Abstract
Background
This is a prospective study of prophylactic mesh placement in the preperitoneal space at the time of stoma formation to prevent parastomal hernia.
Methods
Patients undergoing elective permanent stoma formation and resiting of a stoma were included. Patients with peritoneal contamination were excluded. A 6×6-cm polypropylene mesh was placed in the preperitoneal space (no stitches), and a circular hole was made to let the bowel come through with ease and the stoma was constructed. At follow-up, the patients were examined standing and lying down for parastomal hernia. In the event of clinical uncertainty, a CT scan was done.
Results
A total of 42 patients (20 women, 22 men, mean age 61 years) were eligible for the study. The patients were followed up for a mean of 31 months (range 9–68 months). There were 29 end-colostomies and 8 end-ileostomies and 5 stomas resited. Four parastomal hernias were detected during the follow-up period (9.52%). One required repair due to an ill-fitting stoma bag and leakage. The other three were asymptomatic. One patient developed stomal necrosis which required a new segment of bowel to be brought out through the same opening and the underlying mesh was left undisturbed.
Conclusions
The results of the 2-year follow-up in this study (incidence of parastomal herniation 9.5%) along with available evidence in the literature (incidence 0–8.3%), compared to the results of repair make a strong case for the use of a mesh at the time of initial surgery for the formation of any permanent stoma to prevent parastomal herniation.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Carne PW, Robertson GM, Frizelle FA (2003) Parastomal hernia. Br J Surg 90:784–793
Pearl RK (1989) Parastomal hernias. World J Surg 13:569–572
Tekkis PP, Kocher HM, Payne JG (1999) Parastomal hernia repair: modified thorlakson technique, reinforced by polypropylene mesh. Dis Colon Rectum 42:1505–1508
Israelsson LA (2005) Preventing and treating parastomal hernia. World J Surg 29:1086–1089
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
Janes A, Cengiz Y, Israelsson LA (2004) Preventing parastomal hernia with a prosthetic mesh. Arch Surg 139:1356–1358
Gogenur I, Mortensen J, Harvald T et al (2006) Prevention of parastomal hernia by placement of a polypropylene mesh at the primary operation. Dis Colon Rectum 49:1131–1135
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
Martin L, Foster G (1996) Parastomal hernia. Ann R Coll Surg Engl 78:81–84
Morris-Stiff G, Hughes LE (1998) The continuing challenge of parastomal hernia: failure of a novel polypropylene mesh repair. Ann R Coll Surg Engl 80:184–187
Aldridge AJ, Simson JN (2001) Erosion and perforation of colon by synthetic mesh in a recurrent paracolostomy hernia. Hernia 5:110–112
Steele SR, Lee P, Martin MJ et al (2003) Is parastomal hernia repair with polypropylene mesh safe? Am J Surg 185:436–440
Kanellos I, Vasiliadis K, Angelopoulos S et al (2004) Repair of parastomal hernia with the use of polypropylene mesh extraperitoneally. Tech Coloproctol 8[Suppl 1]:158–160
Rosin JD, Bonardi RA (1977) Paracolostomy hernia repair with Marlex mesh: a new technique. Dis Colon Rectum 20:299–302
Janes A, Cengiz Y, Israelsson LA (2004) Randomized clinical trial of the use of a prosthetic mesh to prevent parastomal hernia. Br J Surg 91:280–282
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
Devlin HB (1983) Alimentary tract and abdominal wall. In: Dudley H (ed) Operative surgery, vol 1, 4th edn. Butterworth, London, pp 441–443
Hansson BM, van Nieuwenhoven EJ, Bleichrodt RP (2003) Promising new technique in the repair of parastomal hernia. Surg Endosc 17:1789–1791
Inan I, Gervaz P, Hagen M, Morel P (2007) Multimedia article. Laparoscopic repair of parastomal hernia using a porcine dermal collagen (Permacol) implant. Dis Colon Rectum 50:1465
Longman RJ, Thomson WH (2005) Mesh repair of parastomal hernias — a safety modification. Colorectal Dis 27:292–294
de Ruiter P, Bijnen AB (1992) Successful local repair of paracolostomy hernia with a newly developed prosthetic device. Int J Colorectal Dis 7:132–134
Balique JG, Benchetrit S, Bouillot JL et al (2005) Intraperitoneal treatment of incisional and umbilical hernias using an innovative composite mesh: four-year results of a prospective multicenter clinical trial. Hernia 9:68–74
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Vijayasekar, C., Marimuthu, K., Jadhav, V. et al. Parastomal hernia: is prevention better than cure? Use of preperitoneal polypropylene mesh at the time of stoma formation. Tech Coloproctol 12, 309–313 (2008). https://doi.org/10.1007/s10151-008-0441-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-008-0441-7