title: Prophylactic stoma mesh did not prevent parastomal hernias.
abstract: OBJECTIVE
  Parastomal herniation is reported in up to 50 % of patients with a colostomy. A prophylactic stoma mesh has been reported to reduce parastomal hernia rates. The aim of the study was to evaluate the rate of parastomal hernias in a population-based cohort of patients, operated with and without a prophylactic mesh at two different time periods.
  
  
  METHODS
  All rectal cancer patients operated with an abdominoperineal excision or Hartmann's procedure between 1996 and 2012 were included. From 2007, a prophylactic stoma mesh was placed in the retro-muscular plane. Patients were followed prospectively with clinical and computed tomography examinations.
  
  
  RESULTS
  There were no differences with regard to age, gender, pre-operative albumin levels, ASA score, body mass index (BMI), smoking or type of surgical resection between patients with (n = 71) and without a stoma mesh (n = 135). After a minimum follow-up of 1 year, 187 (91%) of the patients were alive and available for analysis. At clinical and computed tomography examinations, exactly the same parastomal hernia rates were found in the two groups, viz, 25 and 53%, respectively (p = 0.95 and p = 0.18). The hernia sac contained omentum or intestinal loops in 26 (81%) versus 26 (60%) patients with and without a mesh, respectively (p = 0.155). In the multivariate analyses, high BMI was associated with parastomal hernia formation.
  
  
  CONCLUSIONS
  A prophylactic stoma mesh did not reduce the rate of clinically or computed tomography-verified parastomal hernias. High BMI was associated with an increased risk of parastomal hernia formation regardless of prophylactic stoma mesh.
authors.affiliation: Department of Surgery, Västmanland's Hospital Västerås, 721 89, Västerås, Sweden, maziar.nikberg@ltv.se.
authors.forename: Maziar
authors.initials: M
authors.lastname: Nikberg
authors.forename: Ingvar
authors.initials: I
authors.lastname: Sverrisson
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsimogiannis
authors.forename: Abbas
authors.initials: A
authors.lastname: Chabok
authors.forename: Kenneth
authors.initials: K
authors.lastname: Smedh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003125:Colostomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh