• Mika Vierimaa, Kai Klintrup, Fausto Biancari, Mikael Victorzon, Monika Carpelan-Holmström, Jyrki Kössi, Ilmo Kellokumpu, Erkki Rauvala, Pasi Ohtonen, Jyrki Mäkelä, and Tero Rautio.
• 1 Department of Surgery, Oulu University Hospital, Oulu, Finland 2 Department of Surgery, Vaasa Central Hospital, Vaasa, Finland 3 Department of Surgery, University of Turku, Turku, Finland 4 Department of Surgery, Helsinki University Hospital, Helsinki, Finland 5 Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland 6 Department of Surgery, Keski-Suomi Central Hospital, Jyväskylä, Finland 7 Department of Radiology, Oulu University Hospital, Oulu, Finland.
• Dis. Colon Rectum. 2015 Oct 1; 58 (10): 943-9.

BackgroundProphylactic placement of a mesh has been suggested to prevent parastomal hernia, but evidence to support this approach is scarce.ObjectiveThe aim of this study was to evaluate whether laparoscopic placement of a prophylactic, dual-component, intraperitoneal onlay mesh around a colostomy is safe and prevents parastomal hernia formation after laparoscopic abdominoperineal resection.DesignThis is a prospective, multicenter, randomized controlled clinical trial.SettingsThis study was conducted at 2 university and 3 central Finnish hospitals.PatientsFrom 2010 to 2013, 83 patients undergoing laparoscopic abdominoperineal resection for rectal cancer were recruited. After withdrawals and exclusions, the outcome of 70 patients, 35 patients in each study group, could be examined.InterventionsIn the intervention group, an end colostomy was created with placement of a intraperitoneal, dual-component onlay mesh and compared with a group with a traditional stoma.Main Outcome MeasuresThe main outcome measures were the incidence of clinically and radiologically detected parastomal hernias and their extent 12 months after surgery. Stoma-related morbidity and the need for surgical repair of parastomal hernia were secondary outcome measures.ResultsParastomal hernia was observed by clinical inspection in 5 intervention patients (14.3%) and in 12 control patients (32.3%; p = 0.049). Surgical repair of parastomal hernia was performed in 1 control patient (3.2%) and in none of the patients in the intervention group. CT detected parastomal hernia in 18 intervention patients (51.4%) and in 17 control patients (53.1%; p = 1.00). The extent of hernias was similar according to European Hernia Society classification (p = 0.41). Colostomy-related morbidity (32.3% vs 14.3%; p = 0.140) did not differ between the study groups.LimitationsThe study was limited by its small size and short follow-up time.ConclusionsProphylactic laparoscopic placement of intraperitoneal onlay mesh does not significantly reduce the overall risk of radiologically detected parastomal hernia after laparoscopic abdominoperineal resection. However, prophylactic mesh repair was associated with significantly lower risk of clinically detected parastomal hernia.

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