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Use of a prosthetic mesh to prevent parastomal hernia during laparoscopic abdominoperineal resection: a randomized controlled trial

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Abstract

Purpose

Prevention of parastomal hernia represents an important aim when a permanent stoma is necessary. The objective of this work is to assess whether implantation of a prophylactic prosthetic mesh during laparoscopic abdominoperineal resection contributed to reduce the incidence of parastomal hernia.

Methods

Rectal cancer patients undergoing elective laparoscopic abdominoperineal resection with permanent colostomy were randomized to placement of a large-pore lightweight mesh in the intraperitoneal/onlay position by the laparoscopic approach (study group) or to the control group (no mesh). Parastomal hernia was defined radiologically by a CT scan performed after 12 months of surgery. The usefulness of subcutaneous fat thickness measured by CT to discriminate patients at risk of parastomal hernia was assessed by ROC curve analysis.

Results

Thirty-six patients were randomized, 19 to the mesh group and 17 to the control group. Parastomal hernia was detected in 50 % of patients in the mesh group and in 93.8 % of patients in the control group (P = 0.008). The AUC for thickness of the subcutaneous abdominal was 0.819 (P = 0.004) and the optimal threshold 23 mm. Subcutaneous fat thickness ≥23 mm was a significant predictor of parastomal hernia (odds ratio 15.7, P = 0.010), whereas insertion of a mesh was a protective factor (odds ratio 0.06, P = 0.031).

Conclusions

Use of prophylactic large-pore lightweight mesh in the intraperitoneal/onlay position by a purely laparoscopic approach reduced the incidence of parastomal hernia formation. Subcutaneous fat thickness ≥23 mm measured by CT was an independent predictor of parastomal hernia.

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Acknowledgments

We thank Marta Pulido, MD; for editing the manuscript and editorial assistance.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The study comply with the current laws of the country. The study protocol was approved by the Ethics Committee of the hospital and all patients signed an informed consent before operation. The study was officially registered under NCT00908661 on clinicaltrials.gov.

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Authors and Affiliations

  1. Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Passeig Vall d’Hebron 119-129, 08035, Barcelona, Spain

    M. López-Cano & M. Armengol-Carrasco

  2. Colorectal Surgery Unit, Department of General Surgery, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain

    R. Lozoya-Trujillo, J. L. Sánchez, F. Vallribera, M. Martí, L. M. Jiménez & E. Espín

  3. Department of Radiology, Hospital Universitari Vall d’Hebrón, Universitat Autonoma de Barcelona, Barcelona, Spain

    S. Quiroga

Authors
  1. M. López-Cano
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  2. R. Lozoya-Trujillo
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  3. S. Quiroga
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  4. J. L. Sánchez
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  5. F. Vallribera
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  6. M. Martí
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  7. L. M. Jiménez
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  8. M. Armengol-Carrasco
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  9. E. Espín
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Corresponding author

Correspondence to M. López-Cano.

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López-Cano, M., Lozoya-Trujillo, R., Quiroga, S. et al. Use of a prosthetic mesh to prevent parastomal hernia during laparoscopic abdominoperineal resection: a randomized controlled trial. Hernia 16, 661–667 (2012). https://doi.org/10.1007/s10029-012-0952-z

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  • DOI: https://doi.org/10.1007/s10029-012-0952-z

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