileostomy closure. REGISTRATION NUMBER NCT03445936 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Elisa J Mäkäräinen
- Department of Surgery, Medical Research Centre Oulu, Oulu University Hospital, Oulu, Finland
| | - Heikki T Wiik
- Department of Surgery, Medical Research Centre Oulu, Oulu University Hospital, Oulu, Finland
| | - Jyrki A O Kössi
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - Tarja M Pinta
- Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
| | | | - Anne K Mattila
- Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Marko J Nikki
- Department of Surgery, Medical Research Centre Oulu, Oulu University Hospital, Oulu, Finland
| | - Jyri E Järvinen
- Department of Surgery, Medical Research Centre Oulu, Oulu University Hospital, Oulu, Finland
| | - Pasi P Ohtonen
- Department of Surgery, Medical Research Centre Oulu, Oulu University Hospital, Oulu, Finland
| | - Tero T Rautio
- Department of Surgery, Medical Research Centre Oulu, Oulu University Hospital, Oulu, Finland
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Mäkäräinen EJ, Wiik HT, Kössi JA, Pinta TM, Mäntymäki LMJ, Mattila AK, Kairaluoma MV, Ohtonen PP, Rautio TT. Synthetic mesh versus biological mesh to prevent incisional hernia after loop-ileostomy closure: a randomized feasibility trial. BMC Surg 2023; 23:68. [PMID: 36973782 PMCID: PMC10045611 DOI: 10.1186/s12893-023-01961-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Incisional hernia is a frequent complication after loop-ileostomy closure, rationalizing hernia prevention. Biological meshes have been widely used in contaminated surgical sites instead of synthetic meshes in fear of mesh related complications. However, previous studies on meshes does not support this practice. The aim of Preloop trial was to study the safety and efficacy of synthetic mesh compared to a biological mesh in incisional hernia prevention after loop-ileostomy closure. METHODS The Preloop randomized, feasibility trial was conducted from April 2018 until November 2021 in four hospitals in Finland. The trial enrolled 102 patients with temporary loop-ileostomy after anterior resection for rectal cancer. The study patients were randomized 1:1 to receive either a light-weight synthetic polypropylene mesh (Parietene Macro™, Medtronic) (SM) or a biological mesh (Permacol™, Medtronic) (BM) to the retrorectus space at ileostomy closure. The primary end points were rate of surgical site infections (SSI) at 30-day follow-up and incisional hernia rate during 10 months' follow-up period. RESULTS Of 102 patients randomized, 97 received the intended allocation. At 30-day follow-up, 94 (97%) patients were evaluated. In the SM group, 1/46 (2%) had SSI. Uneventful recovery was reported in 38/46 (86%) in SM group. In the BM group, 2/48 (4%) had SSI (p > 0.90) and in 43/48 (90%) uneventful recovery was reported. The mesh was removed from one patient in both groups (p > 0.90). CONCLUSIONS Both a synthetic mesh and biological mesh were safe in terms of SSI after loop-ileostomy closure. Hernia prevention efficacy will be published after the study patients have completed the 10 months' follow-up.
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Affiliation(s)
- Elisa J Mäkäräinen
- Medical Research Center Oulu, Oulu University Hospital, PL 10, Oulu, 90029, Finland.
| | - Heikki T Wiik
- Medical Research Center Oulu, Oulu University Hospital, PL 10, Oulu, 90029, Finland
| | - Jyrki Ao Kössi
- Päijät-Häme Central Hospital, Keskussairaalankatu 7, Lahti, 15850, Finland
| | - Tarja M Pinta
- Seinäjoki Central Hospital, Hanneksenrinne 7, Seinäjoki, 60220, Finland
| | | | - Anne K Mattila
- Keski-Suomi Central Hospital, Hoitajantie 3, Jyväskylä, 40620, Finland
| | | | - Pasi P Ohtonen
- Medical Research Center Oulu, Oulu University Hospital, PL 10, Oulu, 90029, Finland
| | - Tero T Rautio
- Medical Research Center Oulu, Oulu University Hospital, PL 10, Oulu, 90029, Finland
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Abstract
BACKGROUND Minimally invasive ventral mesh rectopexy (VMR) is a widely used surgical treatment for posterior pelvic organ prolapse; however, evidence of the utility of revisional surgery is lacking. Our aim was to assess the technical details, safety and outcomes of redo minimally invasive VMR for patients with external rectal prolapse (ERP) recurrence or relapsed symptoms of internal rectal prolapse (IRP). METHODS This is a retrospective cohort study of patients with recurrent ERP or symptomatic IRP who underwent redo minimally invasive VMR between 2011 and 2016. The study was conducted at three hospitals in Finland. Data collected retrospectively included patient demographics, in addition to perioperative and short-term postoperative findings. At follow-up, all living patients were sent a questionnaire concerning postoperative disease-related symptoms and quality of life. RESULTS A total of 43 redo minimally invasive VMR were performed during the study period. The indication for reoperation was recurrent ERP in 22 patients and relapsed symptoms of IRP in 21 patients. In most operations (62.8%), the previously used mesh was left in situ and a new one was placed. Ten (23.3%) patients experienced complications, including 2 (4.7%) mesh-related complications. The recurrence rate was 4.5% for ERP. Three patients out of 43 were reoperated on for various reasons. One patient required postoperative laparoscopic hematoma evacuation. Patients operated on for recurrent ERP seemed to benefit more from the reoperation. CONCLUSIONS Minimally invasive redo VMR appears to be a safe and effective procedure for treating posterior pelvic floor dysfunction with acceptable recurrence and reoperation rates.
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Affiliation(s)
- K E Laitakari
- Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland.
- Medical Research Centre Oulu, Centre of Surgical Research, University of Oulu, Oulu, Finland.
| | - J K Mäkelä-Kaikkonen
- Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland
- Medical Research Centre Oulu, Centre of Surgical Research, University of Oulu, Oulu, Finland
| | - M Kairaluoma
- Department of Surgery, Keski-Suomi Central Hospital, Jyväskylä, Finland
| | - A Junttila
- Department of Surgery, Keski-Suomi Central Hospital, Jyväskylä, Finland
| | - J Kössi
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - P Ohtonen
- Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland
- Medical Research Centre Oulu, Centre of Surgical Research, University of Oulu, Oulu, Finland
| | - T T Rautio
- Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland
- Medical Research Centre Oulu, Centre of Surgical Research, University of Oulu, Oulu, Finland
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Laitakari KE, Mäkelä-Kaikkonen JK, Pääkkö E, Kata I, Ohtonen P, Mäkelä J, Rautio TT. Restored pelvic anatomy is preserved after laparoscopic and robot-assisted ventral rectopexy: MRI-based 5-year follow-up of a randomized controlled trial. Colorectal Dis 2020; 22:1667-1676. [PMID: 32544283 DOI: 10.1111/codi.15195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022]
Abstract
AIM Our aim was to compare the long-term anatomical outcomes between robot-assisted ventral mesh rectopexy (RVMR) and laparoscopic ventral mesh rectopexy (LVMR) for external or internal rectal prolapse. METHOD This study is a follow-up of a single-centre randomized controlled trial (RCT). Thirty patients were randomly allocated to RVMR (n = 16) or LVMR (n = 14). The primary end-point was maintenance of the restored pelvic anatomy 5 years after the operation, as assessed by magnetic resonance (MR) defaecography. Secondary outcome measures included the Pelvic Organ Prolapse Quantification (POP-Q) measures and functional results assessed using symptom questionnaires. RESULTS Twenty-six patients (14 RVMR and 12 LVMR) completed the 5-year follow-up and were included in the study. The MRI results, POP-Q measurements and symptom-specific quality of life measures did not differ between the RVMR and LVMR groups. The MRI measurements of the total study population remained unchanged between 3 months and 5 years. In the Pelvic Floor Distress Inventory (PFDI-20), the RVMR group had lower symptom scores (mean 96.0, SD 70.7) than the LVMR group (mean 160.6, SD 58.9; P = 0.004). In the subscales of pelvic organ prolapse (POPDI-6) (mean 23.2, SD 24.3 vs mean 52.4, SD 22.4; P = 0.001) and the Colorectal-Anal Distress Inventory (CRADI-8) (mean 38.4, SD 23.3 vs mean 58.6, SD 25.4; P = 0.009), the patients in the RVMR group had significantly better outcomes. CONCLUSION After VMR, the corrected anatomy was preserved. There were no clinically significant differences in anatomical results between the RVMR and LVMR procedures 5 years after surgery based on MR defaecography. However, functional outcomes were better after RMVR.
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Affiliation(s)
- K E Laitakari
- Department of Surgery, Division of Gastroenterology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Center of Surgical Research, University of Oulu, Oulu, Finland
| | - J K Mäkelä-Kaikkonen
- Department of Surgery, Division of Gastroenterology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Center of Surgical Research, University of Oulu, Oulu, Finland
| | - E Pääkkö
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - I Kata
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - P Ohtonen
- Medical Research Center Oulu, Center of Surgical Research, University of Oulu, Oulu, Finland.,Division of Operative Care, Oulu University Hospital, Oulu, Finland
| | - J Mäkelä
- Department of Surgery, Division of Gastroenterology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Center of Surgical Research, University of Oulu, Oulu, Finland
| | - T T Rautio
- Department of Surgery, Division of Gastroenterology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Center of Surgical Research, University of Oulu, Oulu, Finland
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Mäkelä-Kaikkonen JK, Rautio TT, Koivurova S, Pääkkö E, Ohtonen P, Biancari F, Mäkelä JT. Anatomical and functional changes to the pelvic floor after robotic versus laparoscopic ventral rectopexy: a randomised study. Int Urogynecol J 2016; 27:1837-1845. [DOI: 10.1007/s00192-016-3048-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/10/2016] [Indexed: 12/14/2022]
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Rautio TT, Perälä JM, Wiik HT, Juvonen TS, Haukipuro KA. Endovenous obliteration with radiofrequency-resistive heating for greater saphenous vein insufficiency: a feasibility study. J Vasc Interv Radiol 2002; 13:569-75. [PMID: 12050296 DOI: 10.1016/s1051-0443(07)61649-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To assess the feasibility, safety, and clinical utility of ultrasound (US)- and fluoroscopy-guided endovenous saphenous vein obliteration with radiofrequency (RF)-resistive heating in the treatment of primary venous insufficiency. MATERIALS AND METHODS Thirty legs of 27 patients with mild to moderate varicose veins and primary greater saphenous vein (GSV) insufficiency diagnosed with duplex US were treated. An endovenous catheter was inserted via US-guided percutaneous puncture or a skin incision. Fluoroscopy and US were used to locate the electrodes at the saphenofemoral junction. GSVs were occluded with RF-resistive heating. Local phlebectomies or sclerotherapy were performed in all procedures to treat varicose veins and teleangiectases. Persistence of vein occlusion and complications potentially attributable to endovenous treatment were assessed at 1 week, 6 weeks, 3 months, 6 months, and 1 year. RESULTS The mean follow-up time was 9.6 months (SD, 3.8 mo). By the time of the last follow-up visit, occlusion of the treated segment of the GSV had been achieved in 22 legs (73.3%). Persisting patency or recanalization of the GSV was detected in eight legs (26.7%). One patient (3.3%) had varicosity-related symptoms, and three treated legs (10%) had recurrent or new varicosities. Postoperative complications included saphenous nerve paresthesia in three legs (10%) and thermal skin injury in one limb (3.3%). CONCLUSION Endovenous obliteration employing RF-resistive heating is a relatively safe and promising minimally invasive technique for the treatment of primary GSV insufficiency.
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Affiliation(s)
- Tero T Rautio
- Departments of Surgery, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.
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