Division of Oncologic and Minimally Invasive Surgery, Niguarda General Hospital, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
Hernia. 2021 Jun;25(3):655-663. doi: 10.1007/s10029-020-02326-z. Epub 2020 Oct 31.
Prophylactic mesh placement has been proposed to reduce the high occurrence of parastomal hernia (PSH) after stoma formation.
This is an observational study comparing two cohorts of patients: a mesh prophylaxis group (who received mesh prevention since introduction at our Institution) and a no mesh prophylaxis group (retrospectively selected from our historical series). Same exclusion criteria were applied for both groups. The study was conducted at a tertiary referral center for colorectal surgery. 43 patients were operated with mesh prophylaxis between May 2015 and may 2019. 45 patients underwent end-colostomy formation without prophylaxis between April 2011 and April 2015. The primary outcome measure was PSH development at 12-month follow up.
Demographic variables and risk factors for PSH were comparable between the two groups. There was no difference between the two cohorts in terms of operative time and main early postoperative outcomes. 37 patients completed the 12-month follow up in each group. PSH occurrence after 12-months was 11% in the mesh prophylaxis group and 54% in the no mesh prophylaxis group (p < 0.0001). There were no differences in long-term complications. 5% of patients who received mesh prophylaxis underwent emergency surgery for bowel occlusion at 7 and 10 months after surgery, with partial or complete mesh removal. At multivariate analysis, mesh prophylaxis was a protective factor for PSH development at 12 months (p < 0.0001).
Prophylactic intraperitoneal mesh placement appears to be effective in preventing PSH.
预防性放置补片被提议用于减少造口后发生的高发性造口旁疝（PSH）。
这是一项观察性研究，比较了两组患者：一组是补片预防组（自我院开展该技术以来一直接受补片预防），另一组是无补片预防组（从我们的历史系列中回顾性选择）。两组均采用相同的排除标准。该研究在一家三级转诊中心的结肠直肠外科进行。2015 年 5 月至 2019 年 5 月，43 例患者接受了补片预防术。2011 年 4 月至 2015 年 4 月，45 例患者接受了末端结肠造口术而未行预防。主要观察指标是 12 个月随访时 PSH 的发生情况。
两组患者的人口统计学变量和 PSH 的危险因素相似。两组在手术时间和主要早期术后结果方面无差异。两组各有 37 例患者完成了 12 个月的随访。补片预防组 12 个月后 PSH 的发生率为 11%，无补片预防组为 54%（p<0.0001）。两组在长期并发症方面无差异。接受补片预防的 5%患者在术后 7 个月和 10 个月因肠阻塞而行急诊手术，部分或完全切除补片。多变量分析显示，补片预防是 12 个月时 PSH 发展的保护因素（p<0.0001）。
预防性腹腔内补片放置似乎能有效预防 PSH。
