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Prophylactic Mesh Placement During Formation of an End-colostomy Reduces the Rate of Parastomal Hernia: Short-term Results of the Dutch PREVENT-trial
- Source :
- Annals of Surgery, 265, 4, pp. 663-669, Annals of Surgery, 265, 663-669
- Publication Year :
- 2017
-
Abstract
- Contains fulltext : 175643.pdf (Publisher’s version ) (Closed access) OBJECTIVE: The aim of this study was to investigate the incidence of parastomal hernias (PSHs) after end-colostomy formation using a polypropylene mesh in a randomized controlled trial versus conventional colostomy formation. BACKGROUND: A PSH is the most frequent complication after stoma formation. Symptoms may range from mild abdominal pain to life-threatening obstruction and strangulation. The treatment of a PSH is notoriously difficult and recurrences up to 20% have been reported despite the use of mesh. This has moved surgical focus toward prevention. METHODS: Augmentation of the abdominal wall with a retro-muscular lightweight polypropylene mesh was compared with the traditional formation of a colostomy. In total, 150 patients (1:1 ratio) were included. The incidence of a PSH, morbidity, mortality, quality of life, and cost-effectiveness was measured after 1 year of follow-up. RESULTS: There was no difference between groups regarding demographics and predisposing factors for PSH. Three out of 67 patients (4.5%) in the mesh group and 16 out of 66 patients (24.2%) in the nonmesh group developed a PSH (P = 0.0011). No statistically significant difference was found in infections, concomitant hernias, SF-36 questionnaire, Von Korff pain score, and cost-effectiveness between both study groups. CONCLUSION: Prophylactic augmentation of the abdominal wall with a retromuscular lightweight polypropylene mesh at the ostomy site significantly reduces the incidence of PSH without a significant difference in morbidity, mortality, quality of life, or cost-effectiveness.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
education
Stress-related disorders Donders Center for Medical Neuroscience [Radboudumc 13]
030230 surgery
Polypropylenes
Risk Assessment
Parastomal hernia
Statistics, Nonparametric
law.invention
Stoma
03 medical and health sciences
Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14]
0302 clinical medicine
Randomized controlled trial
law
Colostomy
medicine
Humans
Hospital Mortality
Aged
Netherlands
Surgical Stomata
Chi-Square Distribution
business.industry
Surgical Stomas
Length of Stay
Middle Aged
Surgical Mesh
Prognosis
Hernia, Ventral
digestive system diseases
Surgery
Primary Prevention
Polypropylene mesh
Treatment Outcome
surgical procedures, operative
Surgical mesh
030220 oncology & carcinogenesis
Quality of Life
Female
Colorectal Neoplasms
Complication
business
Subjects
Details
- ISSN :
- 00034932
- Database :
- OpenAIRE
- Journal :
- Annals of Surgery, 265, 4, pp. 663-669, Annals of Surgery, 265, 663-669
- Accession number :
- edsair.doi.dedup.....3a97629972d4773b7cd4fe6e78992821