Use of prophylactic mesh when creating a colostomy does not prevent parastomal hernia

Dr Christoffer Odensten, Sunderby Hospital Sweden, is currently coordinating a trial, Use of prophylactic mesh when creating a colostomy does not prevent parastomal hernia: a randomized controlled trial - STOMAMESH. You can view the abstract of this trial here.

Objective

The aim of this study was compare parastomal hernia (PSH) rate using a prophylactic mesh in the sublay position or without mesh when making a permanent end colostomy. Complications short and long term were secondary endpoints.

Background

Prevention of PSH is important; it can cause problems with dressing, cosmetics and also acute incarceration. The incidence of PSH is high; up to 78% in published studies. A lot of different methods have been tested and lately focus has been on mesh reinforcement around the end stoma at the primary operation. Our research collaboration, Clinical Surgical Trials Epidemiological Research (CLISTER), aid the foundations for this trial in 2006.

Methods

A randomized controlled double-blinded multicenter trial. All patients who had open surgery including a permanent end colostomy were eligible. Randomization was done into two groups, with and without mesh. The mesh used was a lightweight polypropylene mesh, placed around the colostomy in the sublay position. Patients were followed up after 30 days and one year. Computerized tomography and clinical examination were used to detect PSH at the one- year follow-up.

Results

One year after surgery 211 of 232 patients were clinically examined. Of these, 198 also had radiologic assessment. The duration of surgery was 36 min longer in the mesh group, reflecting that the mesh implantations did take some time to perform. We couldn’t find any difference in rate of PSH, either when clinically examined (p=0.866) or when examined by radiology (p=0.748). Neither could we find any significant difference in complications within 30 days postoperatively.

Conclusion

Using a reinforcing mesh does not decrease the rate of PSH. No difference in complication rate could be detected between the two arms at one year follow up. Based on these results, the use of prophylactic of mesh to prevent PSH cannot be recommended, especially since there are few studies of the long term effects of reinforcing parastomal meshes.