title: Bioprosthetic mesh reinforcement during temporary stoma closure decreases the rate of incisional hernia: A blinded, case-matched study in 94 patients with rectal cancer.
abstract: BACKGROUND
  This case-matched study aimed to assess the feasibility and the potential benefits of placement of a prophylactic bioprosthetic collagen porcine mesh during closure of the temporary ileostomy after total mesorectal excision (TME) for rectal cancer.
  
  
  METHODS
  From September 2012 to March 2013, 30 consecutive patients underwent placement of a retromuscular bioprosthetic mesh in the abdominal wall during closure of a diverting ileostomy after sphincter-saving laparoscopic TME for rectal cancer (mesh group). These 30 patients were matched individually to all identical patients who underwent a closure of the ileostomy without mesh after laparoscopic TME extracted from our prospective database (control group). The matching process was performed according to sex, age, body mass index, medically treated diabetes mellitus, neoadjuvant radiotherapy, and the delay between TME and closure of the ileostomy. The primary endpoint was stoma site incisional hernia, assessed in a blinded fashion by CT 1 year later.
  
  
  RESULTS
  Mesh placement was feasible in all mesh group patients. There was no postoperative mortality. Overall postoperative morbidity rates were similar between mesh and control groups (n = 5 [17%] vs n = 7 [11%], respectively; P = .512). On the 1-year CT, incisional hernia at the site of stomal closure was less in the mesh group (n = 1) compared with the control group (n = 12; P = .043). Reoperation for incisional hernia at the site of stomal closure was performed in 8 patients (13%) in the control group, whereas no patient from the mesh group required repair of the hernia (P = .052).
  
  
  CONCLUSIONS
  Placement of a bioprosthetic collagen porcine mesh during closure of the temporary ileostomy after laparoscopic TME for rectal cancer seems to decrease the chance of hernia formation at the stoma site, at least at the 1-year follow-up.
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, Assistance publique-Hôpitaux de Paris, Université Paris VII, Clichy, France.
authors.forename: Léon
authors.initials: L
authors.lastname: Maggiori
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, Assistance publique-Hôpitaux de Paris, Université Paris VII, Clichy, France.
authors.forename: David
authors.initials: D
authors.lastname: Moszkowicz
authors.affiliation: Department of Radiology, Beaujon Hospital, Assistance publique-Hôpitaux de Paris, Université Paris VII, Clichy, France.
authors.forename: Magaly
authors.initials: M
authors.lastname: Zappa
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, Assistance publique-Hôpitaux de Paris, Université Paris VII, Clichy, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Mongin
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, Assistance publique-Hôpitaux de Paris, Université Paris VII, Clichy, France. Electronic address: yves.panis@bjn.aphp.fr.
authors.forename: Yves
authors.initials: Y
authors.lastname: Panis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001705:Bioprosthesis; D016022:Case-Control Studies; D003107:Colorectal Surgery / Q000295:instrumentation / Q000379:methods*; D023381:Endpoint Determination; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000295:instrumentation / Q000379:methods*; D015994:Incidence; D000069290:Incisional Hernia / Q000517:prevention & control*; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D016037:Single-Blind Method; D013552:Swine; D016896:Treatment Outcome