Prevention of parastomal hernia by placement of a polypropylene mesh at the primary operation.
BACKGROUND
Parastomal hernias occur frequently after placement of a permanent colostomy. Preliminary reports have shown a beneficial effect of placing a mesh at the primary operation to prevent the formation of a parastomal hernia. We studied the safety and prophylactic effect of placing a newly designed polypropylene mesh in an onlay position at the primary operation.


METHODS
This was a prospective study that included 25 patients scheduled for elective colorectal surgery. Risk factors for development of parastomal hernia were recorded before surgery. A prepared lasercut polypropylene mesh with six "arms" was placed in an onlay position. Immediate and long-term complications were evaluated by an experienced stoma nurse and a surgeon. Abdominal ultrasound was performed at 6 and 12 months follow-up. Parastomal hernia was defined as both clinical and ultrasonographic signs of protrusion in the vicinity of the stoma.


RESULTS
The median follow-up time was 12 (range, 2-26) months. One patient died eight days after surgery. Of the 24 patients included, none had infections or immediate complications after surgery. Two patients had minor complications necessitating a local revision of one of the mesh arms. No other long-term complication was found. Two patients had signs of parastomal hernia at 6 and 12 months follow-up, respectively.


CONCLUSIONS
Placement of a polypropylene mesh in an onlay position at the primary operation is a safe procedure and probably results in a low risk of parastomal hernia occurrence.
Gögenur
Ismail
I
Department of Surgical Gastroenterology, University of Copenhagen, Gentofte Hospital, Hellerup, Denmark.
Mortensen
Janni
J
Harvald
Thomas
T
Rosenberg
Jacob
J
Fischer
Anders
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003125:Colostomy; D005260:Female; D006555:Hernia, Ventral / Q000000981:diagnostic imaging / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011126:Polypropylenes / Q000627:therapeutic use; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D016896:Treatment Outcome; D014463:Ultrasonography
D011126:Polypropylenes