Brucchi Francesco, Rennis Maria, Achilli Pietro, Morini Lorenzo, Carnevali Pietro, Origi Matteo, Dionigi Gianlorenzo, Ferrari Giovanni
General Surgery Residency Program, University of Milan, Milan, Italy.
Division of Surgery, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.
Hernia. 2025 Sep 23;29(1):281. doi: 10.1007/s10029-025-03481-x.
Parastomal hernia (PSH) is the most common long-term complication after abdominoperineal resection (APR) with permanent end colostomy. Although prophylactic mesh placement has been suggested to reduce the rate of PSH, the optimal mesh type and surgical technique remain unclear. Recently, three-dimensional funnel-shaped meshes have been introduced to stabilize the bowel loop and minimize stoma-related mechanical stress, potentially reducing the incidence of PSH.
This retrospective cohort study, reported in accordance with STROBE guidelines, included consecutive patients who underwent elective laparoscopic permanent end colostomy (PEC) between 2011 and 2019 at a single institution. Patients were assigned to either a group without mesh or a group that received prophylactic intraperitoneal funnel-shaped mesh. The primary endpoint was radiologically confirmed PSH incidence. Kaplan-Meier analysis and Cox regression were used to assess differences in cumulative PSH risk over time.
Seventy-five patients were included (mesh group: 37; no-mesh group: 38), with a median follow-up of 46 and 43 months, respectively. The mesh group had a lower, but not statistically significant, absolute incidence of PSH (21.6% vs. 39.5%, p = 0.094). Importantly, the Kaplan-Meier analysis revealed a significantly lower cumulative incidence of PSH in the mesh group over time (p= 0.033). Postoperative complication rates were comparable between the groups.
Prophylactic placement of a funnel-shaped mesh during PEC was associated with a reduced cumulative incidence of PSH over long-term followup without increasing surgical morbidity. These results underline the potential benefit of funnel-shaped meshes in PSH prevention and highlight the need for prospective randomized studies.
造口旁疝（PSH）是腹会阴联合切除术（APR）并永久性末端结肠造口术后最常见的长期并发症。尽管有人建议放置预防性补片以降低PSH的发生率，但最佳的补片类型和手术技术仍不明确。最近，三维漏斗形补片已被引入，以稳定肠袢并将造口相关的机械应力降至最低，从而可能降低PSH的发生率。
本回顾性队列研究按照STROBE指南报告，纳入了2011年至2019年期间在单一机构接受择期腹腔镜永久性末端结肠造口术（PEC）的连续患者。患者被分为不使用补片组或接受预防性腹膜内漏斗形补片组。主要终点是经影像学证实的PSH发生率。采用Kaplan-Meier分析和Cox回归评估随时间累积PSH风险的差异。
共纳入75例患者（补片组：37例；无补片组：38例），中位随访时间分别为46个月和43个月。补片组PSH的绝对发生率较低，但无统计学意义（21.6%对39.5%，p = 0.094）。重要的是，Kaplan-Meier分析显示，随时间推移，补片组PSH的累积发生率显著较低（p = 0.033）。两组术后并发症发生率相当。
在PEC期间预防性放置漏斗形补片与长期随访中PSH的累积发生率降低相关，且不增加手术发病率。这些结果强调了漏斗形补片在预防PSH方面的潜在益处，并突出了进行前瞻性随机研究的必要性。
