title: A prospective, multicenter, randomized, controlled study of non-cross-linked porcine acellular dermal matrix fascial sublay for parastomal reinforcement in patients undergoing surgery for permanent abdominal wall ostomies.
abstract: BACKGROUND
  A large proportion of patients with a colostomy or an ileostomy develop parastomal hernias. The placement of a reinforcing material at the stoma site may reduce parastomal hernia incidence.
  
  
  OBJECTIVE
  We aimed to assess the safety and efficacy of stoma reinforcement with sublay placement of non-cross-linked porcine-derived acellular dermal matrix at the time of stoma construction.
  
  
  METHODS
  This is a randomized, patient- and third-party assessor-blind, controlled trial.
  
  
  METHODS
  This study took place in colorectal/general surgery institutions.
  
  
  METHODS
  Patients were prospectively randomly assigned to undergo standard end-stoma construction with or without porcine-derived acellular dermal matrix reinforcement.
  
  
  METHODS
  Patients undergoing construction of a permanent stoma were eligible. A total of 113 patients (59 men, 54 women; mean age, 60 years; mean BMI, 25.4 kg/m) participated: 58 controls and 55 with reinforcement.
  
  
  METHODS
  The incidence of parastomal hernia, safety, and stoma-related quality of life were assessed.
  
  
  RESULTS
  Intraoperative complications and blood loss were similar between groups. Quality-of-life scores were similar through 24 months of follow-up. At 24 months of follow-up, the incidence of parastomal hernias was similar for both groups (12.2% of the porcine-derived acellular dermal matrix group and 13.2% of controls).
  
  
  CONCLUSIONS
  Study limitations include the inclusion of ileostomy and colostomy patients, open and laparoscopic techniques, and small numbers of patients at follow-up.
  
  
  CONCLUSIONS
  Safety and quality-of-life data from this randomized control trial show similar outcomes in both groups. Prosthetic reinforcement of stomas was safe, but it did not significantly reduce the incidence of parastomal hernia formation.
  
  
  BACKGROUND
  Identification no. NCT00771407.
authors.affiliation: 1Department of Surgery, Baylor University Medical Center, Dallas, Texas 2Department of Colon and Rectal Surgery, Ochsner Clinic, New Orleans, Louisiana 3University of Vermont, College of Medicine, Burlington, Vermont 4Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, Florida 5Department of Surgery, Mt. Sinai Hospital, New York, New York 6Department of Surgery, Indiana University, Indianapolis, Indiana.
authors.forename: James W
authors.initials: JW
authors.lastname: Fleshman
authors.forename: David E
authors.initials: DE
authors.lastname: Beck
authors.forename: Neil
authors.initials: N
authors.lastname: Hyman
authors.forename: Steven D
authors.initials: SD
authors.lastname: Wexner
authors.forename: Joel
authors.initials: J
authors.lastname: Bauer
authors.forename: Virgilio
authors.initials: V
authors.lastname: George
mesh_terms: D062088:Acellular Dermis; D000818:Animals; D016063:Blood Loss, Surgical; D003125:Colostomy / Q000379:methods*; D005260:Female; D006555:Hernia, Ventral / Q000517:prevention & control*; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013552:Swine