Skip to main content

Advertisement

SpringerLink
Log in

Is absorbable mesh useful in preventing parastomal hernia after emergency surgery? The PARTHENOPE study

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

Colostomy is a frequent event in oncological or inflammatory bowel diseases. Its related morbidity includes retraction, infection and parastomal hernia (PH), which is a quite common late complication. Several surgical options are available for PH repair, the majority including mesh. However, results are often disappointing with relevant recurrence rates, up to 33%. The study aim was to assess the feasibility and effectiveness of prophylactic biosynthetic mesh (BIO-A®, polyglycolide-trimethylene carbonate copolymer) placed during colostomy fashioning, in reducing PH. A prospective randomized controlled double-blind trial was conducted from January 2014 to December 2019 to compare conventional end-colostomy with end-colostomy reinforced with BIO-A mesh in ante-rectus position in patients undergoing colon diversion in emergency surgery.

Methods

Patients were clinically followed up at 3, 6, and 12 months and received a CT scan at 6 and 12 months. The postoperative morbidity and wound events were also evaluated.

Results

55 patients receiving conventional colostomy considered as Control Group and 55 patients receiving BIO-A mesh supported colostomy (Mesh Group) were included in the study. At 12 months, the incidence of PH was 9 (12.7%) and 24 (43.6%) in the Mesh Group and Control Group, respectively (p < 0.05). Postoperative morbidity was similar between Mesh Group and Control Group (7 [12.7%] vs 4 [7.3%], respectively; p = 0.340). The multivariable analysis showed that not using a mesh (p = 0.042), age > 70 years (p = 0.041), diabetes (p < 0.001), colon dilation > 7 cm (p < 0.0001) and COPD (p = 0.009) were all related with postoperative PH.

Conclusions

The prophylactic BIO-A mesh positioning during colostomy is an effective procedure reducing PH incidence at a 1 years follow-up guaranteeing low postoperative morbidity.

Study dataset is available on ClinicalTrials.gov ID

NCT04436887.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Carne PWG, Robertson GM, Frizelle FA (2003) Parastomal hernia. Br J Surg 90:784–793

    Article  CAS  PubMed  Google Scholar 

  2. Cingi A, Cakir T, Sever A et al (2006) Enterostomysite hernias: a clinical and computerized tomographic evaluation. Dis Colon Rectum 49:1559–1563

    Article  PubMed  Google Scholar 

  3. Rubin MS, Schoetz DJ, Matthews JB (1994) Parastomal hernia: is stoma relocation superior to fascial repair? Arch Surg 129:413–419

    Article  CAS  PubMed  Google Scholar 

  4. Hansson BME, Slater NJ, vander Velden AS et al (2012) Surgical techniques for parastomal hernia repair. Ann Surg 255:685–695

    Article  PubMed  Google Scholar 

  5. Borab ZM, Shakir S, Lanni MA et al (2017) Does prophylactic mesh placement in elective, midline laparotomy reduce the incidence of incisional hernia? A systematic review and meta-analysis. Surgery 161:1149–1163

    Article  PubMed  Google Scholar 

  6. Pizza F, D’Antonio D, Ronchi A et al (2021) Prophylactic sub-lay non-absorbable mesh positioning following midline laparotomy in a clean-contaminated field: randomized clinical trial (PROMETHEUS). BJS. https://doi.org/10.1093/bjs/znab068inpress

    Article  Google Scholar 

  7. Odensten C, Strigård K, Rutegård J et al (2019) Use of prophylactic mesh when creating a colostomy does not prevent parastomal hernia: a randomized controlled trial-STOMAMESH. Ann Surg 269(3):427–431

    Article  PubMed  Google Scholar 

  8. Kokotovic D, Bisgaard T, Helgstrand F (2016) Long-term recurrence and complications associated with elective incisional hernia repair. JAMA 316(15):1575–1582

    Article  PubMed  Google Scholar 

  9. Pizza F, D’Antonio D, Arcopinto M et al (2020) Safety and efficacy of prophylactic resorbable biosynthetic mesh following midline laparotomy in clean/contemned field: preliminary results of a randomized double blind prospective trial. Hernia 24(1):85–92

    Article  CAS  PubMed  Google Scholar 

  10. van den Hil LCL, van Steensel S, Schreinemacher MHF et al (2019) Prophylactic mesh placement to avoid incisional hernias after stoma reversal: a systematic review and meta-analysis. Hernia 23(4):733–741

    Article  PubMed  PubMed Central  Google Scholar 

  11. Cuschieri S (2019) The CONSORT statement. Saudi J Anaesth 13(Suppl 1):S27–S30

    Article  PubMed  PubMed Central  Google Scholar 

  12. Costa G, Ruscelli P, Balducci G et al (2016) Clinical strategies for the management of intestinal obstruction and pseudo-obstruction. A Delphi Consensus study of SICUT (Società Italiana di Chirurgia d’Urgenza e del Trauma). Ann Ital Chir 87:105–117

    PubMed  Google Scholar 

  13. Śmietański M, Szczepkowski M, Alexandre JA et al (2014) European Hernia Society classification of parastomal hernias. Hernia 18(1):1–6

    Article  PubMed  Google Scholar 

  14. Moreno-Matias J, Serra-Aracil X, Darnell-Martin J et al (2009) The prevalence of parastomal hernia after formation of an end colostomy. A new clinic-radiological classification. Colorectal Dis 11:173–177

    Article  CAS  PubMed  Google Scholar 

  15. Hodgkinson JD, Worley G, Warusavitarne J et al (2021) Evaluation of the Ventral Hernia Working Group classification for long-term outcome using English Hospital Episode Statistics: a population study. Hernia 25:977–984

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Mangram AJ, Horan TC, Pearson ML et al (1999) Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27(2):97–132 (quiz 133–134; discussion 96)

    Article  CAS  PubMed  Google Scholar 

  17. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  PubMed  Google Scholar 

  18. Morales-Conde S (2012) A new classification for seroma after laparoscopic ventral hernia repair. Hernia 16(3):261–267 (Erratum in: Hernia. 2013 Feb;17(1):153)

    Article  CAS  PubMed  Google Scholar 

  19. Karcioglu O, Topacoglu H, Dikme O et al (2018) A systematic review of the pain scales in adults: which to use? Am J Emerg Med 36(4):707–714

    Article  PubMed  Google Scholar 

  20. McHorney CA, Ware JE, Raczek AE (1993) The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 31(3):247–263

    Article  CAS  PubMed  Google Scholar 

  21. Serra-Aracil X, Bombardo-Junca J et al (2009) Randomized, controlled, prospective trial of the use of a mesh to prevent parastomal hernia. Ann Surg 249:583–587

    Article  PubMed  Google Scholar 

  22. De Raet J, Delvaux G, Haentjens P et al (2008) Waist circumference is an independent risk factor for the development of parastomal hernia after permanent colostomy. Dis Colon Rectum 51:1806–1809

    Article  PubMed  Google Scholar 

  23. Sohn YJ, Moon SM, Shin US et al (2012) Incidence and risk factors of parastomal hernia. J Korean Soc Coloproctol 28:241–246

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hansson BM, Slater NJ, van der Velden AS et al (2012) Surgical techniques for parastomal hernia repair: a systematic review of the literature. Ann Surg 255:685–695

    Article  PubMed  Google Scholar 

  25. Kallinowski F, Ludwig Y, Löffler T et al (2021) Biomechanics applied to incisional hernia repair—Considering the critical and the gained resistance towards impacts related to pressure. Clin Biomech (Bristol, Avon) 82:105253

    Article  CAS  Google Scholar 

  26. Petro CC, Como JJ, Yee S, Prabhu AS, Novitsky YW, Rosen MJ (2015) Posterior component separation and transversus abdominis muscle release for complex incisional hernia repair in patients with a history of an open abdomen. J Trauma Acute Care Surg 78(2):422–429

    Article  PubMed  Google Scholar 

  27. Lambrecht JR (2021) Endoscopic preperitoneal parastomal hernia repair (ePauli repair): an observational study. Surg Endosc 35(4):1903–1907. https://doi.org/10.1007/s00464-020-08192-1 (Epub 2021 Jan 4. Erratum in: Surg Endosc. 2021 Sep;35(9):5397)

    Article  PubMed  PubMed Central  Google Scholar 

  28. Hauters P, Cardin JL, Lepere M et al (2016) Long-term assessment of parastomal hernia prevention by intra-peritoneal mesh reinforcement according to the modified Sugarbaker technique. Surg Endosc 30(12):5372–5379

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Nothing to declare.

Funding

No funds were requested or obtained.

Author information

Authors and Affiliations

  1. Department of Surgery, Aslnapoli2nord - Hospital “A. Rizzoli”, Naples, Italy

    F. Pizza & D. D’Antonio

  2. Division of General, Mininvasive and Bariatric Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy

    F. S. Lucido, L. Brusciano, S. Tolone, L. Docimo & C. Gambardella

  3. Istituto Nazionale dei Tumori IRCS “Fondazione Pascale”, Naples, Italy

    P. Del Rio

  4. AORN “dei Colli” Monaldi-Cotugno-CTO Department of Infectious Diseases-Hepatologic Address, Rome, Italy

    C. Dell’Isola

Authors
  1. F. Pizza
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. D’Antonio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. S. Lucido
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Del Rio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Dell’Isola
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. Brusciano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Tolone
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. L. Docimo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C. Gambardella
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

FP: Conceptualization, methodology, software, data curation, writing-original draft preparation. DD: Visualization, investigation. LB and LD: Supervision, FSL, ST: Software, validation, AM, CD and CG: Reviewing, editing.

Corresponding author

Correspondence to F. Pizza.

Ethics declarations

Conflict of interest

The authors, Francesco Pizza PhD Md, Dario D’antonio Md, Francesco Saverio Lucido Md, Claudio Gambardella Md, Chiara dell’Isola Md, Salvatore Tolone Md, PhD, Ludovico Docimo, Md, Luigi Brusciano and Paolo Del Rio Md declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 205284 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pizza, F., D’Antonio, D., Lucido, F.S. et al. Is absorbable mesh useful in preventing parastomal hernia after emergency surgery? The PARTHENOPE study. Hernia 26, 507–516 (2022). https://doi.org/10.1007/s10029-022-02579-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-022-02579-w

Keywords

Search

Navigation