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Long-term assessment of parastomal hernia prevention by intra-peritoneal mesh reinforcement according to the modified Sugarbaker technique

Surgical Endoscopy volume 30, pages 5372–5379 (2016)Cite this article

Abstract

Background

Parastomal hernia (PSH) is a very frequent complication after creation of a permanent colostomy. The aim of that study is to assess the safety and the long-term efficacy of an intra-peritoneal onlay mesh (IPOM) positioned at the time of primary stoma formation to prevent PSH occurrence.

Materials and methods

That multicentre prospective study concerned 29 consecutive patients operated for cancer of the low rectum between 2008 and 2014. There were 14 men and 15 women with a median age of 73 years (range 39–88) and a BMI of 28 (range 21–43). All the patients had potentially curative abdominoperineal excision associated with IPOM reinforcement of the abdominal wall with a round non-slit composite mesh centred on the stoma site and covering the lateralized colon according to the modified Sugarbaker technique. The major outcomes analysed were operative time, complications related to mesh and PSH incidence. Patients were evaluated at 6-month intervals for the first 2 years and thereafter annually with physical examination and CT scan control. For PSH evaluation, we used the classification of Moreno-Matias.

Results

Surgery was performed by laparoscopy in 24 patients and by laparotomy in 5; 17 had a trans-peritoneal colostomy and 12 an extra-peritoneal colostomy. The median size of the mesh was 15 cm (range 12–20), the operative time 225 min. (range 123–311) and the specific time for mesh placement 15 min. (range 10–30). With a median follow-up of 48 months (range 6–88), no mesh infection or complication requiring mesh removal were recorded. No patient developed a true PSH; two of them had a type Ia PSH (only containing the bowel forming the colostomy with a sac < 5 cm) and were totally asymptomatic.

Conclusion

In our series, the incidence of PSH was 7 % and no specific mesh-related complication was noted. Prophylactic mesh reinforcement according to the modified Sugarbaker is an effective technique that addresses the issues related to the occurrence of PSH.

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Authors and Affiliations

  1. CHwapi, Site Notre-Dame, 9 Avenue Delmée, 7500, Tournai, Belgium

    Philippe Hauters

  2. Polyclinique du Maine, 4 Avenue des Français Libres, 5310, Laval, France

    Jean-Luc Cardin

  3. Clinique Saint-Charles, 11 Bld René Levesque, 8500, La Roche Sur Yon, France

    Marc Lepere

  4. Grand Hôpital Diaconesses, 125 Rue d’Avron, 75020, Paris, France

    Alain Valverde

  5. Clinique Bizet, 23 Rue Georges Bizet, 75116, Paris, France

    Jean-Pierre Cossa

  6. CHP Saint-Martin, 18 Rue des Roquemonts, 14050, Caen, France

    Sylvain Auvray

  7. C.M.C. de la Baie de Morlaix, 29600, Morlaix, France

    Dominique Framery

  8. Clinique du Mail, 96, Allée du Mail, 17000, La Rochelle, France

    Constantin Zaranis

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  1. Philippe Hauters
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  2. Jean-Luc Cardin
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Correspondence to Philippe Hauters.

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Disclosures

The study was not funded and the authors Philippe Hauters, Jean-Luc Cardin, Marc Lepere, Alain Valverde, Jean-Pierre Cossa, Sylvain Auvray, Dominique Framery, Constantin Zaranis declare no conflict of interest.

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Hauters, P., Cardin, JL., Lepere, M. et al. Long-term assessment of parastomal hernia prevention by intra-peritoneal mesh reinforcement according to the modified Sugarbaker technique. Surg Endosc 30, 5372–5379 (2016). https://doi.org/10.1007/s00464-016-4891-0

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  • DOI: https://doi.org/10.1007/s00464-016-4891-0

Keywords

  • Parastomal hernia
  • Prevention
  • Prophylactic mesh
  • Intra-peritoneal only mesh
  • Modified Sugarbaker technique