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Hernia. 2012 Dec;16(6):655-60. doi: 10.1007/s10029-012-0947-9. Epub 2012 Jul 11.
Parastomal hernia (PSH) is a very frequent complication after creation of a permanent colostomy. The aim of this study is to assess the safety and prophylactic effect of intraperitoneal onlay mesh (IPOM) reinforcement of the abdominal wall at the time of primary stoma formation to prevent PSH occurrence.
This multicentre prospective study concerned 20 patients operated for low rectal carcinoma between 2008 and 2010. Those patients had an elective and potentially curative abdominoperineal excision associated with IPOM reinforcement of the abdominal wall with a round composite mesh centred on the stoma site and covering the lateralised colon. There were 8 men and 12 women with a median age of 69 years (range: 44-88) and a body mass index of 27 (range: 21-35). The major outcomes analysed in the study were operative time, complications related to mesh and PSH occurrence. Patients were evaluated 1 month after surgery and then every 6 months with physical examination and computed tomography scan (CT-scan). For PSH, we used the classification of Moreno-Matias.
Surgery was performed by laparoscopy in 17 patients and by laparotomy in 3; 12 had an extraperitoneal colostomy, and 8 had a transperitoneal colostomy. The median size of the mesh was 15 cm (range: 12-15). The median operative time was 225 min (range: 175-300), and specific time for mesh placement was 15 min (range: 12-30). One month after surgery, one patient presented with a mild stoma stenosis that was treated successfully by dilatation. With a median follow-up of 24 months (range: 6-42), no other complication potentially related to the use of the mesh was recorded and no mesh had to be removed. On clinical examination, one patient (1/20 = 5 %) had a stoma bulge that appeared a few months after surgery, but was not associated with symptoms. CT-scan evaluation confirmed that all the patients with a normal clinical examination had no PSH and revealed that the patient with the stoma bulge had a stoma loop hernia (type 1a hernia). This patient was followed up for 36 months, no clinical or radiological aggravation of the stoma loop hernia was observed, and he remained totally asymptomatic.
With 95 % of excellent results, IPOM reinforcement at the time of end colostomy formation in selected patients is a very promising procedure. A drawback of this technique is the possibility of developing a stoma loop hernia due to sliding of the exiting colon between the covering mesh and the abdominal wall. However, this risk is low, and no adverse clinical consequence for the patient was noted in our series.
造口旁疝（PSH）是永久性结肠造口术后非常常见的并发症。本研究旨在评估在初次造口时使用腹腔内补片（IPOM）加强腹壁以预防 PSH 发生的安全性和预防效果。
这是一项多中心前瞻性研究，涉及 2008 年至 2010 年间接受低位直肠癌手术的 20 名患者。这些患者接受了选择性和潜在可治愈的腹会阴联合切除术，并在腹壁上使用圆形复合补片进行 IPOM 加强，补片位于造口部位中央，覆盖侧向结肠。患者包括 8 名男性和 12 名女性，中位年龄为 69 岁（范围：44-88 岁），体重指数为 27（范围：21-35）。研究中主要分析的手术结果包括手术时间、与补片相关的并发症和 PSH 的发生。患者在手术后 1 个月进行评估，然后每 6 个月进行一次体格检查和计算机断层扫描（CT 扫描）。对于 PSH，我们使用 Moreno-Matias 分类。
17 名患者通过腹腔镜手术进行，3 名患者通过剖腹手术进行；12 名患者行腹膜外结肠造口术，8 名患者行经腹膜结肠造口术。补片的中位大小为 15cm（范围：12-15cm）。中位手术时间为 225 分钟（范围：175-300 分钟），放置补片的特定时间为 15 分钟（范围：12-30 分钟）。术后 1 个月，1 名患者出现轻度造口狭窄，经扩张治疗成功。中位随访 24 个月（范围：6-42 个月），未记录到任何与使用补片相关的其他潜在并发症，也无需移除补片。临床检查发现，1 名患者（20 例中的 1 例，5%）在术后几个月出现造口膨出，但无明显症状。CT 扫描评估证实，所有临床检查正常的患者均无 PSH，且发现造口膨出的患者患有造口疝（1a 型疝）。该患者接受了 36 个月的随访，未观察到造口疝环疝的临床或影像学加重，且患者仍无症状。
在选定的患者中，在末端结肠造口形成时使用 IPOM 加强，其 95%的结果非常出色，是一种很有前途的方法。该技术的缺点是由于覆盖补片和腹壁之间的结肠脱出，可能会发生造口疝环疝。然而，这种风险较低，在我们的研究系列中，患者未出现任何不良临床后果。
