title: Prevention of parastomal hernias with 3D funnel meshes in intraperitoneal onlay position by placement during initial stoma formation.
abstract: OBJECTIVE
  In patients with terminal ostomies, parastomal hernias (PSHs) occur on a frequent basis. They are commonly associated with various degrees of complaints and occasionally lead to life-threatening complications. Various strategies and measures have been tested and evaluated, but to date there is a lack of published evidence with regard to the best surgical technique for the prevention of PSH development.
  
  
  METHODS
  We conducted a retrospective analysis of prospectively collected data of eighty patients, who underwent elective permanent ostomy formation between 2009 and 2014 by means of prophylactic implantation of a three-dimensional (3D) funnel mesh in intraperitoneal onlay (IPOM) position.
  
  
  RESULTS
  PSH developed in three patients (3.75%). No mesh-related complications were encountered and none of the implants had to be removed. Ostomy-related complications had to be noted in seven (8.75%) cases. No manifestation of ostomy prolapse occurred. Follow-up time was a median 21 (range 3-47) months.
  
  
  CONCLUSIONS
  The prophylactical implantation of a specially shaped, 3D mesh implant in IPOM technique during initial formation of a terminal enterostomy is safe, highly efficient and comparatively easy to perform. As opposed to what can be achieved with flat or keyhole meshes, the inner boundary areas of the ostomy itself can be well covered and protected from the surging viscera with the 3D implants. At the same time, the vertical, tunnel-shaped part of the mesh provides sufficient protection from an ostomy prolapse. Further studies will be needed to compare the efficacy of various known approaches to PSH prevention.
authors.affiliation: Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria. gernot.koehler@bhs.at.|Academic Teaching Hospital of the University of Graz, Graz, Austria. gernot.koehler@bhs.at.|Academic Teaching Hospital of the University of Innsbruck, Innsbruck, Austria. gernot.koehler@bhs.at.|Department of Surgery, Paracelsus Medical University, Salzburg, Austria. gernot.koehler@bhs.at.
authors.forename: G
authors.initials: G
authors.lastname: Köhler
authors.affiliation: Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Hofmann
authors.affiliation: Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Lechner
authors.affiliation: Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
authors.forename: F
authors.initials: F
authors.lastname: Mayer
authors.affiliation: Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria.|Academic Teaching Hospital of the University of Graz, Graz, Austria.|Academic Teaching Hospital of the University of Innsbruck, Innsbruck, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Wundsam
authors.affiliation: Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria.|Academic Teaching Hospital of the University of Graz, Graz, Austria.|Academic Teaching Hospital of the University of Innsbruck, Innsbruck, Austria.
authors.forename: K
authors.initials: K
authors.lastname: Emmanuel
authors.affiliation: Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria.|Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
authors.forename: R H
authors.initials: RH
authors.lastname: Fortelny
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006547:Hernia / Q000209:etiology / Q000517:prevention & control*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010030:Ostomy / Q000009:adverse effects*; D011474:Prosthesis Design; D012189:Retrospective Studies; D013526:Surgical Mesh; D054047:Surgical Stomas / Q000009:adverse effects*
keywords: Intraperitoneal onlay mesh; Parastomal hernia; Prevention; Three-dimensional funnel mesh