Drissi Farouk, Jurczak Florent, Dabrowski André, Oberlin Olivier, Khalil Haitham, Gillion Jean-François, Meurette Guillaume
Chirurgie Digestive, Viscérale et Générale, Clinique Jules Verne, 2-4 route de Paris, Nantes, 44300, France.
Chirurgie Cancérologique Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Hôtel Dieu, CHU de Nantes, 1 place Alexis Ricordeau, Nantes Cedex 01, 44093, France.
Hernia. 2025 Apr 4;29(1):133. doi: 10.1007/s10029-025-03328-5.
Stoma site incisional hernia (SSIH) is a frequent complication following ileostomy closure but can be potentially decreased by prophylactic mesh reinforcement. The aim was to assess if the use of a slowly absorbable biosynthetic mesh at the time of ileostomy reversal could reduce the incidence of SSIH.
Outcomes of consecutive patients receiving prophylactic biosynthetic mesh (poly-4-hydroxybutyrate Phasix, BD) implantation at the time of ileostomy reversal for colorectal cancer were prospectively collected in the Club Hernie database. Outcomes were compared with those of matched patients from a historical cohort of patients undergoing ileostomy reversal without mesh augmentation.
A total of 100 patients underwent ileostomy reversal: 50 with biosynthetic mesh augmentation (mesh group) and 50 with standard fascial closure without mesh (control group). Mesh augmentation did not increase the operating time (mesh group 49.8 min vs. control group 60.5 min, p < 0.01), the incidence of surgical site infection (mesh group 4% vs. control group 6%, p = 1) or the length of hospital stay (mesh group 5 days vs. control group 6 days, p = 0.28). After a mean follow-up of 4 years, the rate of SSIH, diagnosed by CT scan, was significantly lower in the mesh group (mesh group 8% vs. control group 24%, p = 0.029).
Prophylactic use of a slowly absorbable biosynthetic mesh at the time of ileostomy reversal for colorectal cancer was safe and effective in reducing the rate of SSIH without increasing surgical site infection.
造口部位切口疝（SSIH）是回肠造口关闭术后常见的并发症，但预防性使用补片加强可能会降低其发生率。本研究旨在评估在回肠造口还纳时使用可缓慢吸收的生物合成补片是否能降低SSIH的发生率。
前瞻性收集了结肠直肠癌患者回肠造口还纳时接受预防性生物合成补片（聚-4-羟基丁酸酯Phasix，BD公司）植入的连续患者的资料，并将结果与来自未使用补片加强的回肠造口还纳历史队列中匹配患者的结果进行比较。
共有100例患者接受了回肠造口还纳术：50例使用生物合成补片加强（补片组），50例采用标准筋膜关闭且未使用补片（对照组）。补片加强并未增加手术时间（补片组49.8分钟 vs. 对照组60.5分钟，p < 0.01）、手术部位感染发生率（补片组4% vs. 对照组6%，p = 1）或住院时间（补片组5天 vs. 对照组6天，p = 0.28）。平均随访4年后，通过CT扫描诊断的SSIH发生率在补片组显著更低（补片组8% vs. 对照组24%，p = 0.029）。
对于结肠直肠癌患者，在回肠造口还纳时预防性使用可缓慢吸收的生物合成补片在降低SSIH发生率方面安全有效，且不会增加手术部位感染。
