, Volume 16, Issue 6, pp 661–667 | Cite as

Use of a prosthetic mesh to prevent parastomal hernia during laparoscopic abdominoperineal resection: a randomized controlled trial

  • M. López-CanoEmail author
  • R. Lozoya-Trujillo
  • S. Quiroga
  • J. L. Sánchez
  • F. Vallribera
  • M. Martí
  • L. M. Jiménez
  • M. Armengol-Carrasco
  • E. Espín
Original Article



Prevention of parastomal hernia represents an important aim when a permanent stoma is necessary. The objective of this work is to assess whether implantation of a prophylactic prosthetic mesh during laparoscopic abdominoperineal resection contributed to reduce the incidence of parastomal hernia.


Rectal cancer patients undergoing elective laparoscopic abdominoperineal resection with permanent colostomy were randomized to placement of a large-pore lightweight mesh in the intraperitoneal/onlay position by the laparoscopic approach (study group) or to the control group (no mesh). Parastomal hernia was defined radiologically by a CT scan performed after 12 months of surgery. The usefulness of subcutaneous fat thickness measured by CT to discriminate patients at risk of parastomal hernia was assessed by ROC curve analysis.


Thirty-six patients were randomized, 19 to the mesh group and 17 to the control group. Parastomal hernia was detected in 50 % of patients in the mesh group and in 93.8 % of patients in the control group (P = 0.008). The AUC for thickness of the subcutaneous abdominal was 0.819 (P = 0.004) and the optimal threshold 23 mm. Subcutaneous fat thickness ≥23 mm was a significant predictor of parastomal hernia (odds ratio 15.7, P = 0.010), whereas insertion of a mesh was a protective factor (odds ratio 0.06, P = 0.031).


Use of prophylactic large-pore lightweight mesh in the intraperitoneal/onlay position by a purely laparoscopic approach reduced the incidence of parastomal hernia formation. Subcutaneous fat thickness ≥23 mm measured by CT was an independent predictor of parastomal hernia.


Parastomal Hernia Mesh Prevention Laparoscopy 



We thank Marta Pulido, MD; for editing the manuscript and editorial assistance.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The study comply with the current laws of the country. The study protocol was approved by the Ethics Committee of the hospital and all patients signed an informed consent before operation. The study was officially registered under NCT00908661 on


  1. 1.
    Israelsson LA (2008) Parastomal hernias. Surg Clin North Am 88:113–125PubMedCrossRefGoogle Scholar
  2. 2.
    Cingi A, Cakir T, Sever A, Aktan AO (2006) Enterostomy site hernias: a clinical and computerized tomographic evaluation. Dis Colon Rectum 49:1559–1563PubMedCrossRefGoogle Scholar
  3. 3.
    Wara P (2011) Parastomal hernia repair. An update. Minerva Chir 66:123–128PubMedGoogle Scholar
  4. 4.
    Linn JG, Mikami DJ (2010) Parastomal hernia repair. J Long Term Eff Med Implants 20:133–138PubMedCrossRefGoogle Scholar
  5. 5.
    Tam KW, Wei PL, Kuo LJ, Wu CH (2010) Systematic review of the use of a mesh to prevent parastomal hernia. World J Surg 34:2723–2729PubMedCrossRefGoogle Scholar
  6. 6.
    Wijeyekoon SP, Gurusamy K, El-Gendy K, Chan CL (2010) Prevention of parastomal herniation with biologic/composite prosthetic mesh: a systematic review and meta-analysis of randomized controlled trials. J Am Coll Surg 211:637–645PubMedCrossRefGoogle Scholar
  7. 7.
    Jänes A, Cengiz Y, Israelsson LA (2004) Randomized clinical trial of the use of a prosthetic mesh to prevent parastomal hernia. Br J Surg 91:280–282PubMedCrossRefGoogle Scholar
  8. 8.
    Jänes A, Cengiz Y, Israelsson LA (2004) Preventing parastomal hernia with a prosthetic mesh. Arch Surg 139:1356–1358PubMedCrossRefGoogle Scholar
  9. 9.
    Jänes A, Cengiz Y, Israelsson LA (2009) Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study. World J Surg 33:118–121PubMedCrossRefGoogle Scholar
  10. 10.
    Hammond TM, Huang A, Prosser K, Frye JN, Williams NS (2008) Parastomal hernia prevention using a novel collagen implant: a randomised controlled phase 1 study. Hernia 12:475–481PubMedCrossRefGoogle Scholar
  11. 11.
    Serra-Aracil X, Bombardo-Junca J, Moreno-Matias J, Darnell A, Mora-Lopez L, Alcantara-Moral M, Ayguavives-Garnica I, Navarro-Soto S (2009) Randomized, controlled, prospective trial of the use of a mesh to prevent parastomal hernia. Ann Surg 249:583–587PubMedCrossRefGoogle Scholar
  12. 12.
    Carne PW, Frye JN, Robertson GM, Frizelle FA (2003) Parastomal hernia following minimally invasive stoma formation. ANZ J Surg 73:843–845PubMedCrossRefGoogle Scholar
  13. 13.
    Ng KH, Ng DC, Cheung HY, Wong JC, Yau KK, Chung CC, Li MK (2009) Laparoscopic resection for rectal cancers: lessons learned from 579 cases. Ann Surg 249:82–86PubMedCrossRefGoogle Scholar
  14. 14.
    Janson AR, Jänes A, Israelsson LA (2010) Laparoscopic stoma formation with a prophylactic mesh. Hernia 14:495–498PubMedCrossRefGoogle Scholar
  15. 15.
    López-Cano M, Lozoya-Trujillo R, Espin-Basany E (2009) Prosthetic mesh in parastomal hernia prevention. Laparoscopic approach. Dis Colon Rectum 52:1006–1007CrossRefGoogle Scholar
  16. 16.
    Pilgrim CH, McIntyre R, Bailey M (2010) Prospective audit of parastomal hernia: prevalence and associated comorbidities. Dis Colon Rectum 53:71–76PubMedCrossRefGoogle Scholar
  17. 17.
    Goligher JC (1984) Surgery of the Anus, Colon and Rectum, 5th edn. Ballière Tindall, LondonGoogle Scholar
  18. 18.
    Hansson BM, Bleichrodt RP, de Hingh IH (2009) Laparoscopic parastomal hernia repair using a keyhole technique results in a high recurrence rate. Surg Endosc 23:1456–1459PubMedCrossRefGoogle Scholar
  19. 19.
    Mancini GJ, McClusky DA III, Khaitan L, Goldenberg EA, Heniford BT, Novitsky YW, Park AE, Kavic S, LeBlanc KA, Elieson MJ, Voeller GR, Ramshaw BJ (2007) Laparoscopic parastomal hernia repair using a non-slit mesh technique. Surg Endosc 21:1487–1491PubMedCrossRefGoogle Scholar
  20. 20.
    Heniford B, Park A, Ramshaw B, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–400PubMedGoogle Scholar
  21. 21.
    El-Gazzaz G, Kiran RP, Lavery I (2009) Wound complications in rectal cancer patients undergoing primary closure of the perineal wound after abdominoperineal resection. Dis Colon Rectum 52:1962–1966PubMedCrossRefGoogle Scholar
  22. 22.
    De Raet J, Delvaux G, Haentjens P, Van Nieuwenhove Y (2008) Waist circumference is an independent risk factor for the development of parastomal hernia after permanent colostomy. Dis Colon Rectum 51:1806–1809PubMedCrossRefGoogle Scholar
  23. 23.
    Duchesne JC, Wang YZ, Weintraub SL, Boyle M, Hunt JP (2002) Stoma complications: a multivariate analysis. Am Surg 68:961–966PubMedGoogle Scholar
  24. 24.
    Meagher AP, Owen G, Gett R (2009) Multimedia article. An improved technique for end stoma creation in obese patients. Dis Colon Rectum 52:531–533PubMedCrossRefGoogle Scholar
  25. 25.
    Jänes A, Weisby L, Israelsson LA (2011) Parastomal hernia: clinical and radiological definitions. Hernia 15:189–192PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • M. López-Cano
    • 1
    Email author
  • R. Lozoya-Trujillo
    • 2
  • S. Quiroga
    • 3
  • J. L. Sánchez
    • 2
  • F. Vallribera
    • 2
  • M. Martí
    • 2
  • L. M. Jiménez
    • 2
  • M. Armengol-Carrasco
    • 1
  • E. Espín
    • 2
  1. 1.Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d’HebronUniversitat Autonoma de BarcelonaBarcelonaSpain
  2. 2.Colorectal Surgery Unit, Department of General Surgery, Hospital Universitari Vall d’HebronUniversitat Autonoma de BarcelonaBarcelonaSpain
  3. 3.Department of Radiology, Hospital Universitari Vall d’HebrónUniversitat Autonoma de BarcelonaBarcelonaSpain

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