Reinforcement of closure of stoma site using a biological mesh
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Incisional hernia at the site of stoma closure is an under-reported problem, having been recently shown to occur in up to 30 % of patients. This technical note describes a technique for the placement of intraperitoneal biological mesh to prophylactically reinforce stoma closure sites. Seven consecutive patients underwent mesh placement as part of a pilot study. Following closure of the stoma through a trephine incision, 6 anchoring sutures were placed between the peritoneum/deep fascia and the edges of the mesh circumferentially. The mesh was delivered into the peritoneal cavity and parachuted up against the abdominal wall, and the sutures tied. If closure was performed through a midline laparotomy, the anchoring sutures were placed in a similar fashion through the midline incision. The fascia above the mesh and soft tissues was then closed. The mesh was successfully placed in all 7 patients. Follow-up at 30 days showed one superficial wound infection. An ultrasound scan of this patient revealed that the mesh was still in place and that the infection did not breach the fascia. No other early adverse events occurred. Prophylactic biological mesh reinforcement of stoma closure sites is technically feasible and safe in the short term. Longer-term results from a prospective randomised trial are needed, including clinical and radiological assessment for hernia rates, to establish what if any are the realisable benefits of this technique.
KeywordsIncisional hernia Stoma Biologic mesh Biologic tissue matrix Acellular dermal matrix
Collaborating members of the West Midlands Research Collaborative: David Bartlett, Nick Battersby, Elizabeth Hepburn, Paul Marriott, Pritesh Mistry, Henrietta Poon, Caroline Richardson, Andrew Torrance, Lisa Whisker and the Birmingham Clinical Trials Unit.
Conflict of interest
The mesh was provided free of charge by Lifecell Corporation for the pilot study to establish a standardised technique, as part of their ongoing support of the independently run ROCSS trial (a randomised controlled trial of prophylactic biological mesh reinforcement of closed stoma sites to prevent incisional hernia). The authors declare no conflicts of interest.