Preventing Parastomal Hernia Using a Modified Sugarbaker Technique With Composite Mesh During Laparoscopic Abdominoperineal Resection: A Randomized Controlled Trial.
The aim of this study was to assess the reduction in the incidence of parastomal hernia (PH) after placement of prophylactic synthetic mesh using a modified Sugarbaker technique when a permanent end-colostomy is needed.



Prevention of PH formation is crucial given the high prevalence of PH and difficulties in the surgical repair of PH.



A randomized, prospective, double-blind, and controlled trial. Rectal cancer patients undergoing laparoscopic abdominoperineal resection with permanent colostomy were randomized (1 : 1) to the mesh and nonmesh arms. In the mesh group, a large-pore lightweight composite mesh was placed in the intraperitoneal/onlay fashion using a modified Sugarbaker technique. PH was detected by computed tomography (CT) after a minimum follow-up of 12 months. Analysis was per-protocol.



The mesh group included 24 patients and the control group 28. Preoperative data, surgical time, and postoperative morbidity were similar. The median follow-up was 26 months. After CT examination, 6 of 24 PHs (25%) were observed in the mesh group compared with 18 of 28 (64.3%) in the nonmesh group (odds ratio 0.39, 95% confidence interval 0.18-0.82; P = 0.005). The Kaplan-Meier curves showed significant differences in favor of the mesh group (long-rank = 4.21, P = 0.04). The number needed to treat was 2.5, which confirmed the effectiveness of the intervention.



Placement of a prosthetic mesh by the laparoscopic approach following the modified Sugarbaker technique is safe and effective in the prevention of PH, reducing significantly the incidence of PH.
*Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain †Coloproctology Unit, Corporació Sanitària Parc Taulí, Parc Taulí, Sabadell, Barcelona, Spain ‡Colorectal Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain §Colorectal Surgery Unit, Hospital Universitari de Bellvitge and IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
Manuel
M
López-Cano
Xavier
X
Serra-Aracil
Laura
L
Mora
José Luis
JL
Sánchez-García
Luis Miguel
LM
Jiménez-Gómez
Marc
M
Martí
Francesc
F
Vallribera
Domenico
D
Fraccalvieri
Anna
A
Serracant
Esther
E
Kreisler
Sebastiano
S
Biondo
Eloy
E
Espín
Salvador
S
Navarro-Soto
Manuel
M
Armengol-Carrasco
D034861:Abdominal Wall / Q000601:surgery*; D000368:Aged; D003125:Colostomy; D004311:Double-Blind Method; D005260:Female; D006555:Hernia, Ventral / Q000517:prevention & control*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D013030:Spain; D013526:Surgical Mesh; D016896:Treatment Outcome