title: Long-term assessment of parastomal hernia prevention by intra-peritoneal mesh reinforcement according to the modified Sugarbaker technique.
abstract: Parastomal hernia (PSH) is a very frequent complication after creation of a permanent colostomy. The aim of that study is to assess the safety and the long-term efficacy of an intra-peritoneal onlay mesh (IPOM) positioned at the time of primary stoma formation to prevent PSH occurrence.
  
  
  
  That multicentre prospective study concerned 29 consecutive patients operated for cancer of the low rectum between 2008 and 2014. There were 14 men and 15 women with a median age of 73 years (range 39-88) and a BMI of 28 (range 21-43). All the patients had potentially curative abdominoperineal excision associated with IPOM reinforcement of the abdominal wall with a round non-slit composite mesh centred on the stoma site and covering the lateralized colon according to the modified Sugarbaker technique. The major outcomes analysed were operative time, complications related to mesh and PSH incidence. Patients were evaluated at 6-month intervals for the first 2 years and thereafter annually with physical examination and CT scan control. For PSH evaluation, we used the classification of Moreno-Matias.
  
  
  
  Surgery was performed by laparoscopy in 24 patients and by laparotomy in 5; 17 had a trans-peritoneal colostomy and 12 an extra-peritoneal colostomy. The median size of the mesh was 15 cm (range 12-20), the operative time 225 min. (range 123-311) and the specific time for mesh placement 15 min. (range 10-30). With a median follow-up of 48 months (range 6-88), no mesh infection or complication requiring mesh removal were recorded. No patient developed a true PSH; two of them had a type Ia PSH (only containing the bowel forming the colostomy with a sac < 5 cm) and were totally asymptomatic.
  
  
  
  In our series, the incidence of PSH was 7 % and no specific mesh-related complication was noted. Prophylactic mesh reinforcement according to the modified Sugarbaker is an effective technique that addresses the issues related to the occurrence of PSH.
authors.affiliation: CHwapi, Site Notre-Dame, 9 Avenue Delmée, 7500, Tournai, Belgium. ph.hauters@bipweb.be.
authors.forename: Philippe
authors.initials: P
authors.lastname: Hauters
authors.affiliation: Polyclinique du Maine, 4 Avenue des Français Libres, 5310, Laval, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Cardin
authors.affiliation: Clinique Saint-Charles, 11 Bld René Levesque, 8500, La Roche Sur Yon, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Lepere
authors.affiliation: Grand Hôpital Diaconesses, 125 Rue d'Avron, 75020, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Valverde
authors.affiliation: Clinique Bizet, 23 Rue Georges Bizet, 75116, Paris, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cossa
authors.affiliation: CHP Saint-Martin, 18 Rue des Roquemonts, 14050, Caen, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Auvray
authors.affiliation: C.M.C. de la Baie de Morlaix, 29600, Morlaix, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Framery
authors.affiliation: Clinique du Mail, 96, Allée du Mail, 17000, La Rochelle, France.
authors.forename: Constantin
authors.initials: C
authors.lastname: Zaranis
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D003125:Colostomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery; D006555:Hernia, Ventral / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D013526:Surgical Mesh; D016896:Treatment Outcome
keywords: Intra-peritoneal only mesh; Modified Sugarbaker technique; Parastomal hernia; Prevention; Prophylactic mesh