Prevention of parastomal hernia by placement of a polypropylene mesh at the primary operation

Abstract

Introduction: Parastomal hernias occur frequently after placement of a permanent colostomy. Preliminary reports have shown a beneficial effect of placing a mesh at the primary operation to prevent the formation of a parastomal hernia. We studied the safety and prophylactic effect of placing a newly designed polypropylene mesh in an onlay position at the primary operation.

Methods: This was a prospective study that included 25 patients scheduled for elective colorectal surgery. Risk factors for development of parastomal hernia were recorded before surgery. A prepared lasercut polypropylene mesh with six "arms" was placed in an onlay position. Immediate and long-term complications were evaluated by an experienced stoma nurse and a surgeon. Abdominal ultrasound was performed at 6 and 12 months follow-up. Parastomal hernia was defined as both clinical and ultrasonographic signs of protrusion in the vicinity of the stoma.

Results: The median follow-up time was 12 (range, 2-26) months. One patient died eight days after surgery. Of the 24 patients included, none had infections or immediate complications after surgery. Two patients had minor complications necessitating a local revision of one of the mesh arms. No other long-term complication was found. Two patients had signs of parastomal hernia at 6 and 12 months follow-up, respectively.

Conclusions: Placement of a polypropylene mesh in an onlay position at the primary operation is a safe procedure and probably results in a low risk of parastomal hernia occurrence.