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Randomized Controlled Trial Comparative Study
Prophylactic Mesh Placement During Formation of an End-colostomy Reduces the Rate of Parastomal Hernia: Short-term Results of the Dutch PREVENT-trial.
- Henk-Thijs Brandsma, Birgitta M E Hansson, Theo J Aufenacker, Dick van Geldere, Felix M V Lammeren, Chander Mahabier, Peter Makai, Pascal Steenvoorde, Tammo S de Vries Reilingh, Marinus J Wiezer, Johannes ... more
- *Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands †Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands ‡Department of Surgery, Isala, Zwolle, the Netherlands §D... more
- Ann. Surg. 2017 Apr 1; 265 (4): 663-669.
ObjectiveThe aim of this study was to investigate the incidence of parastomal hernias (PSHs) after end-colostomy formation using a polypropylene mesh in a randomized controlled trial versus conventional colostomy formation.BackgroundA PSH is the most frequent complication after stoma formation. Symptoms may range from mild abdominal pain to life-threatening obstruction and strangulation. The treatment of a PSH is notoriously difficult and recurrences up to 20% have been reported despite the use of mesh. This has moved surgical focus toward prevention.MethodsAugmentation of the abdominal wall with a retro-muscular lightweight polypropylene mesh was compared with the traditional formation of a colostomy. In total, 150 patients (1:1 ratio) were included. The incidence of a PSH, morbidity, mortality, quality of life, and cost-effectiveness was measured after 1 year of follow-up.ResultsThere was no difference between groups regarding demographics and predisposing factors for PSH. Three out of 67 patients (4.5%) in the mesh group and 16 out of 66 patients (24.2%) in the nonmesh group developed a PSH (P = 0.0011). No statistically significant difference was found in infections, concomitant hernias, SF-36 questionnaire, Von Korff pain score, and cost-effectiveness between both study groups.ConclusionProphylactic augmentation of the abdominal wall with a retromuscular lightweight polypropylene mesh at the ostomy site significantly reduces the incidence of PSH without a significant difference in morbidity, mortality, quality of life, or cost-effectiveness.
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