Use of a prosthetic mesh to prevent parastomal hernia during laparoscopic abdominoperineal resection: a randomized controlled trial.
OBJECTIVE
Prevention of parastomal hernia represents an important aim when a permanent stoma is necessary. The objective of this work is to assess whether implantation of a prophylactic prosthetic mesh during laparoscopic abdominoperineal resection contributed to reduce the incidence of parastomal hernia.


METHODS
Rectal cancer patients undergoing elective laparoscopic abdominoperineal resection with permanent colostomy were randomized to placement of a large-pore lightweight mesh in the intraperitoneal/onlay position by the laparoscopic approach (study group) or to the control group (no mesh). Parastomal hernia was defined radiologically by a CT scan performed after 12 months of surgery. The usefulness of subcutaneous fat thickness measured by CT to discriminate patients at risk of parastomal hernia was assessed by ROC curve analysis.


RESULTS
Thirty-six patients were randomized, 19 to the mesh group and 17 to the control group. Parastomal hernia was detected in 50 % of patients in the mesh group and in 93.8 % of patients in the control group (P = 0.008). The AUC for thickness of the subcutaneous abdominal was 0.819 (P = 0.004) and the optimal threshold 23 mm. Subcutaneous fat thickness ≥23 mm was a significant predictor of parastomal hernia (odds ratio 15.7, P = 0.010), whereas insertion of a mesh was a protective factor (odds ratio 0.06, P = 0.031).


CONCLUSIONS
Use of prophylactic large-pore lightweight mesh in the intraperitoneal/onlay position by a purely laparoscopic approach reduced the incidence of parastomal hernia formation. Subcutaneous fat thickness ≥23 mm measured by CT was an independent predictor of parastomal hernia.
Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain. 27689mlc@comb.es
M
M
López-Cano
R
R
Lozoya-Trujillo
S
S
Quiroga
J L
JL
Sánchez
F
F
Vallribera
M
M
Martí
L M
LM
Jiménez
M
M
Armengol-Carrasco
E
E
Espín
D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002277:Carcinoma / Q000601:surgery*; D016009:Chi-Square Distribution; D003125:Colostomy / Q000009:adverse effects / Q000295:instrumentation*; D016001:Confidence Intervals; D005260:Female; D046449:Hernia, Abdominal / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012372:ROC Curve; D012004:Rectal Neoplasms / Q000601:surgery*; D018570:Risk Assessment; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging*; D013526:Surgical Mesh; D014057:Tomography, X-Ray Computed