Parastomal hernia prevention with permanent mesh in end colostomy : failure with late follow-up of cohorts in three randomized trials
López-Cano, Manuel (Hospital Universitari Vall d'Hebron)
Adell-Trapé, Montse (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Verdaguer-Tremolosa, M (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Rodrigues-Gonçalves, V. (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Badia-Closa, Jesus (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Serra-Aracil, Xavier (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Universitat Autònoma de Barcelona

Data:	2023
Resum:	Short-term results have been reported regarding parastomal hernia (PH) prevention with a permanent mesh. Long-term results are scarce. The objective was to assess the long-term PH occurrence after a prophylactic synthetic non-absorbable mesh. Long-term data of three randomized controlled trials (RCTs) were collected. The primary outcome was the detection of PH based exclusively on a radiological diagnosis by computed tomography (CT) performed during the long-term follow-up. The Kaplan-Meier method was used for the comparison of time to diagnosis of PH according to the presence of mesh vs. no-mesh and the technique of mesh insertion: open retromuscular, laparoscopic keyhole, and laparoscopic modified Sugarbaker. We studied 121 patients (87 men, median age 70 years), 82 (67. 8%) of which developed a PH. The median overall length of follow-up was 48. 5 months [interquartile range (IQR) 14. 4-104. 9], with a median time until PH diagnosis of 17. 7 months (IQR 9. 3-49. 0). The survival analysis did not show significant differences in the time to development of a PH according to the presence or absence of a prophylactic mesh neither in the overall study population (log-rank, P = 0. 094) nor in the groups of each technique of mesh insertion, although according to the surgical technique, a higher reduction in the appearance of PH for the open retromuscular technique was found (log-rank, P = 0. 001). In the long-term follow-up placement of a non-absorbable synthetic prophylactic mesh in the context of an elective end colostomy does not seem effective for preventing PH.
Nota:	Altres ajuts: acords transformatius de la UAB
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Parastomal ; Hernia ; Prevention ; Mesh
Publicat a:	Hernia, Vol. 27 N. 3 (june 2023) , p. 657-664, ISSN 1248-9204

DOI: 10.1007/s10029-023-02781-4
PMID: 36966221

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