Diseases of the colon and rectum
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Randomized Controlled Trial
Prospective, Randomized Study on the Use of a Prosthetic Mesh for Prevention of Parastomal Hernia of Permanent Colostomy.
Prophylactic placement of a mesh has been suggested to prevent parastomal hernia, but evidence to support this approach is scarce. ⋯ Prophylactic 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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Recent published articles reported a wide geographic variation in the utilization of laparoscopic colectomy in the United States. ⋯ Although we have finally reached the point where a majority of patients undergoing an elective colectomy for diverticular disease and colon cancer receive a laparoscopic operation, there is wide variation in the implementation of laparoscopic surgery in colon resection in the United States. The utilization of a laparoscopic approach has associations with hospital factors such as size, teaching status of the hospital, and geographic location (urban vs rural).