Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study.
BACKGROUND
Parastomal hernia is a major clinical problem. In a randomized, clinical trial, a prosthetic mesh in a sublay position at the index operation reduced the rate of parastomal hernia at 12-month follow-up, without any increase in the rate of complications. This study was designed to evaluate the rate of complications after 5 years.


METHODS
Between January 2001 and April 2003, 54 patients who had a permanent ostomy were randomized to a conventional stoma or to a stoma with the addition of a mesh in a sublay position. A large-pore, lightweight mesh with a reduced polypropylene content and a high proportion of absorbable material was used.


RESULTS
After 5 years, 21 patients with a conventional stoma were alive and parastomal herniation was recorded in 17 patients, of whom repair had been demanded in 5. In 15 patients operated on with the addition of a mesh herniation, that did not require repair, was present in 2 (P<0.001). No fistulas or strictures developed. No mesh infection was noted and no mesh was removed during the study period.


CONCLUSIONS
At stoma formation, a prophylactic low-weight mesh in a sublay position is a safe procedure that reduces the rate of parastomal hernia.
Jänes
Arthur
A
Department of Surgery, Kirurgkliniken, Sundsvalls sjukhus, 851 86, Sundsvall, Sweden. Arthur.Janes@lvn.se
Cengiz
Yucel
Y
Israelsson
Leif A
LA
D020341:Absorbable Implants; D000368:Aged; D002985:Clinical Protocols; D003125:Colostomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D012307:Risk Factors; D013526:Surgical Mesh; D054047:Surgical Stomas / Q000009:adverse effects*; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome