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Mäkäräinen EJ, Wiik HT, Kössi JAO, Pinta TM, Mäntymäki LMJ, Mattila AK, Ohtonen PP, Rautio TT. Three-year results of a randomized clinical trial comparing retrorectus synthetic mesh and biological mesh for incisional hernia prevention following loop ileostomy closure (Preloop trial). BJS Open 2025; 9:zraf058. [PMID: 40380814 DOI: 10.1093/bjsopen/zraf058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Revised: 03/24/2025] [Accepted: 04/04/2025] [Indexed: 05/19/2025] Open
Affiliation(s)
| | - Heikki T Wiik
- Oulu University Hospital, Medical Research Centre Oulu, Oulu, Finland
| | - Jyrki A O Kössi
- Päijät-Häme Central Hospital, Gastrointestinal surgery department, Lahti, Finland
| | - Tarja M Pinta
- Seinäjoki Central Hospital, Gastrointestinal surgery department, Seinäjoki, Finland
| | | | - Anne K Mattila
- Jyväskylä Central Hospital, Gastrointestinal surgery department, Jyväskylä, Finland
| | - Pasi P Ohtonen
- Oulu University Hospital, Medical Research Centre Oulu, Oulu, Finland
| | - Tero T Rautio
- Oulu University Hospital, Medical Research Centre Oulu, Oulu, Finland
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Drissi F, Jurczak F, Dabrowski A, Oberlin O, Khalil H, Gillion JF, Meurette G. Long-term outcome of prophylactic biosynthetic mesh reinforcement at the time of loop ileostomy reversal for colorectal cancer- results of a case-matched study. Hernia 2025; 29:133. [PMID: 40183887 DOI: 10.1007/s10029-025-03328-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Accepted: 03/23/2025] [Indexed: 04/05/2025]
Abstract
PURPOSE Stoma site incisional hernia (SSIH) is a frequent complication following ileostomy closure but can be potentially decreased by prophylactic mesh reinforcement. The aim was to assess if the use of a slowly absorbable biosynthetic mesh at the time of ileostomy reversal could reduce the incidence of SSIH. METHODS Outcomes of consecutive patients receiving prophylactic biosynthetic mesh (poly-4-hydroxybutyrate Phasix®, BD) implantation at the time of ileostomy reversal for colorectal cancer were prospectively collected in the Club Hernie database. Outcomes were compared with those of matched patients from a historical cohort of patients undergoing ileostomy reversal without mesh augmentation. RESULTS A total of 100 patients underwent ileostomy reversal: 50 with biosynthetic mesh augmentation (mesh group) and 50 with standard fascial closure without mesh (control group). Mesh augmentation did not increase the operating time (mesh group 49.8 min vs. control group 60.5 min, p < 0.01), the incidence of surgical site infection (mesh group 4% vs. control group 6%, p = 1) or the length of hospital stay (mesh group 5 days vs. control group 6 days, p = 0.28). After a mean follow-up of 4 years, the rate of SSIH, diagnosed by CT scan, was significantly lower in the mesh group (mesh group 8% vs. control group 24%, p = 0.029). CONCLUSION Prophylactic use of a slowly absorbable biosynthetic mesh at the time of ileostomy reversal for colorectal cancer was safe and effective in reducing the rate of SSIH without increasing surgical site infection.
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Affiliation(s)
- Farouk Drissi
- Chirurgie Digestive, Viscérale et Générale, Clinique Jules Verne, 2-4 route de Paris, Nantes, 44300, France.
- Chirurgie Cancérologique Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Hôtel Dieu, CHU de Nantes, 1 place Alexis Ricordeau, Nantes Cedex 01, 44093, France.
| | - Florent Jurczak
- Chirurgie Générale et Digestive, Clinique Mutualiste de l'Estuaire, Cité Sanitaire, 11 boulevard Georges Charpak, Saint Nazaire, 44606, France
| | - André Dabrowski
- Chirurgie Viscérale et Digestive, Clinique de Saint Omer, Saint Omer, France
| | - Olivier Oberlin
- Groupe Hospitalier Diaconesses, Croix Saint Simon, Service de Chirurgie Digestive, 125 rue d'Avron, Paris, 75020, France
| | - Haitham Khalil
- Service de Chirurgie Générale et Digestive, CHU de Rouen, 1 rue Germont, Rouen, 76031, France
| | | | - Guillaume Meurette
- Service de Chirurgie Digestive, Hôpitaux Universitaires de Genève, Geneva, Suisse
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Quattrone M, Moyer ED, Zolin SJ, Sodomin EM, Alli VV, Horne CM, Pauli EM. Short-term outcomes of mesh-suture repair in the treatment of ventral hernias: a single-center study. Surg Endosc 2025; 39:2129-2135. [PMID: 39870827 DOI: 10.1007/s00464-025-11524-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 12/30/2024] [Indexed: 01/29/2025]
Abstract
BACKGROUND Defect closure with mesh suture is a novel technique for hernia repair. Originally described as the construction of lightweight macroporous polypropylene mesh strips as a suture material, it is now available as an FDA-approved product. Mesh suture better distributes tensile forces and reduces fascial tearing compared to traditional suture but requires less implanted material and tissue dissection compared to planar mesh. Limited studies have demonstrated mesh suture's effectiveness in short-term recurrence rates. This study describes the short-term outcomes of our initial experience with mesh-suture-based herniorrhaphy. METHODS This study is an IRB-approved, single-center, retrospective review of surgeon case logs from May 2023 to February 2024. All patients who had undergone hernia repair utilizing mesh suture (Duramesh, Mesh Suture Inc, Chicago, IL) as the method of repair at our medical center were enrolled. A descriptive analysis regarding patient and hernia characteristics was performed and short-term outcomes were analyzed. RESULTS We identified 63 patients (Mean age 61, Mean BMI 31.0 kg/m2, 60% female) who had undergone mesh-suture repair since its availability at our institution. Hernias included 31.7% primary, 27.0% incisional, 34.9% parastomal, and 6.4% other. Of these, 8 (12.7%) were recurrent hernia repairs. The average defect size was 41.0 cm2, with a range from 0.25 to 459 cm2. Average length of stay was 3.2 days, with a range of 0 to 20. Eleven patients (17.5%) were readmitted in the 90-day postoperative period. With an average follow-up of 45 days, there were ten surgical site occurrences (including four surgical site infections) and three recurrences (4.8%). CONCLUSIONS Our initial experience with mesh-suture herniorrhaphy has demonstrated acceptable short-term rates of surgical site occurrences and recurrences. This provides additional support for its use, particularly in patients where a planar mesh-based repair might traditionally be avoided. Further studies of mesh-suture herniorrhaphy long-term recurrence rates and cost-effectiveness are needed.
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Affiliation(s)
- McKell Quattrone
- Division of Minimally Invasive and Bariatric Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Eric D Moyer
- Division of Minimally Invasive and Bariatric Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Samuel J Zolin
- Division of Minimally Invasive and Bariatric Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
- Cleveland Medical Center, University Hospitals, Cleveland, OH, USA
| | - Elizabeth M Sodomin
- Division of Minimally Invasive and Bariatric Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Vamsi V Alli
- Division of Minimally Invasive and Bariatric Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Charlotte M Horne
- Division of Metabolic and Abdominal Wall Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eric M Pauli
- Division of Minimally Invasive and Bariatric Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
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Xu ASY, Zhou J, Sherman BE, Peterson CY, Goldblatt MI. Risk factors and timing of incisional hernia development following ostomy reversal: a retrospective analysis. Surg Endosc 2025; 39:2147-2154. [PMID: 39966126 DOI: 10.1007/s00464-025-11578-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 01/20/2025] [Indexed: 02/20/2025]
Abstract
INTRODUCTION Former stoma-site incisional hernia (FSH) is a common complication after ostomy reversal, with a variable reported incidence of up to 50%. Current literature suggests that FSH is underreported due to the lack of a definitive understanding of the timeline of its occurrence and recurrence, making FSH prevention a clinical dilemma. This study identifies FSH risk factors and diagnostic timeline to aid surgeons' clinical decision-making. METHODS A retrospective chart review was conducted on 340 patients who underwent ostomy reversal between January 1, 2016, and December 31, 2021. Data collected include demographics, medical history, course of ostomy treatment, and hernia diagnosis. Logistic regression and Kaplan-Meier analysis were used to identify risk factors and understand the timeline of hernia occurrence. RESULTS The total incidence of hernia, including patients who had a parastomal hernia before ostomy reversal, FSH after reversal, or both, was 38.8%. The incidence of former stoma-site hernia alone was 24.4%. Significant risk factors identified were elevated BMI, presence of parastomal hernia, hypertension, diabetes, immunosuppression, and the emergency nature of the case. Kaplan-Meier analysis showed that patients with either parastomal hernia prior to ostomy reversal or obesity had a greater than 35% likelihood of being diagnosed with FSH within the first 2 years following reversal. Other risk factors, including chemotherapy, radiation therapy, ostomy history, hernia history, smoking, and type of ostomy, lacked significance. The median time between ostomy reversal and the first FSH diagnosis was 295 days, and 84.3% of the cases were diagnosed within the first 2 years. CONCLUSION Patients with ostomy are at substantial risk of developing FSH throughout the entire span of ostomy treatment. Patients with a high BMI, a parastomal hernia before ostomy closure, diabetes, and hypertension are at even higher risk of developing FSH.
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Affiliation(s)
| | - Jessica Zhou
- Medical College of Wisconsin, Wauwatosa, WI, 53226, USA
| | - Brianne E Sherman
- Medical College of Wisconsin, Wauwatosa, WI, 53226, USA
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd., Wauwatosa, WI, 53226, USA
| | - Carrie Y Peterson
- Medical College of Wisconsin, Wauwatosa, WI, 53226, USA
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd., Wauwatosa, WI, 53226, USA
| | - Matthew I Goldblatt
- Medical College of Wisconsin, Wauwatosa, WI, 53226, USA.
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd., Wauwatosa, WI, 53226, USA.
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Peltrini R, Ferrara F, Parini D, Pacella D, Vitiello A, Scognamillo F, Pilone V, Pietroletti R, De Nardi P. Current approach to loop ileostomy closure: a nationwide survey on behalf of the Italian Society of ColoRectal Surgery (SICCR). Updates Surg 2025; 77:97-106. [PMID: 39520612 DOI: 10.1007/s13304-024-02033-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 10/31/2024] [Indexed: 11/16/2024]
Abstract
Compared to standardized minimally invasive colorectal procedures, there is considerable perioperative heterogeneity in loop ileostomy reversal. This study aimed to investigate the current perioperative practice and technical variations of loop ileostomy reversal following rectal cancer surgery. A nationwide online survey was conducted among members of the Italian Society of ColoRectal Surgery (SICCR). A link to the questionnaire was sent via mail. The survey consisted of 31 questions concerning the main procedural steps and application of the ERAS protocol after loop ileostomy reversal. Overall, 219 participants completed the survey. One respondent in four used a combination of water-soluble contrast studies (WSCS) and digital rectal examination to assess the integrity of the anastomosis before ileostomy closure. Conversely, 17.8% of them used either only WSCS or only endoscopy. Surgeons routinely perform hand-sewn or stapled anastomoses in 45.2% and 54.8% of the cases, respectively. Side-to-side antiperistaltic stapled anastomosis was the most performed anastomosis (36%). Most surgeons declared that they have never used prostheses for abdominal wall closure (64%), whereas 35% preferred retromuscular mesh placement in selected cases only. Forty-six respondents (66.7%) reported using interrupted stitches for skin closure, while 65 (29.7%) a purse-string suture. Furthermore, skin approximation at the stoma site using open methods was significantly more common among surgeons with greater experience in ileostomy reversal (p = 0.031). Overall, a good compliance with the ERAS protocol was found. However, colorectal surgeons were significantly more likely to follow the ERAS pathway than general surgeons (p < 0.05). Surgeons use different anastomotic techniques for ileostomy reversal after rectal cancer surgery. Based on current evidence, purse-string skin closure and ERAS pathway should be implemented, while the role of mesh prophylactic strategy needs to be explored further.
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Affiliation(s)
- Roberto Peltrini
- Department of Public Health, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
| | - Francesco Ferrara
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), Unit of General and Oncologic Surgery, Paolo Giaccone" Hospital, University of Palermo, Palermo, Italy
| | - Dario Parini
- Unit of General Surgery, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Daniela Pacella
- Department of Public Health, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Antonio Vitiello
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Fabrizio Scognamillo
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 1 - Patologia Chirurgica, University of Sassari, Sassari, Italy
| | - Vincenzo Pilone
- Department of Public Health, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Renato Pietroletti
- Department of Clinical Sciences and Biotechnology, University of L'Aquila, Surgical Coloproctolgy Hospital Val Vibrata Sant'Omero, Sant'Omero, TE, Italy
| | - Paola De Nardi
- Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Obi M, Beffa L, Melland-Smith M, Messer N, Kanters A, Judeeba S, Baier K, Miller B, Krpata D, Prabhu A, Steele SR, Rosen M, Holubar SD, Petro C. The rate of ileostomy site incisional hernias: more common than we think? Hernia 2024; 28:2311-2320. [PMID: 39325325 PMCID: PMC11530484 DOI: 10.1007/s10029-024-03163-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 09/01/2024] [Indexed: 09/27/2024]
Abstract
PURPOSE Incisional hernias (IH) rates after diverting loop ileostomy reversal (DLI-R) have been reported up to 24%. We aimed to characterize the incidence rate and risk factors associated with DLI-R site IH formation within 1-year in a large patient cohort. METHODS A retrospective review at a single quaternary referral center hospital of adult patients who underwent DLI-R over a 5-year period and abdominal computerized tomography (CT) imaging performed within 1-year for any indication postoperatively was conducted. All CTs scans were independently reviewed by staff surgeons to determine the presence of a fascial defect at the DLI-R site. RESULTS 2,196 patients underwent DLI-R; of these, 569 (25.9%) underwent CT imaging for any indication. Mean patient age, 54.8 (± 14.9), BMI 27.6 kg/m2. 87 (15%) patients had a parastomal hernia at time of DLI-R. After median follow-up of 10 months, 203 patients (35.7%) had IH at the DLI-R site. Age (p = 0.14), sex (p = 0.39), race (p = 0.75), and smoking status (p = 0.82) weren't associated with IH after DLI-R. Comorbidities weren't significantly associated with IH following DLI-R. In univariate analysis, increased BMI (p < 0.001), presence of a parastomal hernia (p = 0.008), and suture type (p = 0.01) were associated with IH development. On multivariate analysis, BMI remained significant, and polyglyconate compared to polydioxanone suture were associated with higher rates of IH (p < 0.001). CONCLUSION We observed that the rate of incisional hernias within 1-year of diverting ileostomy reversal was indeed common at 36%. Granted, a high percentage of the population was excluded due to heterogeneity in radiographic evaluation that could be mitigated in future prospective studies. Our study suggests that IH preventative strategies include weight loss for overweight and obese patients prior to DLI-R and that the optimal suture for DLI-R is polydioxanone.
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Affiliation(s)
- Megan Obi
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lucas Beffa
- Center for Abdominal Core Health, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Megan Melland-Smith
- Center for Abdominal Core Health, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Nir Messer
- Center for Abdominal Core Health, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Arielle Kanters
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sami Judeeba
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Kevin Baier
- Center for Abdominal Core Health, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Benjamin Miller
- Center for Abdominal Core Health, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - David Krpata
- Center for Abdominal Core Health, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Ajita Prabhu
- Center for Abdominal Core Health, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Scott R Steele
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Michael Rosen
- Center for Abdominal Core Health, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Stefan D Holubar
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Clayton Petro
- Center for Abdominal Core Health, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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Dong Z, Cai J, Geng H, Ni B, Yuan M, Zhang Y, Xia X, Zhang H, Zhang J, Zhu C, Wai Choi U, Regmi A, Chan CI, Yan CK, Gu Y, Cao H, Zhang Z. Image-based deep learning model to predict stoma-site incisional hernia in patients with temporary ileostomy: A retrospective study. iScience 2024; 27:111235. [PMID: 39563889 PMCID: PMC11574812 DOI: 10.1016/j.isci.2024.111235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/22/2024] [Accepted: 10/21/2024] [Indexed: 11/21/2024] Open
Abstract
The prophylactic implantation of biological mesh can effectively prevent the occurrence of stoma-site incisional hernia (SSIH) in patients undergoing stoma retraction. Therefore, our study prospectively established and validated a mixed model, which combined radiomics, stepwise regression, and deep learning for the prediction of SSIH in patients with temporary ileostomy. The mixed model showed good discrimination of the SSIH patients on all cohorts, which outperformed deep learning, radiomics, and clinical models alone (overall area under the curve [AUC]: 0.947 in the primary cohort, 0.876 in the external validation cohort 1, and 0.776 in the external validation cohort 2). Moreover, the sensitivity, specificity, and precision for predicting SSIH were improved in the mixed model. Thus, the mixed model can provide more information for SSIH precaution and clinical decision-making.
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Affiliation(s)
- Zhongyi Dong
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R. China
| | - Jianhua Cai
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai 200040, P.R. China
| | - Haigang Geng
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R. China
| | - Bo Ni
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R. China
| | - Mengqing Yuan
- School of Science, The Hongkong University of Science and Technology, Hongkong 999077, P.R. China
| | - Yeqian Zhang
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R. China
| | - Xiang Xia
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R. China
| | - Haoyu Zhang
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R. China
| | - Jie Zhang
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R. China
| | - Chunchao Zhu
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R. China
| | - Un Wai Choi
- School of Medicine, Shanghai Jiaotong University, Shanghai 200025, P.R. China
| | - Aksara Regmi
- School of Medicine, Shanghai Jiaotong University, Shanghai 200025, P.R. China
| | - Cheok I. Chan
- School of Medicine, Shanghai Jiaotong University, Shanghai 200025, P.R. China
| | - Cara Kou Yan
- School of Medicine, Shanghai Jiaotong University, Shanghai 200025, P.R. China
| | - Yan Gu
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai 200040, P.R. China
| | - Hui Cao
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R. China
| | - Zizhen Zhang
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R. China
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Ascari F, Barugola G, Ruffo G. Diverting ileostomy in benign colorectal surgery: the real clinical cost analysis. Updates Surg 2024; 76:1761-1768. [PMID: 38801603 DOI: 10.1007/s13304-024-01879-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/29/2023] [Indexed: 05/29/2024]
Abstract
There are three types of complications stoma related: ones related to its construction, ones related to its function and related to closure. The aim of this study was to assess the risk of complications related to the stoma presence and to identificate variables related to complications. We conducted a retrospective study of patients who underwent sphincter-preserving elective surgery for benign condition between January 2013 and December 2020 at IRCCS Sacro Cuore Don Calabria Hospital in Negrar, Verona. Data were collected regarding demographics and complications associated with primary surgery, stoma closure and the interval period. Univariable and multivariable analysIs were conducted. A total of 446 (12.2%) diverting loop ileostomies were performed. At index procedure, 76 (17%) patients had complications and 34 patients had complications related to ileostomy creation. Twenty patients (4.4%) were re admitted before stoma closure for dehydration. One hundred and eighty-seven patients (41.9%) suffered from ileostomy management's problems. At univariate analysis, complications of having stoma are more frequent in elder patients (p = 0.013), ASA score > 2 (p = 0.02), IBD diagnosis (p = < 0.001) and patients who had ileostomy creation complications (p = 0.04). At stoma closure, 55 (12.3%) patients had complications. Forty-seven patients (10.5%) presented incisional hernia in the stoma closure site. Ileostomy closure complications are more common with ASA score > 2 (p = 0.01) and IBD diagnosis (p < 0.001). IBD was found an independent factor of poor outcome at the time of ileostomy creation and closure. Developing complications at the time of ileostomy creation is statistically related to develop complications during ileostomy maintenance at multivariable analysis A loop ileostomy is usually created to limit the potentially life-threatening consequenceS of anastomotic leakage, but it is not able to decrease the leak-related mortality, wound sepsis, postoperative bleeding and small bowel obstruction. Debate rises not only for its uncertain efficacy but also because of the significant morbidity related to stoma. The surgeon could use these data in order to tailor his surgical strategy to the patients and their disease.
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Affiliation(s)
- F Ascari
- Chirurgia Generale Ospedale Ramazzini, AUSLModena, Carpi, Modena, Italy.
| | - G Barugola
- Chirurgia Generale IRCCS Sacro Cuore Don Calabria, NegrarDiValpolicella, Verona, Italy
| | - G Ruffo
- Chirurgia Generale IRCCS Sacro Cuore Don Calabria, NegrarDiValpolicella, Verona, Italy
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Luo J, Liu D, Wu J, Jiang H, Chen J, Yang H, Yang L. Purse-string versus linear closure of the skin wound following stoma reversal: A meta-analysis with RCT and systematic review. Medicine (Baltimore) 2024; 103:e39477. [PMID: 39213201 PMCID: PMC11365611 DOI: 10.1097/md.0000000000039477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 08/06/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Linear closure (LC) following stoma reversal is associated with a high risk of surgical site infection (SSI). Purse-string closure and LC were both positive for the closure of the skin wound following stoma reversal, and it was not yet possible to distinguish which one was more beneficial to the patient's prognosis. METHODS We conducted a search in Embase, PubMed, Web of Science, and Cochrane Library and conducted a randomized controlled experiment from the inception of each database to July 2024. Among them, the SSI within 30 days, operation time, hospitalization time, incisional hernia, and wound healing time were all outcome indicators. RESULTS Eleven studies were included in this meta-analysis (506 patients in the purse-string closure group and 489 patients in the LC group). The pooled data showed that the SSI rate was significantly lower in the purse-string closure group than in the LC group (odds ratio, 0.15; 95% confidence interval, 0.09-0.24; P < .00001; I2 = 0%). The differences in operative time, hospitalization time, incision hernia, and wound healing time were not statistically significant. CONCLUSION Overall, purse-string closure had a significantly lower SSI rate following stoma reversal than LC.
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Affiliation(s)
- Jinlong Luo
- Department of Colorectal Anal Surgery, Zigong Fourth People’s Hospital, Zigong, Sichuan Province, China
| | - Dan Liu
- Department of Colorectal Anal Surgery, Zigong Fourth People’s Hospital, Zigong, Sichuan Province, China
| | - Junmei Wu
- Department of Gastrointestinal Oncology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan Province, China
| | - Huaiwu Jiang
- Department of General Surgery, Sichuan Mianyang 404 Hospital, Mianyang, Sichuan Province, China
| | - Jin Chen
- Department of General Surgery, Sichuan Mianyang 404 Hospital, Mianyang, Sichuan Province, China
| | - Hua Yang
- Department of Colorectal Anal Surgery, Zigong Fourth People’s Hospital, Zigong, Sichuan Province, China
| | - Lie Yang
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan Province, China
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Wu XW, Yang DQ, Wang MW, Jiao Y. Occurrence and prevention of incisional hernia following laparoscopic colorectal surgery. World J Gastrointest Surg 2024; 16:1973-1980. [PMID: 39087097 PMCID: PMC11287670 DOI: 10.4240/wjgs.v16.i7.1973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/23/2024] [Accepted: 05/31/2024] [Indexed: 07/22/2024] Open
Abstract
Among minimally invasive surgical procedures, colorectal surgery is associated with a notably higher incidence of incisional hernia (IH), ranging from 1.7% to 24.3%. This complication poses a significant burden on the healthcare system annually, necessitating urgent attention from surgeons. In a study published in the World Journal of Gastrointestinal Surgery, Fan et al compared the incidence of IH among 1614 patients who underwent laparoscopic colorectal surgery with different extraction site locations and evaluated the risk factors associated with its occurrence. This editorial analyzes the current risk factors for IH after laparoscopic colorectal surgery, emphasizing the impact of obesity, surgical site infection, and the choice of incision location on its development. Furthermore, we summarize the currently available preventive measures for IH. Given the low surgical repair rate and high recurrence rate associated with IH, prevention deserves greater research and attention compared to treatment.
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Affiliation(s)
- Xi-Wen Wu
- The First Operating Room, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ding-Quan Yang
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Ming-Wei Wang
- Ministry of Health Key Laboratory of Radiobiology, School of Public Health of Jilin University, Changchun 130000, Jilin Province, China
| | - Yan Jiao
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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11
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Dewantoro D, Manson P, Brazzelli M, Ramsay G. Reversal of stoma with biosynthetic mesh fascial reinforcement: a systematic review and meta-analysis. Colorectal Dis 2024; 26:632-642. [PMID: 38374538 DOI: 10.1111/codi.16913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 12/09/2023] [Accepted: 01/14/2024] [Indexed: 02/21/2024]
Abstract
AIM Temporary stoma formation remains a common part of modern-day colorectal surgical operations. At the time of reversal, a second procedure is required when the bowel is anastomosed and the musculature is closed. The rate of incisional hernia at these sites is 30%-35% with conventional suture closure. Mesh placement at this site is therefore an attractive option to reduce hernia risk, particularly as new mesh types, such as biosynthetic meshes, are available. The aim of this work was to conduct a systematic review and meta-analysis assessing the use of mesh for prophylaxis of incisional hernia at stoma closure and to explore the outcome measures used by each of the included studies to establish whether they are genuinely patient-centred. METHOD This is a systematic review and meta-analysis assessing the published literature regarding the use of mesh at stoma site closure operations. Comprehensive literature searches of major electronic databases were performed by an information specialist. Screening of search results was undertaken using standard systematic review principles. Data from selected studies were input into an Excel file. Meta-analysis of the results of included studies was conducted using RevMan software (v.5.4). Randomized controlled trial (RCT) and non-RCT data were analysed separately. RESULTS Eleven studies with a total of 2008 patients were selected for inclusion, with various mesh types used. Of the included studies, one was a RCT, seven were nonrandomized comparative studies and three were case series. The meta-analysis of nonrandomized studies shows that the rate of incisional hernia was lower in the mesh reinforcement group compared with the suture closure group (OR 0.21, 95% CI 0.12-0.37) while rates of infection and haematoma/seroma were similar between groups (OR 0.7, 95% CI 0.41-1.21 and OR 1.05, 95% CI 0.63-1.80, respectively). The results of the RCT were in line with those of the nonrandomized studies. CONCLUSION Current evidence indicates that mesh is safe and reduces incisional hernia. However, this is not commonly adopted into current clinical practice and the literature has minimal patient-reported outcome measures. Future work should explore the reasons for such slow adoption as well as the preferences of patients in terms of outcome measures that matter most to them.
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Affiliation(s)
- Dickson Dewantoro
- Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Paul Manson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - George Ramsay
- Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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12
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Ramírez-Giraldo C, Van-Londoño I, Monroy DC, Navarro-Alean J, Hernández-Ferreira J, Hernández-Álvarez D, Rojas-López S, Avendaño-Morales V. Risk factors associated to incisional hernia in stoma site after stoma closure: A systematic review and meta-analysis. Int J Colorectal Dis 2023; 38:267. [PMID: 37975888 DOI: 10.1007/s00384-023-04560-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND This study aims to identify which risk factors are associated with the appearance of an incisional hernia in a stoma site after its closure. This in the sake of identifying which patients would benefit from a preventative intervention and thus start implementing a cost-effective protocol for prophylactic mesh placement in high-risk patients. METHODS A systematic review of PubMed, Cochrane library, and ScienceDirect was performed according to PRISMA guidelines. Studies reporting incidence, risk factors, and follow-up time for appearance of incisional hernia after stoma site closure were included. A fixed-effects and random effects models were used to calculate odds ratios' estimates and standardized mean values with their respective grouped 95% confidence interval. This to evaluate the association between possible risk factors and the appearance of incisional hernia after stoma site closure. RESULTS Seventeen studies totaling 2899 patients were included. Incidence proportion between included studies was of 16.76% (CI95% 12.82; 21.62). Out of the evaluated factors higher BMI (p = 0.0001), presence of parastomal hernia (p = 0.0023), colostomy (p = 0,001), and end stoma (p = 0.0405) were associated with the appearance of incisional hernia in stoma site after stoma closure, while malignant disease (p = 0.0084) and rectum anterior resection (p = 0.0011) were found to be protective factors. CONCLUSIONS Prophylactic mesh placement should be considered as an effective preventative intervention in high-risk patients (obese patients, patients with parastomal hernia, colostomy, and end stoma patients) with the goal of reducing incisional hernia rates in stoma site after closure while remaining cost-effective.
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Affiliation(s)
- Camilo Ramírez-Giraldo
- Hospital Universitario Mayor-Méderi, Bogotá, Colombia.
- Universidad del Rosario, Bogotá, Colombia.
| | | | - Danny Conde Monroy
- Hospital Universitario Mayor-Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
| | - Jorge Navarro-Alean
- Hospital Universitario Mayor-Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
| | | | | | - Susana Rojas-López
- Hospital Universitario Mayor-Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
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13
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Melland-Smith M, Miller B, Petro C, Beffa L, Prabhu A, Krpata D, LaBelle M, Tamer R, Rosen M. Single-staged retromuscular abdominal wall reconstruction with mesh at the time of ostomy reversal: are we crossing the line? An ACHQC Analysis. Surg Endosc 2023; 37:7051-7059. [PMID: 37353652 DOI: 10.1007/s00464-023-10176-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 05/30/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION The most appropriate method of reconstructing the abdominal wall at the site of a simultaneous stoma takedown is controversial. The contaminated field, concomitant GI procedure being performed and presence of a hernia all complicate decision-making. We sought to describe the surgical approaches, mesh type and outcomes of concomitant abdominal wall reconstruction during stoma takedown in a large hernia registry. METHODS AND PROCEDURES All patients who underwent stoma takedown with simultaneous hernia repair with retromuscular mesh placement from January 2014 to May 2022 were identified within the Abdominal Core Health Quality Collaborative (ACHQC). Patients were stratified by mesh type including permanent synthetic (PS), resorbable synthetic (RS) and biologic mesh. Association of mesh type with 30-day wound events and other complications and 1-year outcomes were evaluated. RESULTS There were 368 patients who met inclusion criteria. Eighty-nine patients had ileostomies, 276 colostomies and 3 had both. Two hundred and seventy-nine (75.8%) patients received PS mesh, 46 (12.5%) biologic, and 43 (11.7%) RS. Seventy percent (259/368) had a parastomal hernia, 75% (285/368) had a midline incisional hernia, and 48% (178/368) had both. All groups had similar preoperative comorbidities and the majority had a transversus abdominus release. All mesh groups had similar thirty-day SSI (13.2-14.3%), SSO (10.5-17.8%) and SSOPI (7.9-14.1%), p = 0.6. Three patients with PS mesh developed infected synthetic mesh and one PS mesh required excision. Four patients with PS developed an enterocutaneous fistula. Of these, only one patient was recorded as having both an enterocutaneous fistula and mesh infection. Thirty-day reoperation and readmission were similar across all mesh groups. Recurrence at 1-year was similar between mesh groups. Quality of life measured using HerQLes scores were higher at one year compared to baseline in all groups indicating improvement in hernia-specific quality of life. CONCLUSION Early complication rates associated with simultaneous stoma takedown and abdominal wall reconstruction are significant, regardless of mesh type utilized. Concomitant surgery should be weighed heavily and tailored to individual patients.
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Affiliation(s)
- Megan Melland-Smith
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA.
| | - Benjamin Miller
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | - Clayton Petro
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | - Lucas Beffa
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | - Ajita Prabhu
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | - David Krpata
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | | | | | - Michael Rosen
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
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14
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Rondelli F, Gemini A, Cerasari S, Avenia S, Bugiantella W, Desiderio J. Laparoscopic vs. open loop ileostomy reversal: a meta-analysis of randomized and non-randomized studies. Langenbecks Arch Surg 2023; 408:329. [PMID: 37615738 DOI: 10.1007/s00423-023-03075-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/17/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE The present meta-analysis compares laparoscopic loop ileostomy reversal (LLIR) with open loop ileostomy reversal (OLIR) to evaluate the advantages of the laparoscopic technique compared to the traditional open technique in ileostomy reversal. METHODS Primary endpoints were hospital stay and overall complications. Secondary endpoints were operative time, EBL, readmission, medical complications, surgical complications, reoperation, wound infection, anastomotic leak, intestinal obstruction, and cost of the procedures. The included studies were also divided based on the type of anastomotic approach: extracorporeal laparoscopic loop ileostomy reversal (ELLIR) and intracorporeal laparoscopic loop ileostomy reversal (ILLIR). RESULTS In the analysis, 4 studies were included. Three hundred fifty-four patients were enrolled. As primary outcomes, a significant difference was found in hospital stay between the LLIR and OLIR groups (MD = -0.67, 95% CI -1.16 to -0.19, P = 0.007). The overall complications outcome resulted in favor of the LLIR group (RR = 0.64, 95% CI 0.43-0.95, P = 0.03). As secondary outcomes, the operative time was in favor of the OLIR group (MD = 19.18, 95% CI 10.20-28.16, P < 0.001). Surgical complications were lower in the LLIR group than in the OLIR group. No other differences between the secondary endpoints were found. Subgroup analysis showed a significant difference in hospital stay between the ILLIR and OLIR groups (MD = -0.92, 95% CI -1.55 to -0.30, P = 0.004). The overall complications outcome significantly favored the ILLIR group (RR = 0.38, 95% CI 0.15-0.96, P = 0.04). CONCLUSION Our meta-analysis shows an advantage in terms of shorter post-operative hospitalization and reduction of complications of LLIR compared to OLIR. The sub-group analysis shows that performing an extracorporeal anastomosis exposes the same risks of the open technique.
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Affiliation(s)
- Fabio Rondelli
- Department of General Surgery and Surgical Specialties, University of Perugia, "S. Maria" Hospital, 05100, Terni, Italy
| | - Alessandro Gemini
- Department of Digestive Surgery, University of Perugia, "S. Maria" Hospital, 05100, Terni, Italy.
| | - Saverio Cerasari
- Department of General Surgery and Surgical Specialties, University of Perugia, "S. Maria" Hospital, 05100, Terni, Italy
| | - Stefano Avenia
- Department of General Surgery and Surgical Specialties, University of Perugia, "S. Maria" Hospital, 05100, Terni, Italy
| | - Walter Bugiantella
- Department of General Surgery, "San Giovanni Battista" Hospital, Usl Umbria 2, 06034, Foligno, PG, Italy
| | - Jacopo Desiderio
- Department of Digestive Surgery, University of Perugia, "S. Maria" Hospital, 05100, Terni, Italy
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15
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Siddiqui UT, Gontarz B, Lewis RT, Wakefield DB, Scott RB. The utilization of an absorbable mesh after ostomy reversal does not decrease incisional hernia rates. Am J Surg 2023; 226:233-238. [PMID: 37301644 DOI: 10.1016/j.amjsurg.2023.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/10/2023] [Accepted: 04/18/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Postoperative ostomy reversal hernias are common and can create strain on the healthcare system. There is little literature evaluating the utilization of absorbable mesh following ostomy reversal. The effect on subsequent hernia rates at our institution has not been evaluated. We examine if the addition of absorbable mesh decreases the postoperative hernia rate in our patient population. METHODS We performed a retrospective review of all ileostomy and colostomy reversals. Patients were divided into two groups based on whether an absorbable mesh was used at ostomy closure or not. RESULTS Hernia recurrence rates were lower in the group that had mesh reinforcement (8.96%) vs the group that did not receive a mesh (14.8%) though this was not statistically significant (p = 0.233). CONCLUSION Prophylactic use of an absorbable biosynthetic mesh did not alter the rate of incisional hernia rates following ostomy reversal in our cohort of patients.
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Affiliation(s)
| | - Brendan Gontarz
- Saint Francis Hospital and Medical Center, Hartford, CT, USA; University of Connecticut, School of Medicine, Farmington, CT, USA
| | - Robert T Lewis
- Saint Francis Hospital and Medical Center, Hartford, CT, USA; Colon and Rectal Surgeons of Greater Hartford, Bloomfield, CT, USA
| | | | - Rachel B Scott
- Saint Francis Hospital and Medical Center, Hartford, CT, USA; Colon and Rectal Surgeons of Greater Hartford, Bloomfield, CT, USA.
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16
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Mao Y, Xi L, Lu C, Miao J, Li Q, Shen X, Yu C. Incidence, risk factors, and predictive modeling of stoma site incisional hernia after enterostomy closure: a multicenter retrospective cohort study. BMC Gastroenterol 2023; 23:201. [PMID: 37296427 DOI: 10.1186/s12876-023-02805-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE Stoma site incisional hernia (SSIH) is a common complication, but its incidence and risk factors are not well known. The objective of this study is to explore the incidence and risk factors of SSIH and build a predictive model. METHODS We performed a multicenter retrospective analysis on the patients who underwent enterostomy closure from January 2018 to August 2020. Patient's general condition, perioperative, intraoperative, and follow-up information was collected. The patients were divided into control group (no occurrence) and observation group (occurrence) according to whether SSIH occurred. Univariate and multivariate analysis were used to evaluate the risk factors of SSIH, following which we constructed a nomogram for SSIH prediction. RESULTS One hundred fifty-six patients were enrolled in the study. The incidence of SSIH was 24.4% (38 cases), of which 14 were treated with hernia mesh repair, and the others were treated with conservative treatment. Univariate and multivariate analysis showed that age ≥ 68 years (OR 1.045, 95% CI 1.002 ~ 1.089, P = 0.038), colostomy (OR 2.913, 95% CI 1.035 ~ 8.202, P = 0.043), BMI ≥ 25 kg/m2 (OR 1.181, 95% CI 1.010 ~ 1.382, P = 0.037), malignant tumor (OR 4.838, 95% CI 1.508 ~ 15.517, P = 0.008) and emergency surgery (OR 5.327, 95% CI 1.996 ~ 14.434, P = 0.001) are the independent risk factors for SSIH. CONCLUSIONS Based on the results, a predictive model for the occurrence of SSIH was constructed to screen high-risk groups of SSIH. For patients at high risk for SSIH, how to deal with the follow-up and prevent the occurrence of SSIH is worth further exploration.
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Affiliation(s)
- Yonghuan Mao
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ling Xi
- Department of Gerontology, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Chen Lu
- Department of General Surgery, Sir Run Run Hospital of Nanjing Medical University, Nanjing, China
| | - Ji Miao
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Qiang Li
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
| | - Xiaofei Shen
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
| | - Chunzhao Yu
- Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
- Department of General Surgery, Sir Run Run Hospital of Nanjing Medical University, Nanjing, China.
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17
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Mäkäräinen EJ, Wiik HT, Kössi JA, Pinta TM, Mäntymäki LMJ, Mattila AK, Kairaluoma MV, Ohtonen PP, Rautio TT. Synthetic mesh versus biological mesh to prevent incisional hernia after loop-ileostomy closure: a randomized feasibility trial. BMC Surg 2023; 23:68. [PMID: 36973782 PMCID: PMC10045611 DOI: 10.1186/s12893-023-01961-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Incisional hernia is a frequent complication after loop-ileostomy closure, rationalizing hernia prevention. Biological meshes have been widely used in contaminated surgical sites instead of synthetic meshes in fear of mesh related complications. However, previous studies on meshes does not support this practice. The aim of Preloop trial was to study the safety and efficacy of synthetic mesh compared to a biological mesh in incisional hernia prevention after loop-ileostomy closure. METHODS The Preloop randomized, feasibility trial was conducted from April 2018 until November 2021 in four hospitals in Finland. The trial enrolled 102 patients with temporary loop-ileostomy after anterior resection for rectal cancer. The study patients were randomized 1:1 to receive either a light-weight synthetic polypropylene mesh (Parietene Macro™, Medtronic) (SM) or a biological mesh (Permacol™, Medtronic) (BM) to the retrorectus space at ileostomy closure. The primary end points were rate of surgical site infections (SSI) at 30-day follow-up and incisional hernia rate during 10 months' follow-up period. RESULTS Of 102 patients randomized, 97 received the intended allocation. At 30-day follow-up, 94 (97%) patients were evaluated. In the SM group, 1/46 (2%) had SSI. Uneventful recovery was reported in 38/46 (86%) in SM group. In the BM group, 2/48 (4%) had SSI (p > 0.90) and in 43/48 (90%) uneventful recovery was reported. The mesh was removed from one patient in both groups (p > 0.90). CONCLUSIONS Both a synthetic mesh and biological mesh were safe in terms of SSI after loop-ileostomy closure. Hernia prevention efficacy will be published after the study patients have completed the 10 months' follow-up.
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Affiliation(s)
- Elisa J Mäkäräinen
- Medical Research Center Oulu, Oulu University Hospital, PL 10, Oulu, 90029, Finland.
| | - Heikki T Wiik
- Medical Research Center Oulu, Oulu University Hospital, PL 10, Oulu, 90029, Finland
| | - Jyrki Ao Kössi
- Päijät-Häme Central Hospital, Keskussairaalankatu 7, Lahti, 15850, Finland
| | - Tarja M Pinta
- Seinäjoki Central Hospital, Hanneksenrinne 7, Seinäjoki, 60220, Finland
| | | | - Anne K Mattila
- Keski-Suomi Central Hospital, Hoitajantie 3, Jyväskylä, 40620, Finland
| | | | - Pasi P Ohtonen
- Medical Research Center Oulu, Oulu University Hospital, PL 10, Oulu, 90029, Finland
| | - Tero T Rautio
- Medical Research Center Oulu, Oulu University Hospital, PL 10, Oulu, 90029, Finland
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18
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ABDELSHAHID MA, ELBALSHY MA, ABU BAKRE F, ELMALLAH AS. "Cross-over" versus mass closure techniques for elective midline laparotomies. Chirurgia (Bucur) 2023. [DOI: 10.23736/s0394-9508.22.05397-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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19
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Müller S, Weyhe D, Herrle F, Horvath P, Bachmann R, von Ehrlich-Treuenstätt V, Heger P, Nasir N, Klose C, Ritz A, Sander A, Grohmann E, Dörr-Harim C, Mihaljevic AL. Prophylactic effect of retromuscular mesh placement during loop ileostomy closure on incisional hernia incidence-a multicentre randomised patient- and observer-blind trial (P.E.L.I.O.N trial). Trials 2023; 24:76. [PMID: 36726155 PMCID: PMC9890770 DOI: 10.1186/s13063-023-07089-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/10/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Incisional hernia is a frequent complication following loop ileostomy reversal. Incisional hernias are associated with morbidity, loss of health-related quality of life and costs and warrant the investigation of prophylactic measures. Prophylactic mesh implantation at the time of surgical stoma reversal has shown to be a promising and safe method to prevent incisional hernias in this setting. However, the efficacy of this method has not yet been investigated in a large multicentre randomised-controlled trial (RCT) with adequate external validity. The P.E.L.I.O.N. trial will evaluate the efficacy of prophylactic mesh reinforcement after loop ileostomy closure in decreasing the rate of incisional hernia versus standard closure alone. METHODS P.E.L.I.O.N. is a multicentre, patient- and observer-blind RCT. Patients undergoing loop ileostomy closure will undergo intraoperative 1:1 randomisation into either abdominal wall closure with a continuous slowly absorbable suture in small-stitch technique without mesh reinforcement (control group) or abdominal wall closure with an additional reinforcement with a retromuscular non-absorbable, macro-pore (pore size ≥ 1000 μm or effective porosity >0%) light-weight monofilament or mixed structure mesh. A total of 304 patients (152 per group) will need to be randomised in the study. Based on inclusion and exclusion criteria, 1,014 patients are expected to be screened for eligibility in order to recruit the necessary number of patients. The primary endpoint will be the frequency of incision hernias within 24 months according to the European Hernia Society definition. Secondary endpoints will be the frequency of surgical site occurrences (including surgical site infections, wound seromas and hematomas, and enterocutaneous fistulas), postoperative pain, the number of revision surgeries and health-related quality of life. Safety will be assessed by measuring postoperative complications ≥ grade 3 according to the Dindo-Clavien classification. DISCUSSION Depending on the results of the P.E.L.I.O.N. trial, prophylactic mesh implantation could become the new standard for loop ileostomy reversal. TRIAL REGISTRATION DRKS00027921, U1111-1273-4657.
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Affiliation(s)
- Sven Müller
- Helios Klinikum Gifhorn, Campus 6, 38518 Gifhorn, Germany
| | - Dirk Weyhe
- grid.477704.70000 0001 0275 7806Klinik für Allgemein- und Viszeralchirurgie, Universitätsmedizin Oldenburg, Pius-Hospital Oldenburg, Georgstraße 12, 26121 Oldenburg, Germany
| | - Florian Herrle
- grid.411778.c0000 0001 2162 1728Chirurgische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Philipp Horvath
- grid.411544.10000 0001 0196 8249Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Robert Bachmann
- grid.411544.10000 0001 0196 8249Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Viktor von Ehrlich-Treuenstätt
- grid.5252.00000 0004 1936 973XKlinik für Allgemein-, Viszeral- und Transplantationschirurgie, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377 München, Germany
| | - Patrick Heger
- grid.410712.10000 0004 0473 882XDepartment of General and Visceral Surgery and Clinical Trial Centre Department of Surgery (ulmCARES), University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Nadir Nasir
- grid.410712.10000 0004 0473 882XDepartment of General and Visceral Surgery and Clinical Trial Centre Department of Surgery (ulmCARES), University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Christina Klose
- grid.7700.00000 0001 2190 4373Institute of Medical Biometry (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Alexander Ritz
- grid.7700.00000 0001 2190 4373Institute of Medical Biometry (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Anja Sander
- grid.7700.00000 0001 2190 4373Institute of Medical Biometry (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Erich Grohmann
- Deutsche ILCO e. V., Nietzschestr. 11, 53177 Bonn, Germany
| | - Colette Dörr-Harim
- grid.410712.10000 0004 0473 882XDepartment of General and Visceral Surgery and Clinical Trial Centre Department of Surgery (ulmCARES), University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - André L. Mihaljevic
- grid.410712.10000 0004 0473 882XDepartment of General and Visceral Surgery and Clinical Trial Centre Department of Surgery (ulmCARES), University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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Shabunin AV, Bagatelija ZA, Kulushev VM, Hmylov LM, Maksimkin AI. [Prognostic factors of dehydration and renal damage in patients with formed preventive ileostomy during rectal resection for cancer]. Khirurgiia (Mosk) 2023:23-29. [PMID: 36583490 DOI: 10.17116/hirurgia202301123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Despite the potential advantages of a preventive intestinal stoma after the formation of a low colon anastomosis during rectal resections, the formation of a preventive loop ileostomy is associated with a significant frequency of complications. OBJECTIVE To determine the potential prognostic factors of complications associated with ileostomy dysfunction in patients who have undergone rectal resection for cancer. MATERIAL AND METHODS We retrospectively analyzed patients over the age of 18 who underwent open and laparoscopic resection of the rectum with the formation of a preventive ileostomy from January 2015 to May 2022. To determine the influence of potential predictors on the frequency of complications associated with large ileostomy losses, a single-factor logistic regression analysis was used. Complications associated with large ileostomy losses were primarily water-electrolyte disorders, dehydration and acute renal failure, which required intensive therapy and re-hospitalization. RESULTS Of the 120 patients included in the study, 26 (21.7%) suffered complications associated with large losses of fluid and electrolytes in the stoma. In this group of patients, at least one repeated emergency hospitalization to a medical institution was required (average value 1.6). Factors associated with ileostomy dysfunction in a single-factor analysis were: the presence of signs of intestinal obstruction (OR=2.6; p=0.047), the development of postoperative complications (OR=3; p=0.024), steroid use (OR=4.3; p=0.010), smoking (OR=4.8; p=0.017) the average amount of discharge from the stoma at discharge is more than 1000 ml/24 h (OR=3.2; p=0.016) and the need for Loperamide at the time of discharge (OR=2.8; p=0.032). Multivariate logistic regression analysis revealed an independent risk factor for complications leading to re-hospitalization: ileostomy losses at discharge ≥1000 ml/24 h (OR=3.3 (1.18-9.37); p=0.023). CONCLUSION In our study, those patients whose ileostomy discharge exceeded 1000 ml/24 h at discharge were at increased risk of dehydration, hypokalemia, hypocalcemia, acute prerenal renal failure, which led to repeated hospitalization to correct these disorders, sometimes in the intensive care unit.
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Affiliation(s)
- A V Shabunin
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia.,Botkin Hospital, Moscow, Russia
| | - Z A Bagatelija
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia.,Botkin Hospital, Moscow, Russia
| | | | | | - A I Maksimkin
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
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Huisman JF, de Haas JWA, Brohet RM, Vleggaar FP, de Vos Tot Nederveen Cappel WH, van Westreenen HL. Clinical outcome of decompressing colostomy for acute left-sided colorectal obstruction: a consecutive series of 100 patients. Scand J Gastroenterol 2022; 57:757-762. [PMID: 35060822 DOI: 10.1080/00365521.2022.2029557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Aim of our study was to evaluate the outcomes of a consecutive series of patients who were treated with a decompressing colostomy (DC) for acute left-sided colorectal obstruction. METHOD A consecutive series of 100 patients with acute left-sided colorectal obstruction who underwent DC from January 2015 to August 2020 was retrospectively analyzed. Demographic characteristics, etiology of the obstruction, postoperative morbidity- and mortality rates, DC-related complication and stoma reversal rates were evaluated. RESULTS Of the 100 included patients, 64 had malignant- and 36 had benign obstruction. The mean age was 69 years, 42% was male, and the ASA score was 2. Morbidity and mortality rates after DC construction were 20 and 2%, respectively. In 39% of the patients, DC ended up as a permanent stoma and in 61% as bridge to surgery (BtS). DC related complication rate was 32%, with a re-intervention rate of 9%. Elective colorectal resection was performed in 59 cases (59%) with subsequent postoperative morbidity rate of 20%. Stoma reversal rate was 77% for the patients who underwent DC as BtS. Stoma reversal was performed in 66% of the patients with benign obstruction and in 36% for oncological obstruction. CONCLUSION DC as bridge to possible elective resection for acute left-sided colorectal obstruction is an effective strategy with low morbidity and mortality rates and a high stoma reversal rate, especially for benign obstruction. However, DC is less appropriate for patients in whom DC turns out to be a permanent stoma due to a relatively high stoma related complications.
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Affiliation(s)
- Jelle F Huisman
- Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, The Netherlands
| | - Job W A de Haas
- Department of Surgery, Isala Hospital, Zwolle, The Netherlands
| | - Richard M Brohet
- Department of Epidemiology and Statistics, Isala Hospital, Zwolle, The Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, UMC, Utrecht, The Netherlands
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Calvo Espino P, Sánchez Movilla A, Alonso Sebastian I, García Schiever J, Varillas Delgado D, Sánchez Turrión V, López Monclús J. Incidence and risk factors of delayed development for stoma site incisional hernia after ileostomy closure in patients undergoing colorectal surgery with temporary ileostomy. Acta Chir Belg 2022; 122:41-47. [PMID: 33176613 DOI: 10.1080/00015458.2020.1846941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Stoma site incisional hernias after ileostomy closure are complex hernias that can be associated with abdominal pain, discomfort, and a diminished quality of life. The aim of this study was to determine the incidence of incisional hernia (IH) following temporary ileostomy reversal in patients undergoing colorectal surgery, and the risk factors associated with its development. METHODS This was a prospective, single-centre, cohort study of patients undergoing ileostomy reversal between January 2010 and December 2016. Comorbidities, operative characteristics, comparison between early and late ileostomy closure and postoperative complications were analysed. RESULTS A total of 202 consecutive patients were prospectively evaluated (median follow-up 46 months; range: 12-109). Stoma site incisional hernia occurred in 23% of patients (n = 47), diagnosed by physical examination or imaging tests. The reasons for the primary surgery were colorectal cancer (n = 141, 69.8%), inflammatory bowel disease (n = 14, 6.9%), emergency surgery (n = 35, 17.3%), and other conditions (n = 12, 5.9%). Secondary outcomes: a statistically significant risk factors for developing an IH was obesity (higher BMI) (OR 1.15, 95% CI: 1.05-1.26) p = .003). CONCLUSIONS 23% of patients developed surgical site IH, a higher BMI being the only risk factor found to be statistically significant in the development of an incisional hernia.
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Affiliation(s)
| | | | | | | | | | - Víctor Sánchez Turrión
- Hospital Universitario Puerta del Hierro Majadahonda, Madrid, Spain
- Universidad Autonoma de Madrid, Madrid, Spain
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23
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Thota R, Nachiappan M, Gadiyaram S. A Rare Occurrence of Spontaneous Closure of a Sigmoid Loop Colostomy and an Inevitable Ventral Hernia. Cureus 2022; 14:e21161. [PMID: 35165611 PMCID: PMC8831464 DOI: 10.7759/cureus.21161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
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Synthetic Mesh in Contaminated Abdominal Wall Surgery: Friend or Foe? A Literature Review. J Gastrointest Surg 2022; 26:235-244. [PMID: 34590215 DOI: 10.1007/s11605-021-05155-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/17/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The use of synthetic mesh in contaminated fields is controversial. In the last decade, published data have grown in this matter suggesting favorable outcomes. However, multiple variables and scenarios that influence the results still make difficult to obtain convincing recommendations. METHODS We performed a review of relevant available data in English regarding the use of synthetic meshes in contaminated abdominal wall surgery using the Medline database. Articles including patients undergoing ventral hernia in contaminated fields were included for analysis. RESULTS Most studies support the use of synthetic meshes for ventral hernia repair in contaminated fields, as they have shown lower recurrence rate and similar wound morbidity. Although no mesh seems ideal in this setting, most surgeons advocate for the use of reduced-in-weight polypropylene mesh. Sublay location of the prosthesis associated with complete fascial closure appears to offer better results in these patients. In addition, current evidence suggests that the use of prophylactic synthetic mesh when performing a stoma or for stoma reversal incisional hernias might be beneficial. CONCLUSION A better understanding of surgical site occurrences and its prevention, as well as the introduction of new reduced-in-weight meshes have allowed using synthetic meshes in a contaminated field. Although the use of mesh has indeed shown promising results in these patients, the surgical team should still balance pros and cons at the time of placing synthetics in contaminated fields.
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Meyer J, Delaune V, Abbassi Z, Douissard J, Toso C, Ris F, Buchs N. PROphylactic MESH (PROMESH) for stoma closure: does it reduce the incidence of incisional hernia? Protocol for a triple-blinded randomised controlled trial. BMJ Open 2021; 11:e053751. [PMID: 34907065 PMCID: PMC8671978 DOI: 10.1136/bmjopen-2021-053751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/19/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Application of a prophylactic mesh during stoma closure was shown to reduce the incidence of incisional hernia at the site of stoma closure. Our objective is to provide high quality evidence to validate this finding. METHODS AND ANALYSIS The study will be a randomised controlled triple-blinded superiority parallel monocentric trial. Patients undergoing elective ileostomy or colostomy closure after surgery for digestive cancer will be eligible for inclusion. Patients allergic to the mesh, immunosuppressed or refusing to participate will be excluded. Randomisation will be performed based on a 1:1 allocation ratio between stoma closure with application of a non-absorbable mesh in the sublay position (intervention) and stoma closure without a mesh (control). The primary outcome will be the 1-year incidence of incisional hernia at the site of stoma closure, determined clinically and by CT. Secondary outcomes will be the 31-day incidence of surgical site infection and the modified Carolinas Comfort Scale. Patients, radiologists and investigators performing the assessment at 1 year will be blinded for the allocated study group. Analysis will be performed in intention-to-treat. The trial will include 68 patients (34 with mesh, 34 without mesh). ETHICS AND DISSEMINATION The present randomised controlled trial was registered into clinicaltrials.gov (NCT04510558) and was accepted by the local ethic committee (Geneva, Switzerland: CCER 2021-00053). The results will be presented at national and international congresses in the fields of colorectal surgery and general surgery, and published in a peer-reviewed journal.
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Affiliation(s)
- Jeremy Meyer
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Vaihere Delaune
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Ziad Abbassi
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Jonathan Douissard
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Toso
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Frédéric Ris
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Nicolas Buchs
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
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Bloomfield I, Dobson B, Von Papen M, Clark D. Incisional hernia following ileostomy closure: who's at risk? The Gold Coast experience. ANZ J Surg 2021; 92:146-150. [PMID: 34791754 DOI: 10.1111/ans.17359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/20/2021] [Accepted: 10/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Diverting ileostomy is utilized to protect high-risk anastomoses, though it is not shown to reduce the leak rate it may reduce the severe consequences of an anastamotic leak. In recent years mesh development has advanced to allow placement of meshes into potentially contaminated fields, such as an ostomy closure site. METHOD A retrospective review of all ileostomy closure procedures in Gold Coast from 1st January 2011 until 31st December 2018 were included. Patient demographics and surgical outcomes and follow up reviewed to identify any cases of incisional hernia relating to ostomy closure. RESULTS A total of 193 patients were identified, after exclusions 171 were suitable for analysis within the study, a total of 25 incisional hernia detected radiologically or clinically. Two independent risk factors were identified BMI >30 and ASA 3-4. Both had significant association with development of incisional hernia with a 3- and 2-fold RR increase, respectively. This was also reflected in a subset analysis of BMI ranges demonstrating increased risk in the obese and severely obese group. DISCUSSION The high-risk group in our population was elevated BMI and ASA, these are the patients we would expect to benefit the most from targeted therapy to reduce the incidence of incisional hernia. Future studies to look at whether reducing BMI or prophylactic mesh placement are effective.
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Affiliation(s)
- Ian Bloomfield
- Medical and Health Sciences, Logan Hospital, Griffith University, Meadowbrooks, Queensland, Australia
| | | | | | - David Clark
- Royal Brisbane Hospital, Brisbane, Queensland, Australia
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When to use a prophylactic mesh after stoma closure: a case-control study. Hernia 2021; 26:467-472. [PMID: 34767104 PMCID: PMC9012710 DOI: 10.1007/s10029-021-02508-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/08/2021] [Indexed: 12/14/2022]
Abstract
Purpose The closure of a stoma is frequently associated with an acceptable morbidity and mortality. One of the most frequent complications is incisional hernia at the stoma site, which occurs in 20%–40% of cases, higher than incisions in other parts of the abdomen. The objective of this study was to identify the risk factors associated with the presentation of incisional hernia after stoma closure, this in order to select patients who are candidates for prophylactic mesh placement during closure. Methods An unpaired case–control study was conducted. This study involved 164 patients who underwent a stoma closure between January 2014 and December 2019. Associated factors for the development of incisional hernia at the site of the stoma after closure were identified, for which it was performed a logistic regression analysis. Results 41 cases and 123 controls were analyzed, with a mean follow-up of 35.21 ± 18.42 months, the mean age for performing the stoma closure was 65.28 ± 14.07 years, the most frequent cause for performing the stoma was malignant disease (65.85%). Risk factor for the development of incisional hernia at the stoma site after its closure was identified as a history of parastomal hernia (OR 5.90, CI95% 1.97–17.68). Conclusions The use of prophylactic mesh at stoma closure should be considered in patients with a history of parastomal hernia since these patients present a significantly higher risk of developing a hernia.
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Nyman J, Lindmark M, Gunnarsson U, Strigård K. Surgical treatment of stoma-related hernias: retrospective cohort study of damage claims to the Swedish National Patient Insurance Company 2010-2016. BMC Surg 2021; 21:390. [PMID: 34727915 PMCID: PMC8565032 DOI: 10.1186/s12893-021-01383-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/19/2021] [Indexed: 11/22/2022] Open
Abstract
Background Parastomal hernia and stoma-site hernia are common stoma complications. Parastomal hernia repair is associated with high complication and recurrence rates. Insurance data can provide novel information on the consequences of perioperative complications from the patient’s point of view. The aim was to investigate what types of complications associated with stoma-related hernia surgery that cause patients to apply for economic compensation through the patient insurance system and to investigate demographic and clinical differences among cases based on gender and type of center at which the surgery was performed. Methods A national patient damage claim database was searched for ICD-10 codes related to parastomal and stoma-site hernia surgery over a seven-year period. Medical records were screened for claims associated with parastomal hernia repair, relocation or reversal due to parastomal hernia, or stoma-site hernia repair. Claims were classified according to one of four primary complaints: surgical, anesthetic, medical or other. Clinical and demographic differences between genders and hospital types were investigated. Reasons for non-compensation were analyzed. Results Thirty claims met the inclusion criteria. Eighteen were related to parastomal hernia repair, seven to stoma-site hernia repair, three to stoma reversal and two to relocation due to parastomal hernia. Twenty-five claims were primarily surgical, two related to anesthesia and three classified as other. Seven claims were granted compensation. No demographic or clinical differences were found apart from female gender being associated with previous parastomal hernia repair [6 women and 0 men (p = 0.02)]. Conclusion Surgical complaints predominated. Few claims were compensated, reflecting the complexity and unsatisfactory outcomes of these procedures. Many claims were identified in relation to the incidence of stoma-related hernia surgery. Trial registration Due to its retrospective and descriptive nature, the study was not registered in any registry.
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Affiliation(s)
- Johan Nyman
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, 901 85, Umeå, Sweden.
| | - Mikael Lindmark
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, 901 85, Umeå, Sweden
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, 901 85, Umeå, Sweden
| | - Karin Strigård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, 901 85, Umeå, Sweden
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Loire M, Bridoux V, Mege D, Mathonnet M, Mauvais F, Massonnaud C, Regimbeau JM, Tuech JJ. Long-term outcomes of Hartmann's procedure versus primary anastomosis for generalized peritonitis due to perforated diverticulitis: follow-up of a prospective multicenter randomized trial (DIVERTI). Int J Colorectal Dis 2021; 36:2159-2164. [PMID: 34086087 DOI: 10.1007/s00384-021-03962-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgical management of Hinchey III and IV diverticulitis involves Hartmann's procedure (HP) or primary resection anastomosis (PRA) with or without fecal diversion. These procedures were evaluated in four randomized controlled trials. Early results from these trials demonstrated similar rates of complications but higher rates of colonic restoration after PRA than HP. Long-term follow-up has not been reported to date. The aim of this study was to analyze long-term outcomes and quality of life (QoL) in patients previously enrolled in a prospective randomized trial comparing HP and PRA for generalized peritonitis due to perforated diverticulitis (DIVERTI trial). STUDY DESIGN Follow-up data were available for 78 of 102 patients. Demographic data, incisional hernia rate, need for additional surgery related to the primary procedure, and QoL were recorded. RESULTS The overall survival rate was 76% and did not differ between the two groups. Incisional hernia was reported in 21 (52%) patients in the HP arm and in 11 (29%) patients in the PRA arm (p = 0.035). The HP arm demonstrated significantly lower SF-36 physical and mental component scores. The mean general QoL (EQ-VAS) and mean EQ-5D index scores were better after PRA than after HP, but this difference was not statistically significant. The results of GIQLI, which measures intestine-specific QOL, did not differ between the two groups. CONCLUSIONS This follow-up study with a median follow-up time of > 9 years among living patients indicates that PRA for perforated diverticulitis is associated with fewer long-term complications and better QoL than HP. PRA significantly reduced the incisional hernia rate and the need for reoperation. Long-term survival was not jeopardized by the PRA approach. Future studies are needed to address the utility of protective stoma.
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Affiliation(s)
- M Loire
- Department of Digestive Surgery, Rouen University Hospital, 76000, Rouen Cedex, France
| | - V Bridoux
- Department of Digestive Surgery, Rouen University Hospital, 76000, Rouen Cedex, France
| | - D Mege
- Department of Digestive Surgery, Marseille University Hospital La Timone, Marseille, France
| | - M Mathonnet
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | - F Mauvais
- Department of Digestive Surgery, Beauvais General Hospital, Beauvais, France
| | - C Massonnaud
- Department of Biostatistics, Rouen University Hospital, 76000, Rouen, France
| | - J M Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - J J Tuech
- Department of Digestive Surgery, Rouen University Hospital, 76000, Rouen Cedex, France.
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Peltrini R, Imperatore N, Altieri G, Castiglioni S, Di Nuzzo MM, Grimaldi L, D’Ambra M, Lionetti R, Bracale U, Corcione F. Prevention of incisional hernia at the site of stoma closure with different reinforcing mesh types: a systematic review and meta-analysis. Hernia 2021; 25:639-648. [PMID: 33713204 PMCID: PMC8197707 DOI: 10.1007/s10029-021-02393-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/08/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate safety and efficacy of a mesh reinforcement following stoma reversal to prevent stoma site incisional hernia (SSIH) and differences across the prostheses used. METHODS A systematic search of PubMed/MEDLINE, EMBASE, SCOPUS and Cochrane databases was conducted to identify comparative studies until September 2020. A meta-analysis of postoperative outcomes and a network meta-analysis for a multiple comparison of the prostheses with each other were performed. RESULTS Seven studies were included in the analysis (78.4% ileostomy and 21.6% colostomy) with a total of 1716 patients with (n = 684) or without (n = 1032) mesh. Mesh placement was associated with lower risk of SSIH (7.8%vs18.1%, OR0.266,95% CI 0.123-0.577, p < 0.001) than no mesh procedures but also with a longer operative time (SMD 0.941, 95% CI 0.462-1.421, p < 0.001). There was no statistically significant difference in terms of Surgical Site infection (11.5% vs 11.1%, OR 1.074, 95% CI 0.78-1.48, p = 0.66), seroma formation (4.4% vs 7.1%, OR 1.052, 95% CI 0.64-1.73, p = 0.84), anastomotic leakage (3.7% vs 2.7%, OR 1.598, 95% CI 0.846-3.019, p = 0.149) and length of stay (SMD - 0.579,95% CI - 1.261 to 0.102, p = 0.096) between mesh and no mesh groups. Use of prosthesis was associated with a significant lower need for a reoperation than no mesh group (8.1% vs 12.1%, OR 0.332, 95% CI 0.119-0.930, p = 0.036). Incidence of seroma is lower with biologic than polypropylene meshes but they showed a trend towards poor results compared with polypropylene or biosynthetic meshes. CONCLUSION Despite longer operative time, mesh prophylactic reinforcement at the site of stoma seems a safe and effective procedure with lower incidence of SSIH, need for reoperation and comparable short-term outcomes than standard closure technique. A significant superiority of a specific mesh type was not identified.
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Affiliation(s)
- Roberto Peltrini
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Nicola Imperatore
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
- Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli, Naples, Italy
| | - Gaia Altieri
- Departement of Gastroenterological, Endocrine-Metabolic and Nephrourological Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simone Castiglioni
- Department of Medical, Oral and Biotechnological Sciences, University G. D’Annunzio Chieti-Pescara, Chieti, Italy
| | | | - Luciano Grimaldi
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Michele D’Ambra
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Ruggero Lionetti
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Umberto Bracale
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Francesco Corcione
- Department of Public Health, University of Naples Federico II, Naples, Italy
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Weyhe D, Salzmann D, Gloy K. [Prophylaxis of parastomal, perineal and incisional hernias in colorectal surgery]. Chirurg 2021; 92:621-629. [PMID: 33913011 DOI: 10.1007/s00104-021-01415-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 11/26/2022]
Abstract
This article gives an overview of the relevant evidence from the literature on the topic of prophylactic use of meshes to prevent incisional and parastomal hernias in colorectal surgery. In addition, based on a structured literature search the incidence of hernias in colorectal surgery over the past 5 years was analyzed. A slight majority (54%) of articles recommended the use of prophylactic mesh implantation in colorectal surgery. The prophylactic use of meshes appears to reduce the risk of hernias in colorectal surgery but is associated with a slightly increased perioperative wound infection rate. Parastomal hernias are associated with higher incidence rates compared with incisional hernias and also appear to benefit more from prophylactic mesh implantation. The evidence in the literature is still unclear regarding the use of synthetic or biological implants due to the lack of randomized controlled trials. Perineal hernias were excluded from the analysis due to the incomparability of the mainly casuistic literature. An overview is given in the discussion. The analysis of the literature and also in reflection of our own experience comes to the conclusion that the disrupted integrity of the abdominal wall due to the operation should be prophylactically reinforced with a mesh after colorectal surgery. An evidence-based recommendation is not possible based on the current state of research on implantation techniques, e.g. onlay, sublay intraperitoneal onlay mesh (IPOM) and selection of the implant.
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Affiliation(s)
- Dirk Weyhe
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik für Viszeralchirurgie, Pius Hospital Oldenburg, Medizinischer Campus Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland.
| | - Daniela Salzmann
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik für Viszeralchirurgie, Pius Hospital Oldenburg, Medizinischer Campus Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland
| | - Kilian Gloy
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik für Viszeralchirurgie, Pius Hospital Oldenburg, Medizinischer Campus Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland
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Rudnicki Y, Horesh N, Lessing Y, Tverskov V, Wachtel A, Slavin M, Tulchinsky H, Wasserberg N, Mavor E, Zmora O, Avital S. Synchronous Hartmann reversal and incisional hernia repair is associated with higher complication rate compared to a staged procedure. Sci Rep 2021; 11:1390. [PMID: 33446852 PMCID: PMC7809028 DOI: 10.1038/s41598-021-81064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 12/29/2020] [Indexed: 11/09/2022] Open
Abstract
Post operative ventral hernias are common following Hartmann's procedure. There is a debate whether hernia repair is safe when performed concomitantly with colostomy closure. In this study we aimed to evaluate the outcomes of synchronous Hartmann reversal (HR) with a hernia repair, compared to a staged procedure. A retrospective multi-center study was conducted, including all patients who underwent Hartmann's procedure from January 2004 to July 2017 in 5 medical centers. Patient data included demographics, surgical data and post-operative outcome. Two hundred and seventy-four patients underwent colostomy reversal following Hartmann's procedure. In 107 patients (39%) a concomitant ventral hernia was reported during the Hartmann's reversal. Out of this cohort, 62 patients (58%) underwent hernia repair during follow-up. Thirty two patients (52%) underwent a synchronous hernia repair and 30 patients (48%) underwent hernia repair as a separate procedure. Post operative complication rate was significantly higher in the colostomy reversal with synchronous hernia repair group when compared to HR alone group (53% vs. 20%; p < 0.01; OR 4.5). In addition, severe complication rate (Clavien-Dindo score ≥ 3) was higher in the synchronous hernia repair group (25% vs. 7%). A tendency for higher hernia recurrence rate was noted in the synchronous group (56% vs. 40%). Median follow up time was 2.53 years (range 1-13.3 years). Synchronous colostomy closure and ventral hernia repair following Hartmann's procedure carries a significant risk for post operative complications, indicating that a staged procedure might be preferable.
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Affiliation(s)
- Y Rudnicki
- Department of Surgery B, Meir Medical Center, 4428164, Kfar Saba, Israel.
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - N Horesh
- Department of General Surgery and Transplantations B, Sheba Medical Center, Ramat Gan, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Lessing
- Department of Surgery, Tel-Aviv Medical Center, Tel-Aviv, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - V Tverskov
- Department of Surgery, Rabin Medical Center, Petah Tikva, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Wachtel
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel
- School of Medicine, Affiliated to the Hadassah-Hebrew University, Jerusalem, Israel
| | - M Slavin
- Department of Surgery B, Meir Medical Center, 4428164, Kfar Saba, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Tulchinsky
- Department of Surgery, Tel-Aviv Medical Center, Tel-Aviv, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Wasserberg
- Department of Surgery, Rabin Medical Center, Petah Tikva, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Mavor
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel
- School of Medicine, Affiliated to the Hadassah-Hebrew University, Jerusalem, Israel
| | - O Zmora
- Department of General Surgery and Transplantations B, Sheba Medical Center, Ramat Gan, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Avital
- Department of Surgery B, Meir Medical Center, 4428164, Kfar Saba, Israel
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Veld JV, Amelung FJ, Borstlap WAA, van Halsema EE, Consten ECJ, Siersema PD, Ter Borg F, van der Zaag ES, de Wilt JHW, Fockens P, Bemelman WA, van Hooft JE, Tanis PJ. Comparison of Decompressing Stoma vs Stent as a Bridge to Surgery for Left-Sided Obstructive Colon Cancer. JAMA Surg 2020; 155:206-215. [PMID: 31913422 DOI: 10.1001/jamasurg.2019.5466] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Bridge to elective surgery using self-expandable metal stent (SEMS) placement is a debated alternative to emergency resection for patients with left-sided obstructive colon cancer because of oncologic concerns. A decompressing stoma (DS) might be a valid alternative, but relevant studies are scarce. Objective To compare DS with SEMS as a bridge to surgery for nonlocally advanced left-sided obstructive colon cancer using propensity score matching. Design, Setting, and Participants This national, population-based cohort study was performed at 75 of 77 hospitals in the Netherlands. A total of 4216 patients with left-sided obstructive colon cancer treated from January 1, 2009, to December 31, 2016, were identified from the Dutch Colorectal Audit and 3153 patients were studied. Additional procedural and intermediate-term outcome data were retrospectively collected from individual patient files, resulting in a median follow-up of 32 months (interquartile range, 15-57 months). Data were analyzed from April 7 to October 28, 2019. Exposures Decompressing stoma vs SEMS as a bridge to surgery. Main Outcomes and Measures Primary anastomosis rate, postresection presence of a stoma, complications, additional interventions, permanent stoma, locoregional recurrence, disease-free survival, and overall survival. Propensity score matching was performed according to age, sex, body mass index, American Society of Anesthesiologists score, prior abdominal surgery, tumor location, pN stage, cM stage, length of stenosis, and year of resection. Results A total of 3153 of the eligible 4216 patients were included in the study (mean [SD] age, 69.7 [11.8] years; 1741 [55.2%] male); after exclusions, 443 patients underwent bridge to surgery (240 undergoing DS and 203 undergoing SEMS). Propensity score matching led to 2 groups of 121 patients each. Patients undergoing DS had more primary anastomoses (104 of 121 [86.0%] vs 90 of 120 [75.0%], P = .02), more postresection stomas (81 of 121 [66.9%] vs 34 of 117 [29.1%], P < .001), fewer major complications (7 of 121 [5.8%] vs 18 of 118 [15.3%], P = .02), and more subsequent interventions, including stoma reversal (65 of 113 [57.5%] vs 33 of 117 [28.2%], P < .001). After DS and SEMS, the 3-year locoregional recurrence rates were 11.7% for DS and 18.8% for SEMS (hazard ratio [HR], 0.62; 95% CI, 0.30-1.28; P = .20), the 3-year disease-free survival rates were 64.0% for DS and 56.9% for SEMS (HR, 0.90; 95% CI, 0.61-1.33; P = .60), and the 3-year overall survival rates were 78.0% for DS and 71.8% for SEMS (HR, 0.77; 95% CI, 0.48-1.22; P = .26). Conclusions and Relevance The findings suggest that DS as bridge to resection of left-sided obstructive colon cancer is associated with advantages and disadvantages compared with SEMS, with similar intermediate-term oncologic outcomes. The existing equipoise indicates the need for a randomized clinical trial that compares the 2 bridging techniques.
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Affiliation(s)
- Joyce V Veld
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Femke J Amelung
- Department of Surgery, Meander Medical Center, Amersfoort, the Netherlands
| | - Wernard A A Borstlap
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Emo E van Halsema
- Cancer Center Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Esther C J Consten
- Department of Surgery, Meander Medical Center, Amersfoort, the Netherlands.,Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frank Ter Borg
- Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, the Netherlands
| | | | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul Fockens
- Cancer Center Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Wilhelmus A Bemelman
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Jeanin E van Hooft
- Cancer Center Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Pieter J Tanis
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
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Zhang L, Zheng W, Cui J, Wu YL, Xu TL, Zhang HZ. Risk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery. Chronic Dis Transl Med 2020; 6:188-197. [PMID: 32908969 PMCID: PMC7451586 DOI: 10.1016/j.cdtm.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Indexed: 12/15/2022] Open
Abstract
Background Defunctioning stoma is widely used to reduce anastomotic complications in rectal cancer surgery. However, the complications of stoma and stoma reversal surgery should not be underestimated. Furthermore, in some patients, stoma reversal failed. Here, we investigated the complications of defunctioning stoma surgery and subsequent reversal surgery and identify risk factors associated with the failure of getting stoma reversed. Methods In total, 154 patients who simultaneously underwent low anterior resection and defunctioning stoma were reviewed. Patients were divided into two groups according to whether their stoma got reversed or not. The reasons that patients received defunctioning stoma and experienced stoma-related complications and the risk factors for failing to get stoma reversed were analysed. Results The mean follow-up time was 47.54 (range 4.0–164.0) months. During follow-up, 19.5% of the patients suffered stoma-related long-term complications. Only 79 (51.3%) patients had their stomas reversed. The morbidity of complications after reversal surgery was 45.6%, and these mainly consisted of incision-related complications. Multivariate analyses showed that pre-treatment comorbidity (HR = 3.17, 95% CI 1.27–7.96, P = 0.014), postoperative TNM stage (HR = 2.55, 95% CI 1.05–6.18, P = 0.038), neoadjuvant therapy (HR = 2.75, 95% CI 1.07–7.05, P = 0.036), anastomosis-related complications (HR = 4.52, 95% CI 1.81–11.29, P = 0.001), and disease recurrence (HR = 24.83, 95% CI 2.90–213.06, P = 0.003) were significant independent risk factors for a defunctioning stoma to be permanent. Conclusions Defunctioning stoma is an effective method to reduce symptomatic anastomotic leakage, but the stoma itself and its reversal procedure are associated with high morbidity of complications, and many defunctioning stomas eventually become permanent. Therefore, surgeons should carefully assess preoperatively and perform defunctioning stomas in very high risk patients. In addition, doctors should perform stoma reversal surgery more actively to prevent temporary stomas from becoming permanent.
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Affiliation(s)
- Lin Zhang
- Department of Colorectal Surgery, State Key Lab of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Wei Zheng
- Department of Colorectal Surgery, State Key Lab of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Jian Cui
- Department of Colorectal Surgery, State Key Lab of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Yun-Long Wu
- Department of Colorectal Surgery, State Key Lab of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Tian-Lei Xu
- Department of Colorectal Surgery, State Key Lab of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Hai-Zeng Zhang
- Department of Colorectal Surgery, State Key Lab of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
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Predictors of hernia after loop ileostomy closure: a single-center retrospective review. Int J Colorectal Dis 2020; 35:1695-1702. [PMID: 32451647 DOI: 10.1007/s00384-020-03637-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Our aims were to determine the rate of incisional hernia after closure of a loop ileostomy (LI) and to identify any perioperative risk factors that may be associated with hernia development. METHODS We performed an IRB-approved retrospective review that included consecutive patients who underwent LI closure from January 1, 2012, to December 31, 2014. The primary outcome was identification of hernia on physical exam or by abdominal imaging. A stepwise logistic regression analysis was used to determine predictors of ileostomy site hernia. RESULTS A total of 243 consecutive patients had LI closure during the study timeframe. The overall rate of hernia formation was 11.9% (29/243). The median time to discovery of the hernia was 16.4 (range, 2.2-55.9) months with a median follow-up time of 49 months. Although LI performed in conjunction with sigmoidectomy for diverticulitis consisted of only 19% of ileostomy cases, 62% of hernias were (18/29) identified in this cohort. Rates of hernia formation increased with respect to body mass index (underweight 0%; normal 4.6%; overweight 13.8%; obese 21%). The multivariable model identified increased BMI (underweight/normal weight versus overweight: OR 4.13, 95% CI 1.06-16.04; underweight/normal weight versus obese: OR 8.74, 95% CI 2.17-35.23) and surgical indication (reference variable: diverticulitis; rectal cancer: OR 0.21, 95% CI 0.06-0.76; Crohn's/ulcerative colitis: OR 0.06, 95% CI 0.01-0.53; other: OR 0.15, 95% CI 0.04-0.64) as significant predictors of ileostomy site hernia. CONCLUSION The development of a hernia at the site of LI closure was influenced mostly by BMI, surgical indication, and operative time.
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Mohamedahmed AYY, Stonelake S, Zaman S, Hajibandeh S. Closure of stoma site with or without prophylactic mesh reinforcement: a systematic review and meta-analysis. Int J Colorectal Dis 2020; 35:1477-1488. [PMID: 32588121 DOI: 10.1007/s00384-020-03681-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2020] [Indexed: 02/04/2023]
Abstract
AIMS To evaluate comparative outcomes of the closure of temporary stoma site with or without prophylactic mesh reinforcement METHODS: A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Studies comparing the reversal of stoma with and without prophylactic mesh reinforcement were included. Stoma site incisional hernia (SSIH), surgical site infection (SSI), operative time, seroma formation, haematoma formation, bowel obstruction, anastomosis leak, length of hospital stay (LOS) and secondary operation to repair the SSIH were the evaluated outcome parameters. RESULTS Six comparative studies reporting a total of 1683 patients who underwent closure of stoma with (n = 669) or without (n = 1014) prophylactic mesh reinforcement were included. Use of mesh was associated with a significantly lower risk of SSIH (OR 0.22, P = 0.003) and need for surgical intervention to repair SSIH (OR 0.32, P = 0.04) compared with no use of mesh. However, it was associated with significantly longer operative time (MD 47.78, P = 0.02). There was no significant difference in SSI (OR 1.09, P = 0.59), bowel obstruction (OR 1.11, P = 0.74), seroma formation (OR 2.86, P = 0.19), anastomosis leak (OR 1.60, P = 0.15), haematoma formation (OR 1.25, P = 0.75) or LOS (MD - 0.45, P = 0.31) between two groups. CONCLUSION Prophylactic mesh reinforcement during the closure of temporary stoma may significantly reduce the risk of SSIH and surgical intervention to repair the hernia without increasing the risk of SSI or other morbidities. However, it may increase the procedure time. Future higher-quality randomised evidence is required.
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Affiliation(s)
- Ali Yasen Y Mohamedahmed
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
| | - Stephen Stonelake
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Shafquat Zaman
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Shahin Hajibandeh
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Pizza F, D’Antonio D, Arcopinto M, Dell’Isola C, Marvaso A. Comparison of Hartmann’s procedure vs. resection with primary anastomosis in perforated sigmoid diverticulitis: a retrospective single-center study. Eur Surg 2020. [DOI: 10.1007/s10353-020-00633-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Seyfried S, Lucas V, Galata C, Reißfelder C, Weiß C, Kienle P, Hardt J. Incisional hernia rate after ileostomy closure in lateral pararectal stoma versus transrectal stoma placement: follow-up of the randomized PATRASTOM trial. Colorectal Dis 2020; 22:445-451. [PMID: 31652025 DOI: 10.1111/codi.14887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/08/2019] [Indexed: 02/08/2023]
Abstract
AIM Because damage to the rectus abdominis muscle during ileostomy placement and reversal might be a risk factor for the development of stoma-site incisional hernia (SSIH), we hypothesized that positioning of the stoma lateral to the rectus abdominis muscle might prevent SSIH. METHOD To investigate whether a lateral pararectal stoma position lowers the incidence of SSIH in comparison with a transrectal position, a follow-up study of the PATRASTOM trial, which had randomized stoma placement (lateral pararectal versus transrectal), was conducted. All former participants were invited simultaneously for a follow-up visit in September 2016, 2 years after database closure of the PATRASTOM trial. For patients who were not able to attend the follow-up, the electronic chart as well as MRI/CT scans were reviewed with regard to the presence of SSIH. RESULTS Follow-up - either clinical or radiological - was available for 47 of the 60 PATRASTOM participants. The median duration of follow-up was 3.4 years (interquartile range 3.0-4.1 years). SSIH occurred in 3 of 23 patients (13.0%) in the lateral pararectal group compared with 7 of 24 patients (29.2%) in the transrectal group (P = 0.287). Four of the 10 patients diagnosed with SSIH had already undergone or were scheduled for hernia repair. Of the patient and procedure characteristics which may have an impact on the development of incisional hernia none was a significant risk factor for SSIH. CONCLUSION In the present follow-up study, no difference in the incidence of SSIH was found between lateral pararectal and transrectal stoma construction in an elective setting.
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Affiliation(s)
- S Seyfried
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - V Lucas
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - C Galata
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - C Reißfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - C Weiß
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - P Kienle
- Department of Surgery, Theresienkrankenhaus Mannheim, Mannheim, Germany
| | - J Hardt
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Glynne-Jones R, Bhuva N, Harrison M. Unintended consequences of treating early rectal cancers for complete clinical response with chemoradiotherapy. COLORECTAL CANCER 2020. [DOI: 10.2217/crc-2019-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The aim was to examine the current trend in rectal cancer, which is to extend ’watch-and-wait’ to earlier-stage tumors, not normally treated with chemoradiotherapy, to define the up-side and down-side regarding quality of life (QOL) and anorectal/sexual/urinary function from this approach. We reviewed the literature regarding a ‘watch-and-wait’ strategy after neoadjuvant chemoradiotherapy. The primary outcome measure was complete clinical response. Secondary measures included colostomy rate, functional outcomes and QOL. There is a trend to use chemoradiotherapy in earlier tumors using dose-escalation of radiation and/or additional chemotherapy, resulting in high rates of complete clinical response, which may impact adversely on QOL if radical surgery is subsequently required. Focusing on organ-preservation as the primary goal of treatment rather than overall functional outcomes and QOL for the whole population, may not provide patients with sufficient information for optimal decision-making.
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Affiliation(s)
- Rob Glynne-Jones
- Radiotherapy Department, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, HA6 2RN, UK
| | - Neel Bhuva
- Radiotherapy Department, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, HA6 2RN, UK
| | - Mark Harrison
- Radiotherapy Department, Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, HA6 2RN, UK
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Ku DH, Kim HS, Shin JY. Short-term and Medium-term Outcomes of Low Midline and Low Transverse Incisions in Laparoscopic Rectal Cancer Surgery. Ann Coloproctol 2020; 36:304-310. [PMID: 32054255 PMCID: PMC7714381 DOI: 10.3393/ac.2019.10.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose Limited data exist on the use of low midline and transverse incisions for specimen extraction or stoma sites in laparoscopic rectal cancer surgery (LRCS). We compared the short-term and medium-term outcomes of these incisions and assessed whether wound complications in specimen extraction sites (SES) are increased by specimen extraction through the stoma site (SESS) in LRCS. Methods From March 2010 to December 2017, 189 patients who underwent LRCS and specimen extraction through low abdominal incisions were divided into 2 groups: midline (n = 102) and transverse (n = 87), and perioperative outcomes were compared. Results The midline group showed a higher frequency of temporary stoma formation (P = 0.001) and splenic flexure mobilization (P < 0.001) than the transverse group. The overall incisional hernia and wound infection rates in the SES were 21.6% and 25.5%, respectively, in the midline group and 26.4% and 17.2%, respectively, in the transverse group (P = 0.494 and P = 0.232, respectively). In patients who underwent SESS, the incisional hernia and wound infection rates of SES after stoma closure were 39.1% and 43.5%, respectively, in the midline group, and 35.5% and 22.6%, respectively, in the transverse group (P = 0.840 and P = 0.035, respectively). Conclusion In terms of incisional hernia and wound infection at the SES, a low midline incision may be used as a low transverse incision in patients without temporary stoma in LRCS. However, considering the high wound complication rates after stoma closure in patients with SESS in this study, SESS should be performed with caution in LRCS.
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Affiliation(s)
- Do Hoe Ku
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyeon Seung Kim
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin Yong Shin
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Bhangu A, Nepogodiev D, Ives N, Magill L, Glasbey J, Forde C, Bisgaard T, Handley K, Mehta S, Morton D, Pinkney T, Mehta S, Handley K, Ives N, Bhangu A, Brown J, Forde C, Futaba K, Glasbey J, Handley K, Ives N, Khan S, Magill L, Mehta S, Morton D, Nepogodiev D, Pallan A, Patel A, Ashdown-Phillips S, Roberts T, Jowett S, Munetsi L, Pinkney T, Torrance A, Brown J, Handley K, Hilken N, Hill M, Hunter M, Ives N, Khan S, Leek S, Lilly H, Magill L, Mehta S, Sawant A, Vince A, Walters M, Bemelman W, Blussé M, Borstlap W, Busch ORC, Buskens C, Klaver C, Marsman H, van Ruler O, Tanis P, Westerduin E, Wicherts D, Das P, Essapen S, Frost V, Glennon A, Gray C, Hussain A, McNichol L, Nisar P, Scott H, Trickett J, Trivedi P, White D, Amarnath T, Ardley R, Gupta R, Hall E, Hodgkins K, Narula H, Sewell TA, Simms JM, Toms J, White T, Atkinson A, Beral D, Lancaster N, Mackenzie F, Wilson T, Cruttenden-Wood D, Gibbins J, Halls M, Hill D, Hogben K, Jones S, Lamparelli MJ, Lewis M, Moreton S, Ng P, Oglesby A, Orbell J, Stubbs B, Subramanian K, et alBhangu A, Nepogodiev D, Ives N, Magill L, Glasbey J, Forde C, Bisgaard T, Handley K, Mehta S, Morton D, Pinkney T, Mehta S, Handley K, Ives N, Bhangu A, Brown J, Forde C, Futaba K, Glasbey J, Handley K, Ives N, Khan S, Magill L, Mehta S, Morton D, Nepogodiev D, Pallan A, Patel A, Ashdown-Phillips S, Roberts T, Jowett S, Munetsi L, Pinkney T, Torrance A, Brown J, Handley K, Hilken N, Hill M, Hunter M, Ives N, Khan S, Leek S, Lilly H, Magill L, Mehta S, Sawant A, Vince A, Walters M, Bemelman W, Blussé M, Borstlap W, Busch ORC, Buskens C, Klaver C, Marsman H, van Ruler O, Tanis P, Westerduin E, Wicherts D, Das P, Essapen S, Frost V, Glennon A, Gray C, Hussain A, McNichol L, Nisar P, Scott H, Trickett J, Trivedi P, White D, Amarnath T, Ardley R, Gupta R, Hall E, Hodgkins K, Narula H, Sewell TA, Simms JM, Toms J, White T, Atkinson A, Beral D, Lancaster N, Mackenzie F, Wilson T, Cruttenden-Wood D, Gibbins J, Halls M, Hill D, Hogben K, Jones S, Lamparelli MJ, Lewis M, Moreton S, Ng P, Oglesby A, Orbell J, Stubbs B, Subramanian K, Talwar A, Wilsher S, Al-Rashedy M, Fensom C, Gok M, Hardstaff L, Malik K, Sadat M, Townley B, Wilkinson L, Cosier T, Mangam S, Rabie M, Broadley G, Canny J, Fallis S, Green N, Hawash A, Karandikar S, Mirza M, Rawstorne E, Reddan J, Richardson J, Thompson C, Waite K, Youssef H, Bisgaard T, De Nes L, Rosenstock S, Strandfelt P, Westen M, Aryal K, Kshatriya KS, Lal R, Velchuru V, Wilhelmsen E, Akbar A, Antoniou A, Clark S, Datt P, Goh J, Jenkins I, Kennedy R, Maeda Y, Nastro P, Owen H, Phillips RKS, Warusavitarne J, Bradley-Potts J, Charleston P, Clouston H, Duff S, Fatayer T, Gipson A, Heywood N, Junejo M, Kennedy J, Lalor H, Manning C, McCormick R, Parmar K, Preston S, Ramesh A, Sharma A, Telford K, Adeosun A, Hammond T, Smolen S, Topliffe J, Docherty JG, Lim M, Lim M, Macleod K, Monaghan E, Patience L, Thomas I, Walker KG, Walker M, Watson AJM, Burgess A, Ghanem Y, Glister G, Kapur S, Paily A, Pal A, Ravikumar R, Rosbergen M, Sargen K, Speakman C, Agarwal AK, Banerjee A, Borowski D, Garg D, Gill T, Johnston T, Kelsey S, Munipalle PC, Tabaqchali M, Wilson D, Acheson A, Cripps H, El-Sharkawy A, Ng O, Sharma P, Ward K, Chandler D, Courtney E, Bunni J, Butcher K, Dalton S, Flindall I, Katebe J, Roy P, Tate J, Vincent T, Williamson MER, Wood J, Bignell M, Branagan G, Broardhurst J, Chave H, Dean H, D'Souza N, Foster G, Sleight S, Sutaria R, Ahmed I, Budhoo MR, Colley J, Cruickshank N, Gill K, Hayes A, Joy H, Kamabjha C, Plowright J, Radley S, Rea M, Thumbe V, Torrance A, Varghese P, Wilkin R, Zulueta E, Allsop L, Atkari B, Badrinath K, Daliya P, Dube M, Heeley C, Hind R, Nash D, Palfreman A, Peacock O, Watson N, Blodwell M, Javaid A, Mohamad A, Muhammad K, Qureshi N, Ridgway S, Siddiqui K, Solkar M, Vere J, Wordie A, Chang J, Elgaddal S, Green M, Hollyman M, Mirza N, Rankin J, Williams G, Ali W, Hardwick A, Mohamed Z, Navid A, Netherton K, Obreja M, Rao M, Stringer J, Tennakoon A, Bullen T, Butt M, Dawson R, Dawson S, Farmer M, Garimella V, Gates Z, Wilkings L, Yeomans N, Adedeji O, Alalawi R, Al Araimi A, Ashraf S, Bach S, Beggs A, Cagigas C, Dattani M, Dimitriou N, Futaba K, Ghods-Ghorbani M, Glasbey J, Gourevitch D, Haydon G, Ismail T, Keh C, Morton DG, Narewal M, Nepogodiev D, Papettas T, Pinkney T, Poh A, Ranstorne E, Royle TJ, Shah T, Singh J, Smart C, Suggett N, Tayyab M, Vijayan D, Vohra R, Wairaich N, Yeung D, Bamford R, Chambers J, Cotton D, Houlihan R, Kynaston J, Longman R, Lowe A, Messenger D, Owais A, Phillpott C, Shabbir J, Baragwanath P, El-Sayed C, Gaunt A, Khatri C, McCullough P, Patel A, Ward S, Wilkin R, Obukofe R, Stroud R, Mason D, Williams N, Wong LS, Chaudhri S, Cooke J, Cunha M, Fairey H, Norwood M, Singh B, Thomasset S, Abbott S, Addison S, Archer J, Bhangu A, Church R, Holford E, Lenehan F, Odogwu S, Richardson L, Sidebotham J, Swan E, Tilley A, Wagstaff L, Amey I, Baird Y, Cripps N, Greenslade S, Harris G, Levy B, Mckenzie P, Misselbrook A, Moore S, Skull A, Nicol D, Reddy B, Thrush J, Iglesias Vecchio M, Dunn Y, Williams C, Furtado S, Gill M, Gilmore L, Goldsmith P, Kocialkowski C, Loganathan S, Nath R, Paraoan M, Taylor T, Allison A, Allison J, Curtis N, Dalton R, D'Costa C, Dennison G, Foster J, Francis N, Gibbons J, Hamdan M, Lewis A, Ockrim J, Sharma R, Spurdle K, Varadharajan S, Aghahoseini A, Alexander DJ, Bandyopadhyay D, Bradford I, Chitsabesan P, Coleman Z, Gibson A, Lasithiotakis K, Panagiotou D, Polyzois K, Stojkovic S, Woodcock N, Wright M, Hargest R, Jackson R, Rajesh A, Ogunbiyi O, Slater A, Yu LM. Prophylactic biological mesh reinforcement versus standard closure of stoma site (ROCSS): a multicentre, randomised controlled trial. Lancet 2020; 395:417-426. [PMID: 32035551 PMCID: PMC7016509 DOI: 10.1016/s0140-6736(19)32637-6] [Show More Authors] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/11/2019] [Accepted: 10/18/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Closure of an abdominal stoma, a common elective operation, is associated with frequent complications; one of the commonest and impactful is incisional hernia formation. We aimed to investigate whether biological mesh (collagen tissue matrix) can safely reduce the incidence of incisional hernias at the stoma closure site. METHODS In this randomised controlled trial (ROCSS) done in 37 hospitals across three European countries (35 UK, one Denmark, one Netherlands), patients aged 18 years or older undergoing elective ileostomy or colostomy closure were randomly assigned using a computer-based algorithm in a 1:1 ratio to either biological mesh reinforcement or closure with sutures alone (control). Training in the novel technique was standardised across hospitals. Patients and outcome assessors were masked to treatment allocation. The primary outcome measure was occurrence of clinically detectable hernia 2 years after randomisation (intention to treat). A sample size of 790 patients was required to identify a 40% reduction (25% to 15%), with 90% power (15% drop-out rate). This study is registered with ClinicalTrials.gov, NCT02238964. FINDINGS Between Nov 28, 2012, and Nov 11, 2015, of 1286 screened patients, 790 were randomly assigned. 394 (50%) patients were randomly assigned to mesh closure and 396 (50%) to standard closure. In the mesh group, 373 (95%) of 394 patients successfully received mesh and in the control group, three patients received mesh. The clinically detectable hernia rate, the primary outcome, at 2 years was 12% (39 of 323) in the mesh group and 20% (64 of 327) in the control group (adjusted relative risk [RR] 0·62, 95% CI 0·43-0·90; p=0·012). In 455 patients for whom 1 year postoperative CT scans were available, there was a lower radiologically defined hernia rate in mesh versus control groups (20 [9%] of 229 vs 47 [21%] of 226, adjusted RR 0·42, 95% CI 0·26-0·69; p<0·001). There was also a reduction in symptomatic hernia (16%, 52 of 329 vs 19%, 64 of 331; adjusted relative risk 0·83, 0·60-1·16; p=0·29) and surgical reintervention (12%, 42 of 344 vs 16%, 54 of 346: adjusted relative risk 0·78, 0·54-1·13; p=0·19) at 2 years, but this result did not reach statistical significance. No significant differences were seen in wound infection rate, seroma rate, quality of life, pain scores, or serious adverse events. INTERPRETATION Reinforcement of the abdominal wall with a biological mesh at the time of stoma closure reduced clinically detectable incisional hernia within 24 months of surgery and with an acceptable safety profile. The results of this study support the use of biological mesh in stoma closure site reinforcement to reduce the early formation of incisional hernias. FUNDING National Institute for Health Research Research for Patient Benefit and Allergan.
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Pizza F, D’Antonio D, Arcopinto M, Dell’Isola C, Marvaso A. Safety and efficacy of prophylactic resorbable biosynthetic mesh in loop-ileostomy reversal: a case–control study. Updates Surg 2020; 72:103-108. [DOI: 10.1007/s13304-020-00702-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 01/02/2020] [Indexed: 12/19/2022]
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Wilson M, Goldwag J, Wilson L, Ivatury S, Tsapakos M. The prevalence of fascial defects at prior stoma sites in patients with colorectal cancer. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2020. [DOI: 10.4103/ijawhs.ijawhs_56_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ibrahim MM, Green JL, Everitt J, Ruppert D, Glisson R, Leopardi F, Risoli T, Kuchibhatla M, Reynolds R, Levinson H. Soft Tissue Anchoring Performance, Biomechanical Properties, and Tissue Reaction of a New Hernia Mesh Engineered to Address Hernia Occurrence and Recurrence. J Med Device 2019; 13:0450021-450029. [PMID: 32280408 PMCID: PMC7104760 DOI: 10.1115/1.4043740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/24/2019] [Indexed: 01/22/2023] Open
Abstract
One opportunity to reduce hernia occurrence and recurrence rates (currently estimated to be 30% at 10 years postoperatively) is by enhancing the ability of hernia meshes to anchor into tissue to prevent mesh migration, mesh contraction, and mesh tearing away from tissue. To address this, we developed a novel moderate-weight, macroporous, polypropylene mesh (termed the T-line mesh) with mesh extensions to optimize anchoring. We examined the physical properties, biomechanical performance, and biocompatibility of this novel mesh versus a predicate mesh anchored with #0-suture. The physical properties of the T-line mesh and predicate mesh were measured using American Society for Testing and Materials (ASTM) standards. Meshes were implanted into a swine hernia model and harvested after one day to determine anchoring strength of the meshes in the perioperative period. A separate group was implanted into a swine hernia model and harvested at 30 days and 90 days for semiquantitative histological analysis of biocompatibility. T-line mesh physical properties were similar to commonly used moderate-weight meshes in thickness and areal density. The T-line mesh outperformed the predicate mesh in all mechanical testing (P < 0.05). In the perioperative period, the T-line mesh was ∼275% stronger (P < 0.001) than the standard of care. Histological analysis of biocompatibility demonstrated no significant difference between the T-line mesh and predicate mesh (P > 0.05). The T-line mesh is a novel hernia mesh that outperforms a predicate mesh in mechanical and biomechanical performance testing while exhibiting similar biocompatibility. The T-line mesh has the potential to reduce hernia occurrence and recurrence caused by mechanical failure.
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Affiliation(s)
- Mohamad M. Ibrahim
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of
Surgery, Duke University Medical Center, DUMC
3181, Durham, NC 27710
| | - Jason L. Green
- Duke University School of Medicine,
487 Medical Science Research Building 1, 203 Research Drive, Durham,
NC 27710
| | - Jeffrey Everitt
- Department of Pathology, Duke University Medical
Center, Durham, NC 27710
| | - David Ruppert
- Division of Plastic and Reconstructive Surgery, Department of Surgery,
Duke University Medical Center, Durham, NC
27710
| | - Richard Glisson
- Department of Orthopaedic Surgery, Duke University Medical
Center, Durham, NC 27710
| | - Frank Leopardi
- Department of Surgery, Duke University Medical
Center, Durham, NC 27710
| | - Thomas Risoli
- Department of Biostatistics and Bioinformatics, Duke
University Medical Center, Durham, NC
27710
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke
University Medical Center, Durham, NC
27710
| | - Randall Reynolds
- Division of Lab Animal Resources (DLAR), Duke University
School of Medicine, Durham, NC 27710
| | - Howard Levinson
- Division of Plastic and Reconstructive Surgery, Department of Surgery,
Duke University Medical Center, Durham, NC
27710
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Incidence and risk factors for incisional hernia after temporary loop ileostomy closure: choosing candidates for prophylactic mesh placement. Hernia 2019; 24:93-98. [PMID: 31494806 DOI: 10.1007/s10029-019-02042-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 08/22/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The primary aim of this study was to identify the incisional hernia rate after temporary loop ileostomy closure. Secondary outcomes were determining the risk factors linked to this incisional hernia, which could improve the patient selection for mesh prophylaxis. METHODS Retrospective cohort study of all consecutive patients with temporary loop ileostomy reversal through a peristomal incision from 1st January 2011 to 1st January 2017 at our centre. Data were extracted from electronic clinical records: baseline patient characteristics, surgical factors and postoperative events. CT scans performed during follow-up were precisely analysed. Survival analysis was applied to identify risk factors for hernia development. RESULTS 129 patients were analysed of whom 15 (11.6%) developed an incisional hernia at previous ileostomy site. The median time for incisional hernia development was 11 months (IQR = 7-21) and the median follow-up time was 37 months (IQR = 22-57). The identified patient risk factors for hernia development in survival analysis were female sex, older age, higher Body Mass Index, clinically significant parastomal hernia, clinically detectable midline incisional hernia and major postoperative complications ranked as Clavien-Dindo grade III and IV. CONCLUSIONS Incisional hernia after temporary loop ileostomy is a relevant problem that affects at least one in every ten patients. The previously cited risk factors might favour its development, therefore the use of a prophylactic mesh should be considered in those high-risk patients.
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van den Hil LCL, van Steensel S, Schreinemacher MHF, Bouvy ND. Prophylactic mesh placement to avoid incisional hernias after stoma reversal: a systematic review and meta-analysis. Hernia 2019; 23:733-741. [PMID: 31302788 PMCID: PMC6661031 DOI: 10.1007/s10029-019-01996-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/20/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE To provide an overview of the available literature on prevention of incisional hernias after stoma reversal, with the use of prophylactic meshes. METHODS A literature search of Pubmed, MEDLINE and EMBASE was performed. Search terms for stoma, enterostomy, mesh, prophylaxis and hernia were used. Search was updated to December 31th 2018. No time limitations were used, while English, Geman, Dutch and French were used as language restrictions. The primary outcome was the incidence of incisional hernia formation after stoma reversal. Secondary outcomes were mesh-related complications. Data on study design, sample size, patient characteristics, stoma and mesh characteristics, duration of follow-up and outcomes were extracted from the included articles. RESULTS A number of 241 articles were identified and three studies with 536 patients were included. A prophylactic mesh was placed in 168 patients to prevent incisional hernias after stoma reversal. Follow-up ranged from 10 to 21 months. The risk of incisional hernia in case of prophylactic mesh placement was significantly lower in comparison to no mesh placement (OR 0.10, 95% CI 0.04-0.27, p < 0.001, I2 = 0%, CI 0-91.40%). No differences in surgical site infections were detected between the groups. CONCLUSIONS The use of a prophylactic mesh seems to reduce the risk on incisional hernias after stoma reversal and therefore mesh reinforcement should be considered after stoma reversal.
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Affiliation(s)
- L C L van den Hil
- Department of General Surgery, Maastricht University Medical Centre, Maastricht, 6202 AZ, The Netherlands.
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, 6200 MD, The Netherlands.
- Department of General Surgery, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - S van Steensel
- Department of General Surgery, Maastricht University Medical Centre, Maastricht, 6202 AZ, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, 6200 MD, The Netherlands
| | - M H F Schreinemacher
- Department of General Surgery, Maastricht University Medical Centre, Maastricht, 6202 AZ, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, 6200 MD, The Netherlands
| | - N D Bouvy
- Department of General Surgery, Maastricht University Medical Centre, Maastricht, 6202 AZ, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, 6200 MD, The Netherlands
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Vergara-Fernández O, Trejo-Avila M, Santes O, Solórzano-Vicuña D, Salgado-Nesme N. Predictors of dehydration and acute renal failure in patients with diverting loop ileostomy creation after colorectal surgery. World J Clin Cases 2019; 7:1805-1813. [PMID: 31417926 PMCID: PMC6692275 DOI: 10.12998/wjcc.v7.i14.1805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/17/2019] [Accepted: 06/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Despite the potential benefits of fecal diversion after low pelvic anastomosis in colorectal surgery, diverting loop ileostomy construction is related to significant rates of complications.
AIM To determine potential predictors of high output related complications in patients with diverting loop ileostomy creation after colorectal surgery.
METHODS Patients who underwent open and laparoscopic colorectal surgery requiring a diverting loop ileostomy from January 2010 to March 2018 were retrospectively analyzed. We included patients older than 18 years, who underwent colorectal surgery with primary low pelvic anastomosis, and with the creation of a diverting loop ileostomy, at elective or emergency settings for the treatment of benign or malignant conditions. Univariate and multivariate logistic regression analysis was used to determine the effect of the potential predictors on the rate of high output related complications. The high output related complications were dehydration and acute renal failure that required visits to the emergency department and hospitalizations.
RESULTS Of the 102 patients included in the study, 23.5% (n = 24) suffered high output related complications. In this group of patients at least one visit to the emergency department (mean 1.6), and at least one readmission to the hospital was needed. The factors associated with high-output ileostomy, in the univariate analysis, were: urgent surgical intervention (OR = 2.6; P = 0.047), the development of postoperative complications (OR = 3; P = 0.024), have ulcerative colitis (OR = 4.8; P = 0.017), use of steroids (OR = 4.3; P = 0.010), mean output at discharge greater than 1000 mL/24 h (OR = 3.2; P = 0.016), and use of loperamide at discharge (OR = 2.8; P = 0.032). Multivariate logistic regression analysis identified two independent risk factors for high output related complications: ulcerative colitis [OR = 7.6 (95%CI: 1.81-31.95); P = 0.006], and ileostomy output at discharge ≥ 1000 mL/24 h [OR = 3.3 (1.18-9.37); P = 0.023].
CONCLUSION In our study, patients with ulcerative colitis and those with an ileostomy output above 1000 mL/24 h at discharge, were at increased risk of high output related complications.
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Affiliation(s)
- Omar Vergara-Fernández
- Department of Colorectal Surgery, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City 14080, Mexico
| | - Mario Trejo-Avila
- Department of Colorectal Surgery, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City 14080, Mexico
| | - Oscar Santes
- Department of Colorectal Surgery, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City 14080, Mexico
| | - Danilo Solórzano-Vicuña
- Department of Colorectal Surgery, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City 14080, Mexico
| | - Noel Salgado-Nesme
- Department of Colorectal Surgery, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City 14080, Mexico
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Green JL, Ruppert D, Glisson R, Ibrahim M, Gall K, Levinson H. Application of a novel suture anchor to abdominal wall closure. Am J Surg 2019; 218:1-6. [DOI: 10.1016/j.amjsurg.2019.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 04/24/2019] [Indexed: 11/16/2022]
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Systematic review and meta-analysis of incisional hernia post-reversal of ileostomy. Hernia 2019; 24:9-21. [PMID: 31073963 DOI: 10.1007/s10029-019-01961-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 04/28/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Incisional hernia following closure of loop ileostomy is a common problem. Assessment of the proportion of this complication is limited by small sample size and inconsistent reporting. The aim of this review was to provide an estimate of the proportion of incisional hernia following closure of loop ileostomy according to clinical and radiological diagnostic criteria and to investigate the association of bibliometric and study quality parameters with reported proportion. METHODS A systematic review of PubMed, Embase, CENTRAL, ISRCTN Registry and Open Grey from 2000 onwards was performed according to PRISMA standards. Reporting on the type of stoma and mesh reinforcement after closure was mandatory for inclusion, whereas studies on paediatric populations were excluded. Fixed effect or random effects models were used to calculate pooled proportion estimates. Meta-regression models were formed to explore potential heterogeneity. RESULTS 42 studies with 7166 patients were included. The pooled estimate of the proportion of incisional hernia after ileostomy closure was 6.1% (95% confidence interval, CI 4.4-8.3%). Proportion estimates for higher quality studies and studies reporting on incisional hernia as primary outcome were 9.0% (95% CI 6.3-12.7%) and 13.1% (95% CI 8.8-19.1%). Significant between-study heterogeneity was identified (P < 0.001, I2 = 87%) and the likelihood of publication bias was high (P = 0.028). Mixed effects regression showed that both year of publication (P = 0.034, Q = 4.484, df = 1.000) and defining hernia as a primary outcome (Q = 20.298, P < 0.001) were related to effect size. Method of follow-up and quality of the studies affected the proportion. CONCLUSION The proportion of incisional hernia at ileostomy closure site is estimated at 6.1%. Reporting incisional hernia as primary or secondary outcome, the method of diagnosis, the year of publication and methodological quality are associated with reported proportion.
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De Robles MS, Bakhtiar A, Young CJ. Obesity is a significant risk factor for ileostomy site incisional hernia following reversal. ANZ J Surg 2019; 89:399-402. [PMID: 30684304 DOI: 10.1111/ans.14983] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 10/21/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Incisional hernia following ileostomy reversal can cause significant morbidity, impaired quality of life, and burden on the healthcare system. This study aimed to determine the prevalence of ileostomy site incisional hernia following reversal and to identify possible risk factors for its development. METHODS This was a retrospective cohort study involving consecutive patients who underwent ileostomy reversal between November 1999 to February 2015 by a single surgeon. Primary outcome analysed was incisional hernia occurrence at the previous stoma site. RESULTS Two hundred and twenty-four ileostomy reversals were identified. The most common indication for ileostomy construction was colorectal cancer, followed by inflammatory bowel disease and diverticulosis. The stomas were either a loop (75%), end-loop (24%) or end ileostomy (1%). The mean time interval from the stoma creation to reversal was 6.1 months (range 2-69, SD 7.1). After a mean follow-up of 30.7 months (range 10-89, SD 15.1), 12 patients (5%) developed a hernia at the previous stoma. The mean time for hernia occurrence was 25.2 months (range 3-126, SD 32). Patients who developed ileostomy site incisional hernia were more likely to have a higher body mass index (28.1 versus 26.3, P = 0.007). CONCLUSION Although we found a lower rate of incisional hernias after reversal of ileostomies than reported elsewhere in the literature, it remains a significant clinical problem. Obesity is a significant risk factor for ileostomy-site incisional hernia.
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Affiliation(s)
- Marie Shella De Robles
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Arsalan Bakhtiar
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney Central Clinical School, Sydney, New South Wales, Australia
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