Hauters Philippe, Cardin Jean-Luc, Lepere Marc, Valverde Alain, Cossa Jean-Pierre, Auvray Sylvain, Framery Dominique, Zaranis Constantin
CHwapi, Site Notre-Dame, 9 Avenue Delmée, 7500, Tournai, Belgium.
Polyclinique du Maine, 4 Avenue des Français Libres, 5310, Laval, France.
Surg Endosc. 2016 Dec;30(12):5372-5379. doi: 10.1007/s00464-016-4891-0. Epub 2016 Apr 8.
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.
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.
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.
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.
造口旁疝（PSH）是永久性结肠造口术后非常常见的并发症。本研究的目的是评估在初次造口形成时放置腹膜内补片（IPOM）预防PSH发生的安全性和长期疗效。
这项多中心前瞻性研究涉及2008年至2014年间连续29例因低位直肠癌接受手术的患者。其中男性14例，女性15例，中位年龄73岁（范围39 - 88岁），体重指数（BMI）为28（范围21 - 43）。所有患者均接受了可能根治性的腹会阴联合切除术，并根据改良的Sugarbaker技术，采用以造口部位为中心、覆盖侧方结肠的圆形无缝合复合补片对腹壁进行IPOM加固。分析的主要结局指标为手术时间、与补片相关的并发症以及PSH发生率。患者在最初2年每6个月评估一次，此后每年进行体格检查和CT扫描对照评估。对于PSH评估，我们采用了Moreno - Matias分类法。
24例患者通过腹腔镜手术，5例通过开腹手术；17例为经腹结肠造口术，12例为腹膜外结肠造口术。补片的中位尺寸为15 cm（范围12 - 20 cm），手术时间为225分钟（范围123 - 311分钟），放置补片的特定时间为15分钟（范围10 - 30分钟）。中位随访时间为48个月（范围6 - 88个月），未记录到补片感染或需要移除补片的并发症。没有患者发生真正的PSH；其中2例为Ia型PSH（仅包含形成结肠造口的肠管，疝囊<5 cm），且完全无症状。
在我们的系列研究中，PSH的发生率为7%，未观察到与补片相关的特定并发症。根据改良的Sugarbaker技术进行预防性补片加固是一种有效的技术，可解决与PSH发生相关的问题。
