title: Stapled Mesh Reinforcement Technique (SMART) to Prevent Parastomal Hernias: Our Initial Experience and Review of the Literature.
abstract: Parastomal hernia is one of the most common stoma related complication, with the correlated risk of incarceration, obstruction, and strangulation. The incidence is high (30-50%) and depends on the length of follow up. Different surgical options for repairing are defective with a 25-70% failure and recurrence rate. Prevention of parastomal hernia with mesh reinforcement seems to be effective. Three available trials are recruiting patients: Prism (with matrix porcine prothesis), Prevent (with preperitoneal polypropylene mesh), and the stapled polypropylene mesh stoma reinforcement technique (SMART). We performed the SMART procedure in six patients undergoing definitive colostomy. Our cases show that the procedure is rapid (duration range 15-20 minutes), cost effective (500 euro), and safe (in our experience, there are no post-surgical complications that are procedure-related). A long term follow-up and a higher number of patients will give us confirmation of the initial hopeful results.
authors.forename: Simona
authors.initials: S
authors.lastname: Macina
authors.affiliation: Department of General Surgery, IRCCS San Martino Hospital, Genoa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Mandolfino
authors.affiliation: Department of General Surgery, IRCCS San Martino Hospital, Genoa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Frascio
authors.affiliation: Department of General Surgery, IRCCS San Martino Hospital, Genoa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Casaccia
authors.affiliation: Department of General Surgery, IRCCS San Martino Hospital, Genoa, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Stabilini
authors.affiliation: Department of General Surgery, IRCCS San Martino Hospital, Genoa, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Fornaro
authors.affiliation: Department of General Surgery, IRCCS San Martino Hospital, Genoa, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Testa
mesh_terms: D004867:Equipment Design; D019544:Equipment Failure Analysis; D046449:Hernia, Abdominal / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D010865:Pilot Projects; D013526:Surgical Mesh; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000295:instrumentation / Q000379:methods; D054047:Surgical Stomas / Q000009:adverse effects*; D013537:Sutures; D016896:Treatment Outcome