• 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 H W de Wilt, Robert P Bleichrodt, Camiel Rosman, and Dutch Prevent Study group.
• *Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands †Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands ‡Department of Surgery, Isala, Zwolle, the Netherlands §Department of Surgery, Slingeland Hospital, Doetinchem, the Netherlands ¶Department of Surgery, Albert Schweitzer Hospital Dordrecht, Dordrecht, the Netherlands ||Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands **Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands ††Department of Surgery, Elkerliek Hospital, Helmond, the Netherlands ‡‡Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands §§Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.
• 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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