Prevention of parastomal hernia after abdominoperineal excision with a prophylactic three-dimensional funnel mesh

Abstract

Aim: A prophylactic three-dimensional (3D) funnel mesh using the keyhole technique (intraperitoneal onlay mesh position) in abdominoperineal excision (APR) may significantly decrease the parastomal hernia (PSH) index without increasing morbidity. The aim of this retrospective observational study was to analyse the incidence of PSH and postoperative complications in patients who underwent permanent colostomy with the use of a prophylactic 3D preformed mesh compared with patients without a mesh.

Method: Patients who underwent an end-colostomy after APR for primary or recurrent rectal cancer in a colorectal surgery unit were divided into two groups: group 1 without a prophylactic mesh and group 2 with a prophylactic synthetic mesh. The main end-point was to analyse the incidence of PSH after a median follow-up of 2.8 years.

Results: One hundred and ten patients (64 in group 1 and 46 in group 2, without significant clinical differences) underwent a permanent colostomy after APR. In group 1 70.3% developed a PSH, compared with 13% in group 2 (P < 0.001). Age (especially for patients ≥ 75 years) represented a significant risk factor for PSH. There were no differences in postoperative complications between the groups.

Conclusion: A prophylactic parastomal 3D mesh using the keyhole technique may reduce the incidence of PSH after permanent colostomy without an increase in postoperative complications.

Keywords: Abdominoperineal excision; keyhole technique; parastomal hernia; permanent end-colostomy.