Abstract
Introduction
Parastomal hernia is a well known clinical problem, and up to 50% of all patients having a stoma will eventually develop a parastomal hernia. There are many surgical options available for the repair of a parastomal hernia, but the prevention of hernia development has only recently received scientific attention. The most encouraging results have included the use of a mesh inserted at the primary operation. We have, therefore, chosen to review the literature regarding the results of operative techniques, including mesh placement, for the prevention of a parastomal hernia.
Materials
We performed a systematic literature search and found five publications which, in total, included 112 patients having a prophylactic mesh during their stoma formation. One study was a randomized controlled trial which included 54 patients, of which, 21 patients had a prophylactic mesh. The remaining four studies were prospective observational series.
Results
Three of the 112 patients had a hernia recurrence within the follow-up period, which ranged from 2 to 48 months. One of the 52 patients that had a sublay mesh placed at the primary operation and two of 60 patients that had an onlay mesh developed a hernia. There were no infections or other serious complications related to the mesh in any of the studies.
Conclusion
The results of placing a prophylactic mesh when performing a permanent stoma in the elective situation are very promising. However, the data are preliminary and with relatively short follow-up times. Therefore, it should be confirmed in larger, double-blinded, controlled randomized clinical trials whether there are short- and long-term advantages of placing a mesh at the primary operation, and where the mesh should be placed in the abdominal wall.
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References
Pearl RK (1989) Parastomal hernias. World J Surg 13:569–572
Carne PW, Robertson GM, Frizelle FA (2003) Parastomal hernia. Br J Surg 90:784–793
Leong AP, Londono-Schimmer EE, Phillips RK (1994) Life-table analysis of stomal complications following ileostomy. Br J Surg 81:727–729
Londono-Schimmer EE, Leong AP, Phillips RK (1994) Life table analysis of stomal complications following colostomy. Dis Colon Rectum 37:916–920
Shellito PC (1998) Complications of abdominal stoma surgery. Dis Colon Rectum 41:1562–1572
Rieger N, Moore J, Hewett P, Lee S, Stephens J (2004) Parastomal hernia repair. Colorectal Dis 6:203–205
Rubin MS, Schoetz DJ Jr, Matthews JB (1994) Parastomal hernia. Is stoma relocation superior to fascial repair? Arch Surg 129:413–418
Amin SN, Armitage NC, Abercrombie JF, Scholefield JH (2001) Lateral repair of parastomal hernia. Ann R Coll Surg Engl 83:206–208
Kasperk R, Klinge U, Schumpelick V (2000) The repair of large parastomal hernias using a midline approach and a prosthetic mesh in the sublay position. Am J Surg 179:186–188
Stephenson BM, Phillips RK (1995) Parastomal hernia: local resiting and mesh repair. Br J Surg 82:1395–1396
Berger D, Bientzle M (2007) Laparoscopic repair of parastomal hernias: a single surgeon’s experience in 66 patients. Dis Colon Rectum 50:1668–1673
Craft RO, Huguet KL, McLemore EC, Harold KL (2008) Laparoscopic parastomal hernia repair. Hernia 12:137–140
Hansson BM, de Hingh IH, Bleichrodt RP (2007) Laparoscopic parastomal hernia repair is feasible and safe: early results of a prospective clinical study including 55 consecutive patients. Surg Endosc 21:989–993
Israelsson LA (2008) Parastomal hernias. Surg Clin North Am 88:113–125
LeBlanc KA, Bellanger DE, Whitaker JM, Hausmann MG (2005) Laparoscopic parastomal hernia repair. Hernia 9:140–144
Mancini GJ, McClusky DA 3rd, Khaitan L, Goldenberg EA, Heniford BT, Novitsky YW, Park AE, Kavic S, LeBlanc KA, Elieson MJ, Voeller GR, Ramshaw BJ (2007) Laparoscopic parastomal hernia repair using a nonslit mesh technique. Surg Endosc 21:1487–1491
McLemore EC, Harold KL, Efron JE, Laxa BU, Young-Fadok TM, Heppell JP (2007) Parastomal hernia: short-term outcome after laparoscopic and conventional repairs. Surg Innov 14:199–204
Bayer I, Kyzer S, Chaimoff C (1986) A new approach to primary strengthening of colostomy with Marlex mesh to prevent paracolostomy hernia. Surg Gynecol Obstet 163:579–580
Gögenur I, Mortensen J, Harvald T, Rosenberg J, Fischer A (2006) Prevention of parastomal hernia by placement of a polypropylene mesh at the primary operation. Dis Colon Rectum 49:1131–1135
Israelsson LA (2005) Preventing and treating parastomal hernia. World J Surg 29:1086–1089
Jänes A, Cengiz Y, Israelsson LA (2004) Preventing parastomal hernia with a prosthetic mesh. Arch Surg 139:1356–1358
Marimuthu K, Vijayasekar C, Ghosh D, Mathew G (2006) Prevention of parastomal hernia using preperitoneal mesh: a prospective observational study. Colorectal Dis 8:672–675
de Ruiter P, Bijnen AB (2005) Ring-reinforced prosthesis for paracolostomy hernia. Dig Surg 22:152–156
Moisidis E, Curiskis JI, Brooke-Cowden GL (2000) Improving the reinforcement of parastomal tissues with Marlex mesh: laboratory study identifying solutions to stomal aperture distortion. Dis Colon Rectum 43:55–60
Longman RJ, Thomson WH (2005) Mesh repair of parastomal hernias—a safety modification. Colorectal Dis 7:292–294
Kingsnorth AN, Sivarajasingham N, Wong S, Butler M (2004) Open mesh repair of incisional hernias with significant loss of domain. Ann R Coll Surg Engl 86:363–366
Mylonakis E, Scarpa M, Barollo M, Yarnoz C, Keighley MR (2001) Life table analysis of hernia following end colostomy construction. Colorectal Dis 3:334–337
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Helgstrand, F., Gögenur, I. & Rosenberg, J. Prevention of parastomal hernia by the placement of a mesh at the primary operation. Hernia 12, 577–582 (2008). https://doi.org/10.1007/s10029-008-0387-8
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DOI: https://doi.org/10.1007/s10029-008-0387-8