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Violante T, Ferrari D, Gomaa IA, Aboelmaaty SA, Behm KT, Cima RR. Robotic parastomal hernia repair: A single-center cohort study. Updates Surg 2024; 76:2627-2634. [PMID: 39223401 DOI: 10.1007/s13304-024-01969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 08/24/2024] [Indexed: 09/04/2024]
Abstract
Parastomal hernia is a common occurrence following stoma construction, necessitating surgical intervention in symptomatic cases. This study presents a comprehensive analysis of Robotic-Assisted Parastomal Hernia Repair (r-PSHR), utilizing the Da Vinci Xi™ Surgical System. Retrospective analysis was conducted on patients undergoing r-PSHR at a high-volume center. Surgical variables, complications, and recurrence rates were assessed. The primary technique involved a modified Sugarbaker intraperitoneal onlay mesh. Eighty-six patients underwent r-PSHR, predominantly females (59.3%), with mean age 60.8 years. Mean BMI was 31.0. Most patients were classified as ASA 2 (31.4%) or ASA 3 (65.1), with 64.6% having no prior PSH repair. Index procedures primarily involved laparoscopic colonic resections (27.8%) and open abdominoperineal resections (27.8%). Parastomal hernias were mainly associated with end ileostomy (50%) and end colostomy (47.7%). A hybrid modification was required in 22.1% of cases, with only one conversion to open repair. Mean operative time was 257 min. Thirty-day morbidity was 40.7% and includes ileus (24.4%), deep surgical-site infections (7.0%), acute kidney injury (5.8%), and sepsis (5.8%). Grade IIIB complications occurred in 5.8% of cases. Thirty-day readmissions were observed in 19.8% of cases. There were five cases (5.8%) of recurrence within 15 months post-surgery. This study highlights the effectiveness of r-PSHR in managing parastomal hernia. R-PSHR shows promising outcomes with an acceptable post-operative occurrence profile and a favorable recurrence rate.
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Affiliation(s)
- Tommaso Violante
- Department of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
- School of General Surgery, Alma Mater Studiorum Università Di Bologna, Bologna, Italy
| | - Davide Ferrari
- Department of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
- General Surgery Residency Program, University of Milan, Milan, Italy
| | - Ibrahim A Gomaa
- Department of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - Sara A Aboelmaaty
- Department of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - Kevin T Behm
- Department of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - Robert R Cima
- Department of Colon and Rectal Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA.
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Dawes AJ, Gahagan JV. Stoma Complications. Clin Colon Rectal Surg 2024; 37:387-397. [PMID: 39399130 PMCID: PMC11466528 DOI: 10.1055/s-0043-1777453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
Stoma-related complications are among the most common sources of perioperative morbidity in colorectal surgery. Complications can occur intraoperatively, in the immediate postoperative period, or even months to years after stoma creation. Although some will require urgent surgical intervention, most are treated nonoperatively with a combination of education, appliance adjustment, and behavioral intervention. Optimal management of stoma complications nearly always requires a multidisciplinary team approach, including surgeons, enterostomal therapists, and other allied health professionals, depending on the specific situation. Patients with a functional stoma should be expected to be able to do anything that patients without a stoma can do with minimal exceptions. The treatment of stoma complications therefore centers on improving stoma function and maximizing quality of life. Although timely and comprehensive intervention will result in the resolution of most stoma complications, there is no substitute for preoperative planning and meticulous stoma creation.
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Affiliation(s)
- Aaron J. Dawes
- Section of Colon and Rectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
- Department of Surgery, Stanford-Surgery Policy Improvement Research and Education Center, Stanford, California
| | - John V. Gahagan
- Section of Colon and Rectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
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3
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Fleming AM, Wood EH. Repair of Parastomal Hernias. Adv Surg 2024; 58:107-119. [PMID: 39089771 DOI: 10.1016/j.yasu.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Parastomal hernias are an inevitable consequence of ostomy formation and their repairs remain a challenge to many surgeons. With multiple systems of classification and a multitude of techniques for hernia repair ranging from suture to mesh repair, the literature remains sparse with regards to the optimal method of repair. The authors describe the most commonly adopted techniques, discuss preventative measures, and review the current literature in the context of perioperative outcomes and hernia recurrence.
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Affiliation(s)
- Andrew M Fleming
- Department of Surgery, The University of Tennessee Health Science Center, 910 Madison Avenue Room 329, Memphis, TN 38103, USA
| | - Elizabeth H Wood
- Department of Surgery, The University of Tennessee Health Science Center, 910 Madison Avenue Room 329, Memphis, TN 38103, USA.
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Bertrand MM, Theuil L, Demattei C, Prudhomme M. Effect of Sublay Preventive Mesh for Terminal Colostomy on Symptoms and Quality of Life in Patients With Parastomal Hernia: A Post Hoc Analysis of the GRECCAR 7 Cohort. Dis Colon Rectum 2024; 67:1210-1216. [PMID: 38830268 DOI: 10.1097/dcr.0000000000003257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND Recent randomized clinical trials and meta-analyses confirm that the use of a prophylactic mesh does not significantly reduce the parastomal hernia rate. Data about the benefits of these meshes concerning the symptoms of parastomal hernia are lacking in the existing literature. OBJECTIVE The aim of this study was to perform a post hoc analysis of the patients presenting parastomal hernia from the GRECCAR 7 (Groupe de recherche sur la chirurgie du cancer du rectum) randomized clinical trials cohort on whether the presence or the absence of the mesh influenced the symptoms, the quality of life, and complications of patients with parastomal hernias. DESIGN We studied the parastomal hernia-related symptoms among the 2 groups of the GRECCAR 7 randomized clinical trial, with or without prophylactic mesh at the time of the index surgery. SETTINGS Data were retrospectively extracted and analyzed from the GRECCAR 7 database. PATIENTS Patients diagnosed with a parastomal hernia during the 2 years of the GRECCAR 7 study. MAIN OUTCOME MEASURES Several prospectively collected data about the symptoms were studied among this population. We also studied the average interval between parastomal hernia repair surgery and both index surgery and diagnosis of parastomal hernia. RESULTS Among the 199 patients included in the GRECCAR study, 36 patients (35.6%) in the nonmesh group and 33 patients (33.7%) in the mesh group were diagnosed with clinical and/or radiological parastomal hernia at 2-year follow-up, without a statistically significant difference ( p = 0.89). None of the studied symptoms showed any statistically significant difference between the groups. LIMITATIONS This study relies on a relatively small number of patients, and although data were prospectively collected, we lacked some details about the categorization of parastomal hernias. CONCLUSIONS We believe that the use of a prosthetic mesh in a sublay position to prevent parastomal hernia in terminal end colostomy patients should no longer be recommended. See Video Abstract . EFECTO DE LA MALLA PREVENTIVA RETROMUSCULAR PARA COLOSTOMA TERMINAL CON RESPECTO A LOS SNTOMAS Y LA CALIDAD DE VIDA EN PACIENTES CON HERNIA PARAESTOMAL UN ANLISIS POSTHOC DE LA COHORTE GRECCAR ANTECEDENTES:Los recientes metaanálisis y ensayos clínicos aleatorizados confirman que el uso de una malla profiláctica no reduce significativamente la tasa de hernia paraestomal. En la literatura existente faltan datos sobre los beneficios de estas mallas en relación con los síntomas de la hernia paraestomal.OBJETIVO:El objetivo de este estudio fue realizar un análisis post-hoc de los pacientes que presentaron hernia paraestomal de la cohorte de 7 ensayos clínicos aleatorizados GRECCAR sobre si la presencia o ausencia de la malla influyó en los síntomas, la calidad de vida y las complicaciones de los pacientes con hernias paraestomales.DISEÑO:Estudiamos los síntomas relacionados con la hernia paraestomal entre los dos grupos del ensayo clínico aleatorizado GRECCAR 7, con o sin malla profiláctica en el momento de la cirugía índice.AJUSTES:Los datos fueron extraídos y analizados de manera retrospectiva de la base de datos GRECCAR 7.PACIENTES:Pacientes diagnosticados con hernia paraestomal durante los dos años del estudio GRECCAR 7.PRINCIPALES MEDIDAS DE RESULTADO:Se estudiaron varios datos recopilados de manera prospectiva sobre los síntomas en esta población. También estudiamos el intervalo promedio entre la cirugía reparadora de la hernia paraestomal así como también la cirugía índice como el diagnóstico de la hernia paraestomal.RESULTADOS:De entre los 199 pacientes incluidos en el estudio GRECCAR, 36 pacientes (35,6%) fueron diagnosticados con hernia paraestomal de manera clínica y/o radiológica en el grupo sin malla a los 2 años de seguimiento y 33 (33,7%) en el grupo con malla, sin diferencia estadísticamente significativa ( p = 0,89). Ninguno de los síntomas estudiados mostró diferencias estadísticamente significativas entre los grupos.LIMITACIONES:Este estudio se basa en un número relativamente pequeño de pacientes y, aunque los datos fueron recopilados de forma prospectiva, nos faltaron algunos detalles sobre la categorización de las hernias paraestomales.CONCLUSIONES:Creemos que ya no se debe recomendar el uso de una malla protésica en posición retromuscular para prevenir la hernia paraestomal en pacientes con colostomía terminal. (Traducción-Dr. Osvaldo Gauto ).
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Affiliation(s)
- Martin M Bertrand
- Department of Digestive Surgery, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Luca Theuil
- Department of Digestive Surgery, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Christophe Demattei
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Michel Prudhomme
- Department of Digestive Surgery, CHU Nîmes, Univ Montpellier, Nîmes, France
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Merritt C, Maldonado P. Management of the Difficult Stoma. Surg Clin North Am 2024; 104:579-593. [PMID: 38677822 DOI: 10.1016/j.suc.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Fecal ostomy creation is a commonly performed procedure with many indications. Better outcomes occur when preoperative patient education and stoma site marking are provided. Despite a seemingly simple operation, ostomy creation is often difficult and complications are common. Certain risk factors, particularly obesity, are strongly associated with stoma-related complications. The ability to optimize the ostomy and stoma in the operating room and to troubleshoot frequently encountered post-operative stoma-related issues are critical skills for surgeons and ostomy nurses alike.
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Affiliation(s)
- Clay Merritt
- Department of Colon and Rectal Surgery, Alexander T. Augusta Military Medical Center, 9300 DeWitt Loop, Sunrise Pavilion, 2nd Floor, General Surgery Reception Desk, Fort Belvoir, VA 22060, USA.
| | - Paola Maldonado
- Wound Care Clinic, Alexander T. Augusta Military Medical Center, 9300 DeWitt Loop, Sunrise Pavilion, 2nd Floor, General Surgery Reception Desk, Fort Belvoir, VA 22060, USA
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Aida T, Kamada T, Takahashi J, Nakashima K, Ito E, Suzuki N, Hata T, Yoshida M, Ohdaira H, Suzuki Y. High Subcutaneous Fat Area Is an Independent Risk Factor for Parastomal Hernia after Transperitoneal Colostomy for Colorectal Cancer. J Anus Rectum Colon 2024; 8:78-83. [PMID: 38689782 PMCID: PMC11056530 DOI: 10.23922/jarc.2023-048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/26/2023] [Indexed: 05/02/2024] Open
Abstract
Objectives Parastomal hernia (PSH) is a common complication of colostomy; however, its risk factors remain poorly investigated. In this study, we examined the associations between sarcopenia, visceral and subcutaneous fat, and PSH in patients who underwent transperitoneal colostomy for colorectal cancer. Methods This retrospective, single-center, cohort study included 60 patients who underwent laparoscopic or robot-assisted abdominoperineal resection or Hartmann's procedure for colorectal cancer between November 2010 and February 2022. Stoma creation was uniformly performed using the transperitoneal approach, and PSH was diagnosed via abdominal computed tomography (CT) at 1 year postoperatively. Visceral fat areas (VFAs) and subcutaneous fat areas (SFAs) were measured through preoperative CT images using an image analysis system. Risk factors for PSH were retrospectively analyzed. Results PSH was diagnosed in 13 (21.7%) patients. In the univariate analysis, PSH was significantly associated with body mass index >22.3 kg/m2 (p=0.002), operation time >319 min (p=0.027), estimated blood loss >230 mL (p=0.008), postoperative complications (p=0.028), stoma diameter >18.6 mm (p=0.015), VFA >89.2 cm2 (p=0.005), and SFA >173.2 cm2 (p=0.001). Multivariate analyses confirmed that SFA >173.2 cm2 (odds ratio: 16.7, 95% confidence interval 1.29-217.2, p=0.031) was an independent risk factor for PSH. Conclusions Subcutaneous fat area is significantly associated with the development of PSH after transperitoneal colostomy. Applying these insights could help to prevent PSH.
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Affiliation(s)
- Takashi Aida
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Teppei Kamada
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Junji Takahashi
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Keigo Nakashima
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Eisaku Ito
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Norihiko Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Taigo Hata
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
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Du Q, Yang W, Zhang J, Qiu S, Liu X, Wang Y, Yang L, Zhou Z. Oncologic outcomes of intersphincteric resection versus abdominoperineal resection for lower rectal cancer: a systematic review and meta-analysis. Int J Surg 2024; 110:2338-2348. [PMID: 36928167 PMCID: PMC11020000 DOI: 10.1097/js9.0000000000000205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/20/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND The efficacy of intersphincteric resection (ISR) surgery for patients with lower rectal cancer remains unclear compared to abdominoperineal resection (APR). The aim of this study is to compare the oncologic outcomes for lower rectal cancer patients after ISR and APR through a systematic review and meta-analysis. MATERIALS AND METHODS A systematic electronic search of the Cochrane Library, PubMed, EMBASE, and MEDLINE was performed through January 12, 2022. The primary outcomes included 5-year disease-free survival (5y-DFS) and 5-year overall survival. Secondary outcomes included circumferential resection margin involvement, local recurrence, perioperative outcomes, and other long-term outcomes. The pooled odds ratios, mean difference, or hazard ratios (HRs) of each outcome measurement and their 95% CIs were calculated. RESULTS A total of 20 nonrandomized controlled studies were included in the qualitative analysis, with 1217 patients who underwent ISR and 1135 patients who underwent APR. There was no significant difference in 5y-DFS (HR: 0.84, 95% CI: 0.55-1.29; P =0.43) and 5-year overall survival (HR: 0.93, 95% CI: 0.60-1.46; P =0.76) between the two groups. Using the results of five studies that reported matched T stage and tumor distance, we performed another pooled analysis. Compared to APR, the ISR group had equal 5y-DFS (HR: 0.76, 95% CI: 0.45-1.30; P =0.31) and 5y-LRFS (local recurrence-free survival) (HR: 0.72, 95% CI: 0.29-1.78; P =0.48). Meanwhile, ISR had equivalent local control as well as perioperative outcomes while significantly reducing the operative time (mean difference: -24.89, 95% CI: -45.21 to -4.57; P =0.02) compared to APR. CONCLUSIONS Our results show that the long-term survival and safety of patients is not affected by ISR surgery, although this result needs to be carefully considered and requires further study due to the risk of bias and limited data.
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Affiliation(s)
- Qiang Du
- Department of General Surgery, Division of Gastrointestinal Surgery
| | - Wenming Yang
- Department of General Surgery, Division of Gastrointestinal Surgery
| | - Jianhao Zhang
- Department of General Surgery, Division of Gastrointestinal Surgery
| | - Siyuan Qiu
- Department of General Surgery, Division of Gastrointestinal Surgery
| | - Xueting Liu
- Department of Evidence-Based Medicine and Clinical Epidemiology
| | - Yong Wang
- Department of General Surgery, Division of Gastrointestinal Surgery
| | - Lie Yang
- Department of General Surgery, Division of Gastrointestinal Surgery
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zongguang Zhou
- Department of General Surgery, Division of Gastrointestinal Surgery
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Aubert M, Buscail E, Duchalais E, Cazelles A, Collard M, Charleux-Muller D, Jeune F, Nuzzo A, Pellegrin A, Theuil L, Toutain A, Trilling B, Siproudhis L, Meurette G, Lefevre JH, Maggiori L, Mege D. Management of adult intestinal stomas: The 2023 French guidelines. J Visc Surg 2024; 161:106-128. [PMID: 38448363 DOI: 10.1016/j.jviscsurg.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
AIM Digestive stoma are frequently performed. The last French guidelines have been published twenty years ago. Our aim was to update French clinical practice guidelines for the perioperative management of digestive stoma and stoma-related complications. METHODS A systematic literature review of French and English articles published between January 2000 and May 2022 was performed. Only digestive stoma for fecal evacuation in adults were considered. Stoma in children, urinary stoma, digestive stoma for enteral nutrition, and rare stoma (Koch, perineal) were not included. RESULTS Guidelines include the surgical landmarks to create digestive stoma (ideal location, mucocutaneous anastomosis, utility of support rods, use of prophylactic mesh), the perioperative clinical practice guidelines (patient education, preoperative ostomy site marking, postoperative equipment, prescriptions, and follow-up), the management of early stoma-related complications (difficulties for nursing, high output, stoma necrosis, retraction, abscess and peristomal skin complications), and the management of late stoma-related complications (stoma prolapse, parastomal hernia, stoma stenosis, late stoma retraction). A level of evidence was assigned to each statement. CONCLUSION These guidelines will be very useful in clinical practice, and allow to delete some outdated dogma.
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Affiliation(s)
- Mathilde Aubert
- Department of Digestive Surgery, hôpital Timone, Aix Marseille University, AP-HM, Marseille, France
| | - Etienne Buscail
- Digestive Surgery Department, hôpital Rangueil, Toulouse, France
| | | | - Antoine Cazelles
- Digestive Surgery Department, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - Maxime Collard
- Digestive Surgery Department, hôpital Saint-Antoine, AP-HP, Sorbonne université, 75012, Paris, France
| | | | - Florence Jeune
- Digestive Surgery Department, hôpital Saint-Louis, AP-HP, Paris, France
| | - Alexandre Nuzzo
- Digestive Surgery Department, hôpital Beaujon, AP-HP, Paris, France
| | | | | | - Amandine Toutain
- Digestive Surgery Department, hôpital Saint-Louis, AP-HP, Paris, France
| | | | | | | | - Jérémie H Lefevre
- Digestive Surgery Department, hôpital Saint-Antoine, AP-HP, Sorbonne université, 75012, Paris, France
| | - Léon Maggiori
- Digestive Surgery Department, hôpital Saint-Louis, AP-HP, Paris, France
| | - Diane Mege
- Department of Digestive Surgery, hôpital Timone, Aix Marseille University, AP-HM, Marseille, France.
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Khan M, Patnaik R, Lue M, Dao Campi H, Montorfano L, Sarmiento Cobos M, Valera RJ, Rosenthal RJ, Wexner SD. Modified Frailty Index Predicts Postoperative Complications Following Parastomal Hernia Repair. Am Surg 2024; 90:207-215. [PMID: 37632725 DOI: 10.1177/00031348231198102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
BACKGROUND The 5-factor frailty index (5-mFI), validated frailty index with Spearmen rho correlation of .95 and C statistic >.7 for predicting postoperative complications, can be preoperatively used to stratify patients prior to parastomal hernia repairs. METHODS Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database identified patients from 2015 to 2020. 5-mFI scores were calculated by adding one point for each comorbidity present: diabetes mellitus, congestive heart failure (CHF), hypertension requiring medication, severe chronic obstructive pulmonary disease (COPD), non-independent functional status. Primary endpoint was 30-day overall complications; secondary endpoints were 30-day readmission, reoperation, and discharge to care facility. RESULTS 2924 (52.2% female) patients underwent elective parastomal hernia repair. Univariate analysis showed 5-mFI > 2 had higher rates of overall (P = .008), pulmonary (P = .002), cardiovascular (P = .003)), hematologic (P = .003), and renal (P = .002) complications and higher rates of readmission (P = .009), reoperation (P = .001), discharge to care facility (P < .001), and death (P < .001). Multivariate analysis identified a 5-mFI of 2 or more as an independent risk factor for overall complications [OR: 1.40, 1.03-1.78; P = .032], pulmonary complications [2.97, 1.63-5.39; P < .001], hematological complications [1.60, 1.03-2.47; P = .035], renal complications [2.04, 1.19-3.46; P = .009], readmission [1.54, 1.19-1.99; P < .001], and discharge to facility [2.50, 1.66-3.77; P < .001]. Reoperation was not signification on multivariate analysis. CONCLUSIONS Parastomal hernia repair patients with 5-mFI score of >2 had higher risk of renal, cardiovascular, pulmonary, and hematologic complications, readmissions, longer hospitalization, discharge to care facility, and mortality, and can be useful during preoperative risk stratification.
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Affiliation(s)
- Mustafa Khan
- Department of General Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Ronit Patnaik
- Department of General Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Melinda Lue
- Department of General Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Haisar Dao Campi
- Department of General Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Lisandro Montorfano
- Department of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | | | - Roberto J Valera
- Department of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Raul J Rosenthal
- Department of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
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10
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Fortunato A, Rumi F, Zazzetta M, Valle MD, Pedace V, Cicchetti A. Il burden clinico ed economico delle complicanze della cute peristomale: un’analisi di Activity Based Costing. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2024; 11:31-37. [PMID: 38283083 PMCID: PMC10813189 DOI: 10.33393/grhta.2024.2639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/06/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction: An ostomy is a procedure in which an opening is made in the abdominal wall to establish a communication between the intestinal or urinary system and the external environment. Peristomal skin complications pose a constant challenge for the majority of individuals with a stoma, as they represent the most common postoperative complication. The aim of this study was to develop an economic evaluation model for assessing the costs associated with peristomal skin complications. Methods: In order to identify these costs, a survey was conducted in collaboration with the Coloplast Ostomy Forum group with the aim of mapping and documenting the timelines and all activities in the management of these complications. The data obtained from the survey were subsequently analyzed using the Activity Based Costing methodology. Results: The results of this analysis clearly indicate that the expenditure for initial visits is higher compared to subsequent ones, and that severe peristomal skin complications impose a greater economic burden than less severe complications. Specifically, the average total cost for managing severe peristomal skin complications amounts to € 104.6. Conclusion: This kind of analysis could provide support to decision-makers in dealing with a more accurate estimate of costs related to healthcare processes, aiming to implement rates able to “cover” the overall cost of certain healthcare activities. Specifically, there is currently no specific rate aimed at defining the value associated with the care and management of this type of complication, so this study confirms that this is an economic challenge that the National Health Service must address.
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Affiliation(s)
- Agostino Fortunato
- ALTEMS, Alta Scuola di Economia e Management dei Servizi Sanitari, Università Cattolica del Sacro Cuore, Roma - Italy
| | - Filippo Rumi
- ALTEMS, Alta Scuola di Economia e Management dei Servizi Sanitari, Università Cattolica del Sacro Cuore, Roma - Italy
| | | | | | | | - Americo Cicchetti
- ALTEMS, Alta Scuola di Economia e Management dei Servizi Sanitari, Università Cattolica del Sacro Cuore, Roma - Italy
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11
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Holmdahl V, Strigård K, Gunnarsson U. Autologous full-thickness skin in the repair of complex ventral hernias: an innovative step into the future of complex hernia repair? Front Surg 2023; 10:1301702. [PMID: 38162093 PMCID: PMC10754975 DOI: 10.3389/fsurg.2023.1301702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024] Open
Abstract
The repair of complex ventral hernias, such as giant incisional or parastomal hernia, is associated with a high risk for complications and recurrence. Some serious complications are related to implantation of synthetic mesh as reinforcement material. Autologous full-thickness skin graft (FTSG) as reinforcement material in the repair of these complex hernias may offer a safe alternative. This is a review of the history of FTSG use in hernia surgery and the experiences of our research group regarding its application over the last decade. The results of FTSG used in the repair of giant ventral hernias are promising, and this method may already be recommended in selected cases. We have also conducted a translational chain of preclinical studies, based on a murine model, to gain a greater understanding of the behaviour of FTSG implanted in various positions in the abdominal wall. The use of intraperitoneal FTSG as reinforcement material in parastomal hernia repair is currently being evaluated in a randomised, controlled, multicentre study.
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12
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Demirel AH, Kurtoğlu İ, Altıner S, Aydın R. Repair of stoma prolapse with the "peristomal cerclage" method using vessel tape. Turk J Surg 2023; 39:373-376. [PMID: 38694531 PMCID: PMC11057931 DOI: 10.47717/turkjsurg.2023.6154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/30/2023] [Indexed: 05/04/2024]
Abstract
Stoma prolapse is one of the most common late complications following stoma construction. Although prolapses can be managed conservatively, they often require surgical revision. This study aimed to describe a revision method called peristomal cerclage applied with local anesthesia to treat stoma prolapse. A 66-year-old male patient with advanced rectal cancer underwent sigmoid loop colostomy one year ago due to a distal occlusive tumor. A revision of the colostomy prolapse that developed postoperatively was planned. After the reduction of the 12 cm prolapse into the abdomen under local anesthesia, a repair was performed in the form of peristomal wrapping of a vessel tape; except for short-term abdominal distension, no complications developed in the patient. He is currently in the postoperative 26th month and terminal period, and his colostomy is working normally. The present report aimed to describe the peristomal cerclage method, a minimally invasive revision procedure applied to patients with stoma prolapse, and to deliver its long-term results. It is important to report the results obtained with the more widespread use of this method.
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Affiliation(s)
- Arif Hakan Demirel
- Clinic of General Surgery, Ankara Training and Research Hospital, Ankara, Türkiye
| | - İbrahim Kurtoğlu
- Clinic of General Surgery, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Saygın Altıner
- Clinic of General Surgery, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Recep Aydın
- Clinic of General Surgery, Ankara Training and Research Hospital, Ankara, Türkiye
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13
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Näverlo S, Strigård K, Gunnarsson U, Edin-Liljegren A. Patients' experiences of living with a stoma in rural areas in Northern Sweden. Int J Circumpolar Health 2023; 82:2221767. [PMID: 37300840 PMCID: PMC10259297 DOI: 10.1080/22423982.2023.2221767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
Introduction: Stoma complications are common and interfere with many aspects of everyday life. Stoma problems are usually managed by a specialised stoma nurse, a service not present in the rural areas of South Lapland in Sweden. The aim of this study was to describe how stoma patients in rural areas experience living with a stoma.Methods: A qualitative descriptive study with semi-structured interviews were conducted with 17 stoma patients living in rural municipalities and who received a part of their care at the local cottage hospital. Qualitative content analysis was employed.Results: Initially, the stoma was experienced as very depressing. Participants had difficulties in properly managing the dressing. Over time they learned how to properly care for their stoma, making their life easier. Both satisfaction and dissatisfaction with the healthcare were experienced. Those who were dissatisfied expressed a lack of competence in dealing with stoma-related problems.Conclusions: Living with a stoma in a rural area in northern Sweden is experienced as a learning process and acceptance of the stoma's existence is important. This study emphasises the need for increased knowledge of stoma-related problems in rural primary healthcare in order to help patients cope with everyday life.
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Affiliation(s)
- Simon Näverlo
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Karin Strigård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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14
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Mills J. Rethinking recovery: rehabilitation and intra-abdominal pressure management to reduce the risk of parastomal hernia. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S18-S20. [PMID: 37682759 DOI: 10.12968/bjon.2023.32.16.s18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Julie Mills, RN, Global Ostomy Nurse Engagement Manager, Convatec, writes that parastomal hernia is a common and consequential complication of stoma surgery, but the risk can be reduced with a structured rehabilitation programme based on appropriate core abdominal exercises, supported by the full multidisciplinary team.
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Affiliation(s)
- Julie Mills
- RN, Global Ostomy Nurse Engagement Manager, Convatec
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15
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Brandsma HT, Hansson BM, Aufenacker TJ, de Jong N, V Engelenburg KC, Mahabier C, Donders R, Steenvoorde P, de Vries Reilingh TS, Leendert van Westreenen H, Wiezer MJ, de Wilt JHW, Rovers M, Rosman C. Prophylactic Mesh Placement During Formation of an End-colostomy: Long-term Randomized Controlled Trial on Effectiveness and Safety. Ann Surg 2023; 278:e440-e446. [PMID: 36727747 DOI: 10.1097/sla.0000000000005801] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to determine if prophylactic mesh placement is an effective, safe, and cost-effective procedure to prevent parastomal hernia (PSH) formation in the long term. BACKGROUND A PSH is the most frequent complication after stoma formation. Prophylactic placement of a mesh has been suggested to prevent PSH, but long-term evidence to support this approach is scarce. METHODS In this multicentre superiority trial patients undergoing the formation of a permanent colostomy were randomly assigned to either retromuscular polypropylene mesh reinforcement or conventional colostomy formation. Primary endpoint was the incidence of a PSH after 5 years. Secondary endpoints were morbidity, mortality, quality of life, and cost-effectiveness. RESULTS A total of 150 patients were randomly assigned to the mesh group (n = 72) or nonmesh group (n = 78). For the long-term follow-up, 113 patients were analyzed, and 37 patients were lost to follow-up. After a median follow-up of 60 months (interquartile range: 48.6-64.4), 49 patients developed a PSH, 20 (27.8%) in the mesh group and 29 (37.2%) in the nonmesh group ( P = 0.22; RD: -9.4%; 95% CI: -24, 5.5). The cost related to the meshing strategy was € 2.239 lower than the nonmesh strategy (95% CI: 491.18, 3985.49), and quality-adjusted life years did not differ significantly between groups ( P = 0.959; 95% CI: -0.066, 0.070). CONCLUSIONS Prophylactic mesh placement during the formation of an end-colostomy is a safe procedure but does not reduce the incidence of PSH after 5 years of follow-up. It does, however, delay the onset of PSH without a significant difference in morbidity, mortality, or quality of life, and seems to be cost-effective.
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Affiliation(s)
| | - Birgitta Me Hansson
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Nienke de Jong
- Department of Surgery, Bernhoven Hospital, Uden, The Netherlands
| | | | - Chander Mahabier
- Department of Surgery, Albert Schweitzer Hospital Dordrecht, The Netherlands
| | - Rogier Donders
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pascal Steenvoorde
- Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | | | - Marinus J Wiezer
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Maroeska Rovers
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of operating rooms, Radboud university medical centre, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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16
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Garoufalia Z, Mavrantonis S, Emile SH, Gefen R, Horesh N, Freund MR, Wexner SD. Surgical treatment of stomal prolapse: A systematic review and meta-analysis of the literature. Colorectal Dis 2023; 25:1128-1134. [PMID: 36965087 DOI: 10.1111/codi.16548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/27/2023]
Abstract
AIM This study aimed to assess success, recurrence, and overall complication rates among different surgical procedures for stomal prolapse. METHODS This study was a PRISMA-compliant systematic review. PubMed, Scopus, and Google Scholar were searched until March 2022. Studies that assessed surgical treatments of stomal prolapse in adults were included. The primary outcome was recurrence of stomal prolapse and the secondary outcome was 30-day complications. A random-effect meta-analysis was used to estimate the weighted mean rates of recurrence. RESULTS Six studies published (111 patients; 103 males) were included. 52 (46.8%) patients had end colostomies, 35 (31.5%) had loop colostomies. Seven procedures were assessed and included local stoma reconstruction (40%), stapled local repair (27%), modified Altemeier technique (10%), mesh strip repair (9%), stoma relocation (6%) redo laparotomy repair (5%), and colectomy and end ileostomy (3%). The weighted mean recurrence rate after local stoma reconstruction was 37.2% (95% CI: -1.8 to 76.3), higher than that after the stapled local repair technique (14.9%; 95% CI: 1.7-28.2). The crude recurrence rate of the modified Altemeier technique was 20%, and of stoma relocation was 66.6%. No recurrence was detected after the mesh strip technique (n = 10). The median follow-up ranged between 7 months and 2.5 years. CONCLUSION Several surgical techniques are available to treat stomal prolapse. Local stoma reconstruction may be associated with high rates of recurrence while the stapled local repair and modified Altemeier procedure has relatively low recurrence. Further larger studies are needed to compare the efficacy of these techniques.
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Affiliation(s)
- Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
| | | | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Israel
| | - Michael R Freund
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
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17
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de Ponthaud C, Roupret M, Vernerey D, Audenet F, Brouquet A, Cotte E, Cuvillier X, Kanso F, Meurette G, Ledaguenel P, Maggiori L, Neuzillet Y, Ouaissi M, Roumiguié M, Phé V, Vuong NS, Parc Y, Lefèvre JH. StomaCare: quality of life impact after enhanced follow-up of ostomy patients by a home healthcare nursing service-a multicentre, randomized, controlled trial. Colorectal Dis 2023; 25:128-143. [PMID: 36128685 PMCID: PMC10091978 DOI: 10.1111/codi.16343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/17/2022] [Accepted: 08/16/2022] [Indexed: 02/02/2023]
Abstract
AIM A stoma exposes patients to several complications which could impair their quality of life (QoL). In the last decade, the market for stoma therapy in France has evolved, with a significant increase in the activities of home health providers, meeting a need for patient follow-up and companionship. International studies have demonstrated the impact of the stoma therapist (ST) follow-up on the improvement of an ostomy patient's QoL. However, the impact of home stoma nurse management has not been analysed. In this context we would like to assess the added value on health-related QoL from the enhanced follow-up of ostomy patients by STs. METHODS This is a randomized, controlled, open, national and multicentre trial (12 centres) which includes patients with an ostomy who benefit from either standard follow-up or from an enhanced and personalized follow-up with, in particular, regular consultations with an ST after discharge. The primary end-point is the 3-month QoL score obtained from the Stoma-QoL questionnaire. The secondary end-points are satisfaction of the care, comparison of QoL scores (Stoma-QoL and EuroQuol EQ-5D) and the economic gains by calculating the consumption of resources between the two arms. There will be a modified intention-to-treat analysis with 6-month follow-up in both study arms. DISCUSSION The StomaCare trial will be the first randomized controlled study in France to evaluate the impact on QoL of an enhanced follow-up at home of ostomy patients by an ST.
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Affiliation(s)
- Charles de Ponthaud
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, Paris, France
| | - Morgan Roupret
- Urology, GRC no. 5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Dewi Vernerey
- INSERM UMR 1098, Methodology and Quality of Life in Oncology, Besançon, France
| | - François Audenet
- Department of Urological Surgery, Georges Pompidou Hospital, AP-HP, Paris, France
| | - Antoine Brouquet
- Department of General and Oncologic Surgery, Bicêtre Hospital, AP-HP, Kremlin Bicêtre, France
| | - Eddy Cotte
- Department of General and Visceral Surgery, Lyon-Sud Hospital, Lyon, France
| | - Xavier Cuvillier
- Department of Urology, Clinique Esquirol Saint-Hilaire, Agen, France
| | - Frédéric Kanso
- Department of General and Visceral Surgery, Foch Hospital, Suresnes, France
| | | | - Patrick Ledaguenel
- Department of Digestive Surgery, Polyclinique Jean Villar, Bruges, Belgium
| | - Léon Maggiori
- Department of Visceral and Digestive Surgery, Saint Louis Hospital, AP-HP, Paris, France
| | - Yann Neuzillet
- Department of Urological Surgery, Foch Hospital, Suresnes, France
| | - Mehdi Ouaissi
- Departement of Digestive Surgery, CHU, Tours, France
| | - Mathieu Roumiguié
- Department of Urological Surgery, Rangueil Hospital, Toulouse, France
| | - Véronique Phé
- Department of Urology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Nam-Son Vuong
- Department of Urology, Clinique Saint-Augustin, Bordeaux, France
| | - Yann Parc
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, Paris, France
| | - Jérémie H Lefèvre
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, Paris, France
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18
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van de Laar BCT, de Jong GM. Two undesirable complications of a blowhole colostomy in left-sided colonic obstruction. BMJ Case Rep 2022; 15:e252366. [PMID: 36400721 PMCID: PMC9677025 DOI: 10.1136/bcr-2022-252366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/20/2022] Open
Abstract
Two patients with an acute left-sided colonic obstruction had a successful decompression after construction of a blowhole transverse colostomy as a bridge to surgery. However, they presented with two rather unknown stoma-related complications during this bridging period. Patient A had a stomal prolapse with additional skin problems.Patient B complained of abdominal discomfort during follow-up. The blowhole colostomy appeared to be stenotic. Stoma dilation and irrigation was initiated to prevent complete closure.Definite resection of the left-sided obstruction and reversal of both blowhole colostomies was successful, and the patients recovered without further complications.We hypothesise that incision size may be related to prolapse and stenosis rates and that eversion of the mucosa of the blowhole may reduce the risk of stomal stenosis.
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19
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Yu S, Yao X, Sang Y, Yu L, Shen Y, Che X, Ding Y, Huang Y. The mediating role of resilience in the relationship between social support and quality of life among patients after radical cystectomy: A structural equation model analysis. Nurs Open 2022; 10:1574-1581. [PMID: 36325731 PMCID: PMC9912425 DOI: 10.1002/nop2.1408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/23/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
AIM This study aimed to examine the relationship between social support and quality of life in urostomy patients and identify the mediating role of resilience in that relationship. DESIGN A cross-sectional design. METHODS Participants included 232 patients who were recruited from a tertiary hospital in Beijing during March 2020 and August 2020. They completed questionnaires about perceived social support, resilience and ostomy-related quality of life. Structural equation modelling was performed to analyse the data. RESULTS The mean age of patients was 65.79 (SD = 8.67) years, and the mean length of time after surgery was 42.14 (SD = 15.76) months. Urostomy patients' quality of life, social support and resilience were all above moderate. Social support had a positive direct effect on the quality of life and a positive indirect effect on the quality of life through the mediating role of resilience.
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Affiliation(s)
- Shuhui Yu
- Department of UrologyPeking University First HospitalBeijingChina,Peking University Health Science Centre for Evidence‐Based Nursing: A Joanna Briggs Institute Affiliated GroupBeijingChina
| | - Xiuyu Yao
- School of NursingPeking Union Medical CollegeBeijingChina
| | - Yonghui Sang
- Department of UrologyPeking University First HospitalBeijingChina
| | - Lingling Yu
- School of NursingPeking Union Medical CollegeBeijingChina
| | - Yiru Shen
- School of NursingPeking Union Medical CollegeBeijingChina
| | - Xinyan Che
- Department of UrologyPeking University First HospitalBeijingChina
| | - Yanming Ding
- Nursing DepartmentPeking University First HospitalBeijingChina
| | - Yanbo Huang
- Department of UrologyPeking University First HospitalBeijingChina
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20
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Tsuchiya Y, Takahashi H, Ishibiki Y, Iwanuma Y, Sakamoto K, Fukunaga M. Case of laparoscopic parastomal hernia repair using modified Sugarbaker mesh method. J Surg Case Rep 2022; 2022:rjac488. [DOI: 10.1093/jscr/rjac488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/30/2022] [Indexed: 11/21/2022] Open
Abstract
Abstract
A 75-year-old woman underwent sigmoid colon resection and transverse colostomy for perforation of the diverticulum of the sigmoid colon at 70 years of age at another hospital. She was referred to our hospital with complaints of abdominal discomfort 3 months prior to presentation. Abdominal computed tomography revealed a parastomal hernia (PSH). We performed laparoscopic repair using the Sugarbaker approach with a Symbotex Composite Mesh™ and laparoscopic adhesive intestinal repair. The patient’s post-operative course was unremarkable, and she was transferred to the Department of Internal Medicine after 10 days. There was no recurrence 6 months after surgery. Tension-free surgery using a mesh has been reported to be effective in preventing the recurrence of PSH. We performed a laparoscopic modified Sugarbaker mesh method using the Symbotex Composite Mesh™ with collagen film to repair an abdominal hernia.
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Affiliation(s)
- Yuki Tsuchiya
- Department of Surgery , Gastrointestinal Surgery, , Tokyo , Japan
- Juntendo Tokyo koto Geriatric Medical Center , Gastrointestinal Surgery, , Tokyo , Japan
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine , Tokyo , Japan
| | - Hiromitsu Takahashi
- Department of Surgery , Gastrointestinal Surgery, , Tokyo , Japan
- Juntendo Tokyo koto Geriatric Medical Center , Gastrointestinal Surgery, , Tokyo , Japan
| | - Yosiro Ishibiki
- Department of Surgery , Gastrointestinal Surgery, , Tokyo , Japan
- Juntendo Tokyo koto Geriatric Medical Center , Gastrointestinal Surgery, , Tokyo , Japan
| | - Yoshimi Iwanuma
- Department of Surgery , Gastrointestinal Surgery, , Tokyo , Japan
- Juntendo Tokyo koto Geriatric Medical Center , Gastrointestinal Surgery, , Tokyo , Japan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine , Tokyo , Japan
| | - Masaki Fukunaga
- Department of Surgery , Gastrointestinal Surgery, , Tokyo , Japan
- Juntendo Tokyo koto Geriatric Medical Center , Gastrointestinal Surgery, , Tokyo , Japan
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21
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Nozawa H, Kawasaki A, Hayashi C, Kawai K, Sasaki K, Murono K, Emoto S, Ishihara S. Impact of COVID-19 Outbreak on Stoma Surgery and Stoma Clinic Service: A Retrospective Study at a Single Japanese Referral Hospital. Int J Clin Pract 2022; 2022:4789775. [PMID: 36016825 PMCID: PMC9371875 DOI: 10.1155/2022/4789775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/05/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022] Open
Abstract
Aim The impact of the COVID-19 pandemic on medical practice has been frequently reported from Western countries, but there have been few studies in other areas, especially regarding stoma surgery and stoma care. Methods We investigated the numbers of all operations and stoma-related surgeries at our hospital in 2019 and 2020. The cumulative numbers of consultations at our ostomy clinic and patient population stratified by the period of having a stoma were compared between these calendar years. The frequency of ostomy clinic visit by individual patients within the first year after stoma creation and stoma-related complications per consultation were also analyzed. Results The number of elective surgeries decreased by approximately 10% from 2019 to 2020, but the numbers of stoma creation and closure procedures did not differ. The total numbers of consultations at our ostomy clinic were also similar between these years. However, the percentage of patients with a stoma for less than a year who visited our ostomy clinic increased from 49.7% in 2019 to 53.5% in 2020, whereas the visitation rate for other patients decreased. Moreover, patients with a stoma for less than a year visited the ostomy clinic more frequently in 2020 (0.42/month) than in 2019 (0.30/month, p=0.032). There were fewer grade 2 or more severe peristomal complications in 2020 (11% vs 17% in 2019, p < 0.001) at our ostomy clinic. Conclusion The COVID-19 outbreak led to a shift in the patient population at ostomy clinics of new stoma patients, which may have resulted in fewer peristomal complications.
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Affiliation(s)
- Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Akiko Kawasaki
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan
| | - Chieko Hayashi
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan
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22
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Dellafiore F, Caruso R, Bonavina L, Udugampolage NS, Villa G, Russo S, Vangone I, BaronI I, Di Pasquale C, Nania T, Manara DF, Arrigoni C. Risk factors and pooled incidence of intestinal stoma complications: systematic review and Meta-analysis. Curr Med Res Opin 2022; 38:1103-1113. [PMID: 35608158 DOI: 10.1080/03007995.2022.2081455] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The present systematic review aimed to identify, critically assess and summarize which risk factors might determine the onset of ostomy complications, describing a pooled incidence and stratified incidences by each identified risk factor. METHODS A systematic literature review with a meta-analysis of observational studies was performed by following the PRISMA statement and flow chart. The quality assessment of the included articles was performed through the Newcastle-Ottawa Scale (NOS). RESULTS Sixteen articles published between 1990 and 2018 focused on the risk factors related to intestinal stomal complications, and the performed analysis led to identifying influenceable and non-influenceable risk factors. The median of the NOS evaluation was 6 (IQR = 5.75-6). Among 10,520 included patients, the pooled incidence of stomal complications was 35%, ranging from 9% to 63%, regardless of the nature of the complications. Analysis of the sub-groups highlighted obesity and ostomy surgery performed via laparoscopy or emergency conditions have significant incidences, respectively, of 66% and 68%. CONCLUSIONS The pooled incidence of stomal complications requires greater attention for its relevant epidemiology. From the clinical point of view, patients with obesity and chronic conditions require more attention to prevent complications, possibly employing accurate educational interventions to enhance proper stoma management.
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Affiliation(s)
- Federica Dellafiore
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Division of General Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | - Sara Russo
- ItalyVascular Surgery Unit, IRCCS Policlinic San Matteo Foundation, Nursing degree course, University of Pavia, section Istituti Clinici di Pavia e Vigevano S.p.A., Pavia, Italy
| | - Ida Vangone
- Department of Oncology and Hematology-Oncology, Istituto Europeo Oncologia, Milan, Italy
| | - Irene BaronI
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Tiziana Nania
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Duilio F Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
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23
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Li Z, Tian L, Liu R, Zheng B, Wang B, Zhao X, Quan P, Qiu J. A technique for laparoscopic extraperitoneal colostomy with an intact posterior sheath of rectus. BMC Surg 2022; 22:239. [PMID: 35725604 PMCID: PMC9210575 DOI: 10.1186/s12893-022-01686-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022] Open
Abstract
Regardless of the advances in surgical techniques, parastomal hernia is still an inevitable complication for many patients with low rectal cancer undergoing abdominal perineal resection (APR). Extraperitoneal colostomy (EPC) seems to be a effective method to reduce the risk of parastomal hernia. We propose a new approach to simplify and standardize laparoscopic EPC to make this operation easy to perform. We used the technique of laparoscopic TEP groin hernia repair to produce an extraperitoneal tunnel, which can not only facilitate precise visualization of the extraperitoneal tunnel but also utilize the intact posterior rectus abdominis sheath as biologic materials to maintain soft-tissue augmentation, with a satisfactory result. With laparoscopy, we can create adequate space without insufficient dissection of the extraperitoneal tunnel while avoiding damage to the retrorectus sheath. At the time of writing, we had performed this method in four patients, without any complications. This technique is effective at preventing parastomal hernia without extra costs.
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Affiliation(s)
- Zeyu Li
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, People's Republic of China
| | - Lifei Tian
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, People's Republic of China
| | - Ruiting Liu
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, People's Republic of China
| | - Bobo Zheng
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, People's Republic of China
| | - Ben Wang
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, People's Republic of China
| | - Xu Zhao
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, People's Republic of China
| | - Pan Quan
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, People's Republic of China
| | - Jian Qiu
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, People's Republic of China.
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24
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Huisman JF, de Haas JWA, Brohet RM, Vleggaar FP, de Vos Tot Nederveen Cappel WH, van Westreenen HL. Clinical outcome of decompressing colostomy for acute left-sided colorectal obstruction: a consecutive series of 100 patients. Scand J Gastroenterol 2022; 57:757-762. [PMID: 35060822 DOI: 10.1080/00365521.2022.2029557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Aim of our study was to evaluate the outcomes of a consecutive series of patients who were treated with a decompressing colostomy (DC) for acute left-sided colorectal obstruction. METHOD A consecutive series of 100 patients with acute left-sided colorectal obstruction who underwent DC from January 2015 to August 2020 was retrospectively analyzed. Demographic characteristics, etiology of the obstruction, postoperative morbidity- and mortality rates, DC-related complication and stoma reversal rates were evaluated. RESULTS Of the 100 included patients, 64 had malignant- and 36 had benign obstruction. The mean age was 69 years, 42% was male, and the ASA score was 2. Morbidity and mortality rates after DC construction were 20 and 2%, respectively. In 39% of the patients, DC ended up as a permanent stoma and in 61% as bridge to surgery (BtS). DC related complication rate was 32%, with a re-intervention rate of 9%. Elective colorectal resection was performed in 59 cases (59%) with subsequent postoperative morbidity rate of 20%. Stoma reversal rate was 77% for the patients who underwent DC as BtS. Stoma reversal was performed in 66% of the patients with benign obstruction and in 36% for oncological obstruction. CONCLUSION DC as bridge to possible elective resection for acute left-sided colorectal obstruction is an effective strategy with low morbidity and mortality rates and a high stoma reversal rate, especially for benign obstruction. However, DC is less appropriate for patients in whom DC turns out to be a permanent stoma due to a relatively high stoma related complications.
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Affiliation(s)
- Jelle F Huisman
- Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, The Netherlands
| | - Job W A de Haas
- Department of Surgery, Isala Hospital, Zwolle, The Netherlands
| | - Richard M Brohet
- Department of Epidemiology and Statistics, Isala Hospital, Zwolle, The Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, UMC, Utrecht, The Netherlands
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25
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Liu L, Zheng L, Zhang M, Hu J, Lu Y, Wang D. Incidence and risk factors for parastomal hernia with a permanent colostomy. J Surg Oncol 2022; 126:535-543. [PMID: 35608292 DOI: 10.1002/jso.26919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/30/2022] [Indexed: 12/20/2022]
Abstract
AIM This study aims to explore the incidence and risk factors for permanent colostomy complicated with a parastomal hernia (PSH) after rectal cancer resection. METHODS This was a retrospective study of gastrointestinal surgery performed from January 2013 to December 2017 in patients with colorectal cancer treated at the Affiliated Hospital of Qingdao University. The relevant clinical variables of the patient were analyzed. Kaplan-Meier, univariate, and Cox multivariate analyses were used to evaluate the influencing factors and morbidity of PSH. RESULTS Among the 211 patients, 65 developed PSH. The cumulative incidence reached 33.5% at 62 months. In the multivariate Cox survival analysis, the results showed that being a woman, aged ≥65 years, having a body mass index (BMI) ≥ 25 kg/m2 , diabetes, and Clavien-Dindo Grade III and IV complications were risk factors for the occurrence of PSH. CONCLUSION In our study, the incidence of PSH increased annually and reached a maximum of 33.5% after 62 months. Among the patient-related factors, female sex, age ≥65 years, BMI ≥ 25 kg/m2 , diabetes, and postoperative Clavien-Dindo Grade III and IV complications were significantly associated with the development of PSH. Therefore, intervention measures to prevent patients with this risk factor are advisable.
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Affiliation(s)
- Lei Liu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Longbo Zheng
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Maoshen Zhang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jilin Hu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yun Lu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dongsheng Wang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
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26
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Haddad A, Beji H, Chaker Y, Maghrebi H, Makni A, Rebai W, Jouini M, Kacem M. Strangulated stoma prolapse: surgical treatment conserving proximal ileostomy. ANZ J Surg 2021; 92:2324-2325. [PMID: 34962354 DOI: 10.1111/ans.17434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 10/24/2021] [Accepted: 12/11/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Anis Haddad
- Department of general surgery, A Hospital La Rabta Tunis, Hammamet, Tunisia
| | - Hazem Beji
- Department of general surgery, A Hospital La Rabta Tunis, Hammamet, Tunisia
| | - Youssef Chaker
- Department of general surgery, A Hospital La Rabta Tunis, Hammamet, Tunisia
| | - Houcine Maghrebi
- Department of general surgery, A Hospital La Rabta Tunis, Hammamet, Tunisia
| | - Amin Makni
- Department of general surgery, A Hospital La Rabta Tunis, Hammamet, Tunisia
| | - Wael Rebai
- Department of general surgery, A Hospital La Rabta Tunis, Hammamet, Tunisia
| | - Mohamed Jouini
- Department of general surgery, A Hospital La Rabta Tunis, Hammamet, Tunisia
| | - Montassar Kacem
- Department of general surgery, A Hospital La Rabta Tunis, Hammamet, Tunisia
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27
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Holmdahl V, Gunnarsson U, Strigård K. Autologous full-thickness skin graft as reinforcement in parastomal hernia repair: a randomised controlled trial. Trials 2021; 22:891. [PMID: 34876195 PMCID: PMC8650734 DOI: 10.1186/s13063-021-05884-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/26/2021] [Indexed: 11/12/2022] Open
Abstract
Background Parastomal hernia is a common complication of an enterostomy and can have a significant impact on health-related quality of life. Currently used methods of repair have high recurrence rates and considerable risk for complications. We have developed a new technique for parastomal hernia repair that uses full-thickness skin graft as reinforcement. Methods This study protocol describes a multicentre randomised controlled trial on parastomal hernia repair comparing a new full-thickness skin graft technique with conventional synthetic composite mesh as reinforcement of the abdominal wall. Patients with a symptomatic parastomal hernia will be included and followed up at 3, 12 and 36 months, with surgical complication as the primary outcome. Secondary outcomes will be recurrence rate and health-related quality of life assessed with VHPQ, EORTC C30 and CR29. Tissue biology and collagen metabolism will be investigated pre- and postoperatively using biopsies of the abdominal wall fascia and blood samples. Discussion Parastomal hernia constitutes a major clinical problem where the prospects of a good result after hernia repair are presently poor. This new method of repair with full-thickness skin grafting could be a new alternative in our surgical toolbox, but before then, it must be evaluated properly. Trial registration ClinicalTrials.gov NCT03667287. Registered on September 12, 2018
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Affiliation(s)
- Viktor Holmdahl
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden. .,Sunderby Research Unit, Umeå University, Luleå, Sweden.
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Karin Strigård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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28
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Mohiuddin S, Reeves BC, Smart NJ, Hollingworth W. A semi-Markov model comparing the lifetime cost-effectiveness of mesh prophylaxis to prevent parastomal hernia in patients undergoing end colostomy creation for rectal cancer. Colorectal Dis 2021; 23:2967-2979. [PMID: 34331840 DOI: 10.1111/codi.15848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 02/08/2023]
Abstract
AIM Parastomal hernia (PSH) is a common problem following colostomy. Using prophylactic mesh during end colostomy creation may reduce PSH incidence, but concerns exist regarding the optimal type of mesh, potential long-term complications, and cost-effectiveness of its use. We evaluated the cost-effectiveness of mesh prophylaxis to prevent PSH in patients undergoing end colostomy creation for rectal cancer. METHODS We developed a decision-analytical model, stratified by rectal cancer stages I-IV, to estimate the lifetime costs, quality-adjusted life-years (QALYs) and net monetary benefits (NMBs) of synthetic, biologic and no mesh from a UK NHS perspective. We pooled the mesh-related relative risks of PSH from 13 randomised controlled trials (RCTs) and superimposed these on the baseline (no mesh) risk from a population-based cohort. Uncertainty was assessed in sensitivity analyses. RESULTS Synthetic mesh was less costly and more effective than biologic and no mesh to prevent PSH for all rectal cancer stages. At the willingness-to-pay threshold of £20,000/QALY, the incremental NMBs (95% CI) ranged between £1,706 (£1,692 to £1,720) (stage I) and £684 (£678 to £690) (stage IV) for synthetic versus no mesh, and £2,038 (£1,997 to £2,079) (stage I) and £1,671 (£1,653 to £1,689) (stage IV) for synthetic versus biologic mesh. Synthetic mesh was more cost-effective than no mesh unless the relative risk of PSH was ≥0.95 for stages I-III and ≥0.93 for stage IV. [Correction added on 05 October 2021 after first online publication: The estimation of health outcomes (QALYs) for all three interventions evaluated (synthetic mesh; biologic mesh; no mesh) have been corrected in this version.] CONCLUSIONS: Synthetic mesh was the most cost-effective strategy to prevent the formation of PSH in patients after end colostomy for any rectal cancer stage; however, conclusions are dependent on which subset of RCTs are considered to provide the most robust evidence.
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Affiliation(s)
- Syed Mohiuddin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Barnaby C Reeves
- Bristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, UK
| | - Neil J Smart
- Royal Devon & Exeter Hospital, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - William Hollingworth
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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29
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Robin Valle de Lersundi A, Rupealta N, San Miguel Mendez C, Muñoz Rodriguez J, Pérez Flecha M, López Monclús J, Blazquez Hernando L, García Ureña MA. High recurrence rate after posterior component separation and keyhole mesh reconstruction for complex parastomal hernia: A case series study. Colorectal Dis 2021; 23:2137-2145. [PMID: 34075675 DOI: 10.1111/codi.15729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/17/2021] [Accepted: 05/04/2021] [Indexed: 01/06/2023]
Abstract
AIM This study aimed to describe the results of complex parastomal hernia repair after posterior component separation and keyhole reconstruction. METHOD We conducted a retrospective review of a prospectively sustained database in one single complex abdominal wall referral centre. We analysed the data of patients who underwent the posterior component separation technique using modified transversus abdominis release for complex parastomal hernia and retromuscular keyhole mesh repair from February 2014 to January 2017. Demographic data, hernia characteristics, operative details and outcomes were analysed. The primary outcome measured was the recurrence rate during the follow-up. RESULTS Twenty patients were included in this study. Among the patients who underwent surgery for parastomal hernia, 17 patients had a colostomy (85%) and three patients had a ureteroileostomy after the Bricker procedure (15%). The mean body mass index was 33.2 kg/m2 (range 25-47). Twelve patients had an expected associated risk according to the Carolinas equation for determining associated risk classification of >60%. Sixty per cent of our patients had contaminated or dirty/infected wounds. The overall complication rate was 60%. Surgical site infection was observed in 25% of the cases. The mortality rate in our study group was 5% (n = 1). We found clinical or radiological evidence of parastomal hernia recurrence in nine out of 20 (45%) patients during follow-up. No hernia recurrence was detected in the concomitant incisional hernias. CONCLUSIONS Although posterior component separation in the form of modified transversus abdominis muscle release allows abdominal wall reconstruction, keyhole mesh configuration at the stoma site does not offer satisfactory results in terms of long-term recurrence rate at the parastomal defect.
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Affiliation(s)
| | - Niccolo Rupealta
- Department of General Surgery, Hospital Universitario del Henares, Coslada, Spain
| | | | | | - Marina Pérez Flecha
- Department of General Surgery, Hospital Universitario del Henares, Coslada, Spain
| | - Javier López Monclús
- Department of General Surgery, Hospital Universitario Puerta del Hierro Majadahonda, Majadahonda, Spain
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30
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Akamoto S, Imura S, Fujiwara Y, Habu K, Konishi Y, Fukuhara T, Nakagawa K. Extraperitoneal colostomy in robotic surgery for rectal cancer using a tip-up fenestrated grasper. Asian J Endosc Surg 2021; 14:636-639. [PMID: 33084208 DOI: 10.1111/ases.12880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/23/2020] [Accepted: 10/01/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although extraperitoneal colostomy could reduce the risk for parastomal hernia formation, it is often technically demanding to dissect the extraperitoneal route laparoscopically. Here, we demonstrate our original surgical technique for extraperitoneal tunneling using a robotic instrument. MATERIALS AND SURGICAL TECHNIQUE After total mesorectal excision (TME) and before specimen retrieval, the edge of the outer leaf of the parietal peritoneum was elevated by the grasper in the left hand and the tip-up fenestrated grasper (Tip-Up) in the right hand. The extraperitoneal tissue was opened using the scissor forceps (right hand). Then, extraperitoneal tunneling (inner tunnel) was performed using a Tip-Up with a width of approximately 4 cm that could reach adjacent to the lateral border of the abdominal rectus muscle. A round incision was made at a preoperatively marked site on the skin. The anterior rectal sheath was cut in a cruciate fashion. The abdominal rectus muscle was split, and then the posterior rectus sheath was cut longitudinally not just below the stoma marking site but also at a slant on the lateral side. The peritoneum was dissected with care to avoid opening the peritoneum. The outer side of the tunnel was broken through to the inner tunnel using an easy blunt dissection with two fingers. Kelly forceps were introduced through the extraperitoneal tunnel along with the fingers, and the stump of the sigmoid colon was grasped and exteriorized through this tunnel. DISCUSSION Robotic retroperitoneal tunneling using a Tip-Up is easy and useful for preventing parastomal hernia.
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Affiliation(s)
- Shintaro Akamoto
- Department of Surgery, Sumitomo Besshi Hospital, Niihama-shi, Japan
| | - Shin Imura
- Department of Surgery, Sumitomo Besshi Hospital, Niihama-shi, Japan
| | - Yuta Fujiwara
- Department of Surgery, Sumitomo Besshi Hospital, Niihama-shi, Japan
| | - Kyosuke Habu
- Department of Surgery, Sumitomo Besshi Hospital, Niihama-shi, Japan
| | - Yusuke Konishi
- Department of Surgery, Sumitomo Besshi Hospital, Niihama-shi, Japan
| | - Tetsuji Fukuhara
- Department of Surgery, Sumitomo Besshi Hospital, Niihama-shi, Japan
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31
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Prudhomme M, Fabbro-Peray P, Rullier E, Occean BV, Bertrand MM. Meta-analysis and Systematic Review of the Use of a Prosthetic Mesh for Prevention of Parastomal Hernia. Ann Surg 2021; 274:20-28. [PMID: 33378298 DOI: 10.1097/sla.0000000000004704] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The primary endpoint of this meta-analysis was the PSH rate at 1 year of follow-up with or without the use of a mesh. SUMMARY OF BACKGROUND DATA European guidelines currently recommend the use of a mesh at the time of a stoma formation for the prevention of PSH. These recommendations are based on the RCT and meta-analyses published before 2017. More recently 2 large RCT found no benefit in the mesh group. We investigated whether these latest results could change the conclusion of a meta-analysis. METHODS We conducted a comprehensive literature search and analyzed RCT investigating the use of a mesh to prevent PSH formation. All studies including end colostomies were included in the qualitative analysis no matter the surgical technique or the type of mesh. All studies with a limited risk of bias and presenting with usable data were used in the quantitative analysis. RESULTS There is a large heterogeneity among the studies, in terms of position of the mesh, surgical technique, and diagnostic method for the PSH.No statistically significant difference was found on the PSH rate at 1 or 2 years between the mesh and non-mesh groups. CONCLUSIONS Based on this meta-analysis including the latest RCT on the prevention of PSH, the use of a mesh should not be recommended.
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Affiliation(s)
- Michel Prudhomme
- Department of Digestive Surgery, CHU Nimes, Univ Montpellier, Nimes, France
| | - Pascale Fabbro-Peray
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, CHU Nimes, Univ Montpellier, Nimes, France
| | - Eric Rullier
- Department of Colorectal Surgery, GH Sud Haut-Lévêque - CHU de Bordeaux, Pessac, France
| | - Bob V Occean
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, CHU Nimes, Univ Montpellier, Nimes, France
| | - Martin M Bertrand
- Department of Digestive Surgery, CHU Nimes, Univ Montpellier, Nimes, France
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32
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Burch J, Boyles A, Maltby E, Marsden J, Martin N, McDermott B, Voegeli D. Keep it simple: peristomal skin health, quality of life and wellbeing. ACTA ACUST UNITED AC 2021; 30:5-24. [PMID: 33949894 DOI: 10.12968/bjon.2021.30.sup6.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jennie Burch
- (chair), Head of Gastrointestinal Nurse Education, St Mark's Hospital, London North West University Healthcare NHS Foundation Trust
| | - Anna Boyles
- Stoma Care Nurse, King's College Hospital NHS Foundation Trust
| | - Emma Maltby
- Stoma Care Nurse, Hampshire Hospitals NHS Foundation Trust
| | - Jenny Marsden
- Stoma Care Nurse, York Teaching Hospital NHS Foundation Trust
| | - Nuria Martin
- Tissue Viability Nurse, St Mark's Hospital, London North West University Healthcare NHS Foundation Trust
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33
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Frigault J, Lemieux S, Breton D, Bouchard P, Bouchard A, Grégoire RC, Letarte F, Bouchard G, Boun V, Massé K, Drolet S. Prophylactic retromuscular mesh placement for parastomal hernia prevention: a retrospective cohort study of permanent colostomies and ileostomies. Hernia 2021; 26:495-506. [PMID: 34132954 DOI: 10.1007/s10029-021-02440-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Parastomal hernia (PSH) is the most common complication of stoma formation. The safety and efficiency of prophylactically placing mesh to prevent PSH remain controversial. To address this question, we examined the incidence of clinical and radiological PSH when using parastomal prophylactic mesh (PPM). METHODS We performed a retrospective, single-center, cohort study that included all patients with permanent stoma creation between 2015 and 2018. Patients were divided into two groups according to the utilization of PPM or not. RESULTS During the study period, 185 patients had a permanent stoma created, 144 with colostomy and 41 with ileostomy. PPM was placed in 79 patients. There was no difference in the need for early surgical reintervention (p = 0.652) or rehospitalization (p = 0.314) for stoma-related complications in patients with mesh as compared with patients without. Similarly, there was no difference in operative time (p = 0.782) or in length of hospital stay (p = 0.806). No patients experienced infection of the mesh or required prosthesis removal. There was a lower incidence rate of PSH with PPM placement in patients with permanent colostomy [adjusted hazard ratio (HR) 0.50 (95% confidence interval 0.28-0.89); p = 0.018]. In contrast, a higher incidence rate of PSH was observed in patients with ileostomy and PPM [adjusted HR 5.92 (95% confidence interval 1.07-32.65); p = 0.041]. CONCLUSION Parastomal prophylactic mesh placement to prevent PSH is a safe and efficient approach to reduce the incidence of PSH in patients requiring a permanent colostomy. However, mesh may increase the rate of PSH after permanent ileostomy.
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Affiliation(s)
- Jonathan Frigault
- Surgery Department, CHU de Quebec-Laval University, 1050 Avenue de la Médecine, Quebec, QC, Canada.
| | - Simon Lemieux
- Radiology and Nuclear Medicine Department, CHU de Quebec-Laval University, Quebec, Canada
| | - Dominic Breton
- Radiology and Nuclear Medicine Department, CHU de Quebec-Laval University, Quebec, Canada
| | - Philippe Bouchard
- Surgery Department, CHU de Quebec-Laval University, 1050 Avenue de la Médecine, Quebec, QC, Canada
| | - Alexandre Bouchard
- Surgery Department, CHU de Quebec-Laval University, 1050 Avenue de la Médecine, Quebec, QC, Canada
| | - Roger C Grégoire
- Surgery Department, CHU de Quebec-Laval University, 1050 Avenue de la Médecine, Quebec, QC, Canada
| | - François Letarte
- Surgery Department, CHU de Quebec-Laval University, 1050 Avenue de la Médecine, Quebec, QC, Canada
| | - Gilles Bouchard
- Radiology and Nuclear Medicine Department, CHU de Quebec-Laval University, Quebec, Canada
| | | | | | - Sébastien Drolet
- Surgery Department, CHU de Quebec-Laval University, 1050 Avenue de la Médecine, Quebec, QC, Canada
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34
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Correa Marinez A, Bock D, Carlsson E, Petersén C, Erestam S, Kälebo P, Rosenberg J, Haglind E, Angenete E. Stoma-related complications: a report from the Stoma-Const randomized controlled trial. Colorectal Dis 2021; 23:1091-1101. [PMID: 33326678 DOI: 10.1111/codi.15494] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/07/2022]
Abstract
AIM The impact of construction techniques on the development of stoma complications is partly undiscovered. The aim of this paper was to report and analyse the impact of the three surgical techniques in a randomized controlled trial Stoma-Const on stoma-related complications as well as identifying risk factors and patient-reported stoma function as a planned secondary analysis. METHODS This was a randomized, multicenter trial where all patients scheduled to receive an end colostomy were invited to participate. Patients were randomized to one of three techniques for stoma construction; cruciate fascial incision, circular incision or prophylactic mesh. Stoma complications were assessed by a surgeon and stoma care nurses within 1 year postoperatively. RESULTS Two hundred and nine patients were randomized. Patient demographics were similar in all three groups. Data on stoma-related complications were available for analysis in 201 patients. A total of 127 patients (63%) developed some type of stoma complication within 1 year after surgery. The risk ratio (95% CI) for stoma complications was 0.93 (0.73; 1.2) between cruciate vs. circular incision groups and 1.02 (0.78; 1.34) between cruciate vs. mesh groups. There were no statistically significant differences between the groups regarding parastomal hernia rate and no risk factors could be identified. CONCLUSION This randomized trial confirmed a high prevalence of stoma-related complications but could not identify an impact of surgical technique or identify modifiable risk factors for stoma-related complications.
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Affiliation(s)
- Adiela Correa Marinez
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Scandinavian Surgical Outcomes Research Group, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - David Bock
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Scandinavian Surgical Outcomes Research Group, University of Gothenburg, Gothenburg, Sweden
| | - Eva Carlsson
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Charlotta Petersén
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Sofia Erestam
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Scandinavian Surgical Outcomes Research Group, University of Gothenburg, Gothenburg, Sweden
| | - Peter Kälebo
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jacob Rosenberg
- Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Eva Haglind
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Scandinavian Surgical Outcomes Research Group, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Eva Angenete
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Scandinavian Surgical Outcomes Research Group, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
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35
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Gavlin A, Kierans AS, Chen J, Song C, Guniganti P, Mazzariol FS. Imaging and Treatment of Complications of Abdominal and Pelvic Mesh Repair. Radiographics 2021; 40:432-453. [PMID: 32125951 DOI: 10.1148/rg.2020190106] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Surgical mesh is used most frequently for tension-free repair of abdominal wall hernias in adults, because the rate of hernia recurrence is lower with mesh than with primary soft-tissue repair. Since the introduction of polypropylene mesh in the middle of the 20th century, many mesh materials and configurations for specific surgical procedures have been developed. In addition to abdominal wall hernia repair, mesh may be used for repair of diaphragmatic hernias, urinary incontinence in women (female slings), genitourinary prolapse (vaginal mesh and sacrocolpopexy), rectal prolapse (rectopexy), and postprostatectomy male urinary incontinence (male slings). General mesh repair complications include chronic pain; fluid collections such as seromas, hematomas, and abscesses; adhesions that may lead to intestinal blockage; erosion into solid or hollow viscera including enterocutaneous fistulizing disease; and mesh failure characterized by mesh shrinkage, detachment, and migration with repair malfunction. Several mesh complications are often diagnosed with imaging, primarily with CT and less frequently with MRI and US, despite variable mesh visibility at imaging. This article reviews the common surgical mesh applications in the abdomen and pelvis, discusses imaging of mesh repair complications, and provides complication treatment highlights.©RSNA, 2020.
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Affiliation(s)
- Alexander Gavlin
- From the Department of Radiology, Division of Abdominal Imaging, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065
| | - Andrea S Kierans
- From the Department of Radiology, Division of Abdominal Imaging, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065
| | - Johnson Chen
- From the Department of Radiology, Division of Abdominal Imaging, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065
| | - Christopher Song
- From the Department of Radiology, Division of Abdominal Imaging, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065
| | - Preethi Guniganti
- From the Department of Radiology, Division of Abdominal Imaging, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065
| | - Fernanda S Mazzariol
- From the Department of Radiology, Division of Abdominal Imaging, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065
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Gómez Sánchez J, Ubiña Martínez JA, Gutierrez Sainz J. A new plasty as treatment for end-colostomy stenosis. Updates Surg 2021; 73:1589-1590. [PMID: 33847895 DOI: 10.1007/s13304-021-01053-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/07/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Javier Gómez Sánchez
- Department of Colorectal Surgery, Hospital Universitario San Cecilio, 18016, Granada, Spain.
| | | | - Javier Gutierrez Sainz
- Department of Colorectal Surgery, Hospital Universitario San Cecilio, 18016, Granada, Spain
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Methods of Colostomy Construction: No Effect on Parastomal Hernia Rate: Results from Stoma-const-A Randomized Controlled Trial. Ann Surg 2021; 273:640-647. [PMID: 32209907 DOI: 10.1097/sla.0000000000003843] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The primary objective of this trial was to compare the parastomal hernia rates 1 year after the construction of an end colostomy by 3 surgical techniques: cruciate incision, circular incision in the fascia and using prophylactic mesh. Secondary objectives were evaluation of postoperative complications, readmissions/reoperations, and risk factors for parastomal hernia. SUMMARY OF BACKGROUND DATA Colostomy construction techniques have been explored with the aim to improve function and reduce stoma complications, but parastomal herniation is frequent with an incidence of approximately 50%. METHODS A randomized, multicenter trial was performed in 3 hospitals in Sweden and Denmark; all patients scheduled to receive an end colostomy were asked to participate. Parastomal hernia within 12 months was determined by computed tomography of the abdomen in prone position and by clinical assessment. Complications, readmissions, reoperations, and risk factors were also assessed. RESULTS Two hundred nine patients were randomized to 1 of the 3 arms of the study. Patient demographics were similar in all 3 groups. Assessment of parastomal hernia was possible in 185 patients. The risk ratio (95% confidence interval) for parastomal hernia was 1.25 (0.83; 1.88), and 1.22 (0.81; 1.84) between cruciate versus circular and cruciate versus mesh groups, respectively. There were no statistically significant differences between the groups with regard to parastomal hernia rate. Age and body mass index were found to be associated with development of a parastomal hernia. CONCLUSION We found no significant differences in the rates of parastomal hernia within 12 months of index surgery between the 3 surgical techniques of colostomy construction.
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38
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Zhang T, Yang D, Sun G, Zhang D. Modified technique of extraperitoneal colostomy without incision of the posterior rectus sheath. Sci Rep 2021; 11:2857. [PMID: 33536513 PMCID: PMC7859403 DOI: 10.1038/s41598-021-82626-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/14/2021] [Indexed: 11/24/2022] Open
Abstract
Extraperitoneal colostomy is a widely used technique during abdominoperineal resection (APR) operation for lower rectal cancer. This technique has been reported to be effective to prevent the postoperative parastomal hernia in some retrospective studies, however, there is still a certain incidence of parastomal hernia. A modification of the extraperitoneal colostomy technique is described in this paper that keeps posterior rectal sheath intact instead of having a conventional incision, to further reduce the risk of parastomal hernia. Until now, this modified technique has been performed in 15 patients, no occurrence of parastomal hernia was observed.
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Affiliation(s)
- Tao Zhang
- Department of Colorectal and Hernia Surgery, The Fourth Affiliated Hospital of China Medical University, 4# Chong-shan East Road, Shenyang, Liaoning, China
| | - Daye Yang
- Department of Colorectal and Hernia Surgery, The Fourth Affiliated Hospital of China Medical University, 4# Chong-shan East Road, Shenyang, Liaoning, China
| | - Gongping Sun
- Department of Colorectal and Hernia Surgery, The Fourth Affiliated Hospital of China Medical University, 4# Chong-shan East Road, Shenyang, Liaoning, China
| | - Dewei Zhang
- Department of Colorectal and Hernia Surgery, The Fourth Affiliated Hospital of China Medical University, 4# Chong-shan East Road, Shenyang, Liaoning, China.
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39
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Holmdahl V, Gunnarsson U, Strigård K. Autologous full-thickness skin graft as reinforcement in parastomal hernia repair: a feasibility study. Tech Coloproctol 2020; 25:131-136. [PMID: 33151386 PMCID: PMC7847461 DOI: 10.1007/s10151-020-02368-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/23/2020] [Indexed: 11/06/2022]
Abstract
Background Parastomal hernia is a common complication of stoma formation and the methods of repair available today are unsatisfactory with high recurrence and complication rates. To improve outcome after surgical repair of parastomal hernia, a surgical method using autologous full-thickness skin grafts as intraperitoneal reinforcement has been developed. The purpose of this study was to evaluate the feasibility of this novel surgical technique in the repair of parastomal hernia. Methods A pilot study was conducted between January 2018 and June 2019 on four patients with symptomatic parastomal hernia. They had a laparotomy with suture reduction of the hernia and reinforcement of the abdominal wall with autologous full-thickness skin. They were then monitored for at least 1 year postoperatively for technique-related complications and recurrence. Results No major technique-related complications were noted during the follow-up Two patients developed a recurrent parastomal hernia at the long term follow-up. The other two had no recurrence. Conclusions Autologous full-thickness skin graft as reinforcement in parastomal hernia repair is feasible and should be evaluated in a larger clinical trial.
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Affiliation(s)
- V Holmdahl
- Department of Surgical and Perioperative Sciences, Umeå University, Norrlands Universitetssjukhus, Daniel Naezéns väg, Västerbottens län, 90185, Umeå, Sweden.
| | - U Gunnarsson
- Department of Surgical and Perioperative Sciences, Umeå University, Norrlands Universitetssjukhus, Daniel Naezéns väg, Västerbottens län, 90185, Umeå, Sweden
| | - K Strigård
- Department of Surgical and Perioperative Sciences, Umeå University, Norrlands Universitetssjukhus, Daniel Naezéns väg, Västerbottens län, 90185, Umeå, Sweden
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40
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Krogsgaard M, Gögenur I, Helgstrand F, Andersen RM, Danielsen AK, Vinther A, Klausen TW, Hillingsø J, Christensen BM, Thomsen T. Surgical repair of parastomal bulging: a retrospective register-based study on prospectively collected data. Colorectal Dis 2020; 22:1704-1713. [PMID: 32548884 DOI: 10.1111/codi.15197] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/13/2020] [Indexed: 12/16/2022]
Abstract
AIM The aim of this work was to examine (1) the incidence of primary repair, (2) the incidence of recurrent repair and (3) the types of repair performed in patients with parastomal bulging. METHOD Prospectively collected data on parastomal bulging from the Danish Stoma Database were linked to surgical data on repair of parastomal bulging from the Danish National Patient Register. Survival statistics provided cumulative incidences and time until primary and recurrent repair. RESULTS In the study sample of 1016 patients with a permanent stoma and a parastomal bulge, 180 (18%) underwent surgical repair. The cumulative incidence of a primary repair was 9% [95% CI (8%; 11%)] within 1 year and 19% [95% CI (17%; 22%)] within 5 years after the occurrence of a parastomal bulge. We found a similar probability of undergoing primary repair in patients with ileostomy and colostomy. For recurrent repair, the 5-year cumulative incidence was 5% [95% CI (3%; 7%)]. In patients undergoing repair, the probability was 33% [95% CI (21%; 46%)] of having a recurrence requiring repair within 5 years. The main primary repair was open or laparoscopic repair with mesh (43%) followed by stoma revision (39%). Stoma revision and repair with mesh could precede or follow one another as primary and recurrent repair. Stoma reversal was performed in 17% of patients. CONCLUSION Five years after the occurrence of a parastomal bulge the estimated probability of undergoing a repair was 19%. Having undergone a primary repair, the probability of recurrent repair was high. Stoma reversal was more common than expected.
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Affiliation(s)
- M Krogsgaard
- Department of Surgical Gastroenterology, Clinic C Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - I Gögenur
- Department of Surgery, Centre for Surgical Sciences, Zealand University Hospital, Koege, Denmark
| | - F Helgstrand
- Department of Surgery, Centre for Surgical Sciences, Zealand University Hospital, Koege, Denmark
| | - R M Andersen
- Department of Surgical Gastroenterology, Clinic C Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A K Danielsen
- Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - A Vinther
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital in Herlev and Gentofte, Copenhagen, Denmark.,QD-Research Unit, Copenhagen University Hospital in Herlev and Gentofte, Denmark
| | - T W Klausen
- Department of Haematology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J Hillingsø
- Department of Surgical Gastroenterology, Clinic C Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - B M Christensen
- Department of Surgical Gastroenterology, Clinic C Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - T Thomsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Herlev Acute, Critical and Emergency Care Science Group, Department of Anaesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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41
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Koide Y, Maeda K, Katsuno H, Hanai T, Masumori K, Matsuoka H, Endo T, Cheong YC, Uyama I. Outcomes of stapler repair with anastomosis for stoma prolapse. Surg Today 2020; 51:226-231. [PMID: 32656699 DOI: 10.1007/s00595-020-02076-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The published data on the outcomes of an operative repair for stoma prolapse are limited. This study aimed to clarify the long-term outcomes of stapler repair with anastomosis for stoma prolapse. METHODS Twenty-four patients (15 men, median age 64 years, range 33-88 years) undergoing 25 stapler repairs with anastomosis were prospectively registered, and their medical records were retrospectively reviewed. RESULTS The median length of prolapse was 10 cm (range 5-22). Stoma prolapse repair was performed by means of 16 loop colostomies, four end colostomies, three loop ileostomies, and one end ileostomy. A stapler was used 4.6 times on average (range 4-8). The average operative time and bleeding were 40.8 (range 15-75) min and 40 (range 0-214) mL, respectively. No mortality and morbidity were observed after surgery. A recurrence of stoma prolapse was reported in only one of 25 repairs (4%) at the proximal limb of loop ileostomy during a median follow-up period of 1 year (range 1-120 months). However, a new stoma prolapsed in one untreated limb of loop stoma. CONCLUSIONS Stapler repair with anastomosis is a safe and minimally invasive treatment option for stoma prolapse with a low recurrence. However, the effectiveness of reparing stoma prolapse on the proximal limb of loop ileostomy might be limited.
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Affiliation(s)
- Yoshikazu Koide
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kotaro Maeda
- International Medical Center Fujita, Health University Hospital, 1-98, Kutsukake, Toyoake, 470-1192, Japan.
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Koji Masumori
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Yeong Cheol Cheong
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
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Kish KJ, Buinewicz BR, Morris JB. Acellular Dermal Matrix (AlloDerm): New Material in the Repair of Stoma Site Hernias. Am Surg 2020. [DOI: 10.1177/000313480507101212] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Parastomal hernias are a common complication after ileostomy or colostomy formation and can lead to complications, such as intestinal obstruction and strangulation. When a parastomal hernia presents, repair of the defect can pose a challenge to the surgeon to choose a repair that both reduces complications and recurrence rates. We present three cases of parastomal hernia repair using acellular dermal matrix (AlloDerm) as reinforcement to the primary hernia repair. We prospectively followed three patients who presented with parastomal hernia after ostomy formation in 2001–2002. The patients underwent repair of the parastomal hernia using primary fascial repair with reinforcement using AlloDerm as an on-lay patch. Two patients were followed for 6 months and 1 year, respectively, and remained hernia-free. One patient presented 8 months later with symptoms of intestinal obstruction that were relieved by nasogastric tube decompression and bowel rest. The patient subsequently returned 3 months later with intestinal obstruction and recurrent parastomal hernia that necessitated an operation for relocation of the stoma and repeat hernia repair. Repair of parastomal hernias using AlloDerm acellular dermal matrix as a substitute for a synthetic graft showed resilience to infection and, more importantly, tolerated exposure in an open wound without having to be removed. Larger studies with longer follow-up are needed to see if this material reduces the incidence of hernia recurrence.
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Affiliation(s)
- Karen J. Kish
- Divisions of General Surgery and Abington Memorial Hospital, Abington, Pennsylvania
| | - Brian R. Buinewicz
- Divisions of Plastic Surgery, Abington Memorial Hospital, Abington, Pennsylvania
| | - Jon B. Morris
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Baron E, Gushchin V, King MC, Nikiforchin A, Sardi A. Pelvic Anastomosis Without Protective Ileostomy is Safe in Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2020; 27:4931-4940. [PMID: 32506191 DOI: 10.1245/s10434-020-08479-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND During cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), surgeons are reluctant to perform unprotected pelvic anastomosis despite lack of supporting data. We analyzed pelvic anastomosis outcomes and factors that influence ostomy creation in CRS/HIPEC patients. METHODS A single-center, descriptive study of patients with rectal resection during CRS/HIPEC was conducted using a prospective database. Surgical variables were reviewed. Multinomial logistic regression of outcomes (end or protective ostomy) was performed with pre- and intraoperative factors as predictors. RESULTS Overall, 274 of 789 CRS/HIPEC patients underwent rectal resection, including 243 (89%) with pelvic anastomosis [232 (85%) without ostomy, 11 (4%) with protective ileostomy] and 31 (11%) with no anastomosis [16 (6%) with end colostomy, 15 (5%) with end ileostomy]. The median age was 57 and 29% (79) were male. Of 243 pelvic anastomosis patients, 3 (1.2%) had rectal anastomotic leaks, including 1 with a protective ileostomy. Other anastomotic leaks occurred in 3.6%. Overall, 13% had Clavien-Dindo complications ≥ IIIB and the readmission rate was 30%. Mortality at 30 days and 100 days was 0.4% and 2.2%, respectively. Male gender and primary rectal cancer were associated with protective ileostomy [odds ratio (OR) = 7.01, 95% CI: 1.6-31.5, p = 0.011, and OR = 16.4, 95% CI: 3-88.4, p = 0.001, respectively). Male gender and prior pelvic surgery were associated with end colostomy (OR = 13.9, 95% CI: 3.7-53, p < 0.0001, and OR = 17.2, 95% CI: 3.8-78.6, p < 0.0001). CONCLUSIONS Pelvic bowel reconstruction without protective or end ostomy during CRS/HIPEC is safe. Protective ileostomy is associated with male gender and primary rectal cancer. End colostomy is associated with male gender and prior pelvic surgery.
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Affiliation(s)
- Ekaterina Baron
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Mary Caitlin King
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Andrei Nikiforchin
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Armando Sardi
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA.
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Hashida H, Kita R, Kondo M, Mizuno R, Kobayashi H, Kaihara S. Internal hernia of the stomach associated with colostomy after laparoscopic surgery for rectal cancer: a case report. Surg Case Rep 2020; 6:127. [PMID: 32495102 PMCID: PMC7270322 DOI: 10.1186/s40792-020-00889-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/27/2020] [Indexed: 11/28/2022] Open
Abstract
Background Colostomy via the intraperitoneal route is often performed during laparoscopic Hartmann’s operation or abdominoperineal resection. Internal hernia of the small intestine often occurs after colostomy. This report shows a rare case of internal hernia of the stomach associated with sigmoid colostomy after laparoscopic abdominoperineal resection for rectal cancer. Case presentation The patient was a 79-year-old woman with a sigmoid colostomy. Computed tomography scan showed a markedly distended stomach in the space between the lifted sigmoid colon and the lateral abdominal wall. Laparoscopy revealed that the body of the stomach had passed through a hernia orifice located between the lifted sigmoid colon and the left lateral abdominal wall. The dislocated stomach was restored to its normal position, and the lateral defect was closed with the lateral peritoneum and the lifted sigmoid colon laparoscopically. Conclusions Internal hernia associated with colostomy can lead to not only obstruction of the small intestine, but also obstruction of the stomach. We reported a successful case of the suture repair for the internal hernia of the stomach associated with colostomy.
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Affiliation(s)
- Hiroki Hashida
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Ryosuke Kita
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Masato Kondo
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Ryosuke Mizuno
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Hiroyuki Kobayashi
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Satoshi Kaihara
- Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
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45
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Holmdahl V, Backman O, Gunnarsson U, Strigård K. The Tensile Strength of Full-Thickness Skin: A Laboratory Study Prior to Its Use as Reinforcement in Parastomal Hernia Repair. Front Surg 2020; 6:69. [PMID: 31921883 PMCID: PMC6915078 DOI: 10.3389/fsurg.2019.00069] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/19/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose: Parastomal hernia is a common complication of an enterostoma. Current methods of repair have high recurrence rates and are associated with severe complications. Autologous full-thickness skin as reinforcement may reduce the recurrence and complication rates. This study aims to investigates the tensile strength of full-thickness skin; information that is essential if we are to proceed with clinical trials on humans. Methods: Full-thickness skin samples from 12 donors were tested for tensile strength, as well as the load tolerated by a suture through the skin. Strips of skin were cut out and stretched until breaking point. Sutures were made through skin samples and traction applied until either the tissue or the suture gave way. All done while recording the forces applied using a dynamometer. Identical tests were carried out on commercially available synthetic and biologic graft material for comparison. Results: The full-thickness skin strips had a median tensile strength of 604 N/cm. This tensile strength was significantly higher than that of the compared materials evaluated in this study. In full-thickness skin, the suture, or tissue endured a median force of 67 N before giving way, which was as high as, or higher than similar sutures through the compared materials. Conclusions: The tensile strength of full-thickness skin vastly exceeds the physiological forces affecting the abdominal wall, and sutures through skin endure high loads before giving way. The tensile strength of a full-thickness skin graft and the strength of sutures through this material will not limit its use for reinforcement in parastomal hernia repair.
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Affiliation(s)
- Viktor Holmdahl
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.,Sunderby Research Unit, Department of Surgical and Perioperative Sciences, Umeå University, Luleå, Sweden
| | - Olof Backman
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Karin Strigård
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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Mäkäräinen-Uhlbäck E, Wiik H, Kössi J, Nikberg M, Ohtonen P, Rautio T. Chimney Trial: study protocol for a randomized controlled trial. Trials 2019; 20:652. [PMID: 31779699 PMCID: PMC6883681 DOI: 10.1186/s13063-019-3764-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 09/28/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Parastomal hernias (PSHs) are common, troubling the lives of people with permanent colostomy. In previous studies, retromuscular keyhole mesh placement has been the most-used technique for PSH prevention but results have been controversial. Additionally, surgical treatment of PSHs is associated with a high rate of complications and recurrences. Therefore, it is crucial to find the most effective way to prevent PSHs in the first place without an increased risk of complications. Due to a lack of adequate research, there is no clear evidence or recommendations on which mesh or technique is best to prevent PSHs. METHODS/DESIGN The Chimney Trial is a Nordic, prospective, randomized controlled, multicenter trial designed to compare the feasibility and the potential benefits of specifically designed, intra-abdominal onlay mesh (DynaMesh®-Parastomal, FEG Textiltechnik GmbH, Aachen, Germany) against controls with permanent colostomy without mesh. The primary outcome of the Chimney Trial is the incidence of a PSH detected by a computerized tomography (CT) scan at 12-month follow-up. Secondary outcomes are the rate of clinically detected PSHs, surgical-site infection as defined by the Centers for Disease Control and Prevention (CDC), complications as defined by the Clavien-Dindo classification, the reoperation rate, operative time, length of stay, quality of life as measured by the RAND-36 survey and colostomy impact score, and both direct and indirect costs. For each group, 102 patients were enrolled at attending hospitals and randomized at a ratio of 1:1 by browser-based software to receive a preventive mesh or a conventional colostomy without a mesh. Patients will be followed for 1 month and at 1, 3, and 5 years after the operation for long-term results and complications. DISCUSSION The Chimney Trial aims to provide level-I evidence on PSH prevention. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03799939. Registered on 10 January 2019.
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Affiliation(s)
| | - Heikki Wiik
- Oulu University Hospital, PL 21, 90029 OYS, Finland
| | - Jyrki Kössi
- Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850 Lahti, Finland
| | | | - Pasi Ohtonen
- Oulu University Hospital, PL 21, 90029 OYS, Finland
| | - Tero Rautio
- Oulu University Hospital, PL 21, 90029 OYS, Finland
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Ambe PC, Kurz NR, Nitschke C, Odeh SF, Möslein G, Zirngibl H. Intestinal Ostomy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:182-187. [PMID: 29607805 DOI: 10.3238/arztebl.2018.0182] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 07/25/2017] [Accepted: 11/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND About 100 000 ostomy carriers are estimated to live in Germany today. The creation of an ostomy represents a major life event that can be associated with impaired quality of life. Optimal ostomy creation and proper ostomy care are crucially important determinants of the success of treatment and of the patients' quality of life. METHODS This article is based on pertinent publications retrieved by a selective search in PubMed, GoogleScholar, and Scopus, and on the authors' experience. RESULTS Intestinal stomata can be created using either the small or the large bowel. More than 75% of all stomata are placed as part of the treatment of colorectal cancer. The incidence of stoma-related complications is reported to be 10-70%. Skin irritation, erosion, and ulceration are the most common early complications, with a combined incidence of 25-34%, while stoma prolapse is the most common late complication, with an incidence of 8-75%. Most early complications can be managed conservatively, while most late complications require surgical revision. In 19% of cases, an ostomy that was initially planned to be temporary becomes permanent. Inappropriate stoma location and inadequate ostomy care are the most common causes of early complications. Both surgical and patient-related factors influence late complications. CONCLUSION Every step from the planning of a stoma to its postoperative care should be discussed with the patient in detail. Preoperative marking is essential for an optimal stoma site. Optimal patient management with the involvement of an ostomy nurse increases ostomy acceptance, reduces ostomy-related complications, and improves the quality of life of ostomy carriers.
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Affiliation(s)
- Peter C Ambe
- Department of; Visceral, Minimally Invasive, and Oncological Surgery, Marien Hospital Düsseldorf; Department of General and Visceral Surgery, Chair of Surgery II, Helios University Hospital Wuppertal, University of Witten/Herdecke Helios University Hospital Wuppertal, University of Witten/Herdecke; Center for Hereditary Gastrointestinal Tumors, Chair of Surgery II, Helios; University Hospital Wuppertal, University of Witten/Herdecke
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Etiological analysis of parastomal hernia by computed tomography examination. Wideochir Inne Tech Maloinwazyjne 2019; 14:387-393. [PMID: 31534568 PMCID: PMC6748055 DOI: 10.5114/wiitm.2019.81409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Parastomal hernia is a common complication after stoma formation. The definitive risk factors for parastomal hernia development remain unclear. Aim This study evaluated the risk factors through computed tomography (CT) scan of patients with parastomal hernia. Material and methods All patients who underwent an operation at our institution from January 2008 to February 2014 were included. We recorded patient-related and operation-related variables, and CT scans were checked. All the variables were analyzed with SPSS 19 to identify the risk factors for parastomal hernia formation. Results Of the 128 patients who underwent colostomy, 49 (38.3%) developed a parastomal hernia during a median follow-up period of 20.1 months (range: 4-84 months). Hernia development was significantly associated with the thickness of subcutaneous fat in the abdominal wall, the location of the stoma, anteroposterior diameter and horizontal diameter of the body. The defect size of the abdominal wall is another risk factor. The larger the defect size of the abdominal wall, the larger is the parastomal stoma (3.79 ±1.51 vs. 2.13 ±0.74 cm horizontally and 4.90 ±2.25 vs. 2.94 ±0.73 cm vertically, p < 0.001). The hernia contents protrude into the hernial sac through the path of the inner side more than the outer side (77.6% vs. 12.2%). Conclusions Our findings in Chinese patients with parastomal hernia match those from Western countries: obesity, the location of the stoma, and the defect size of the abdominal wall are significant risk factors for parastomal hernia formation. The mesenteric region is a weak area, which is a site prone to parastomal hernia, and should be protected.
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Näverlo S, Gunnarsson U, Strigård K, Näsvall P. Quality of life after end colostomy without mesh and with prophylactic synthetic mesh in sublay position: one-year results of the STOMAMESH trial. Int J Colorectal Dis 2019; 34:1591-1599. [PMID: 31392405 DOI: 10.1007/s00384-019-03359-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine whether prophylactic mesh in a sublay position has an impact on the quality-of-life (QoL) of patients receiving an end colostomy. METHODS One-year follow-up of patients from the STOMAMESH trial, a randomized controlled double-blinded multicenter study. Patients were randomized to either prophylactic synthetic mesh with a cruciform incision in the center, placed in sublay position, or no prophylactic mesh. Patients attended a 1-year visit and responded to the questionnaires EORTC QLQ C-30 and CR-38. The impact of having a mesh on QoL was determined by comparing a group of patients receiving a mesh with a group without. A subgroup analysis was made depending on whether a PSH was clinically present or not. RESULTS Of the 232 randomized patients, 211 patients reached the 1-year clinical follow-up. The response rate of these 211 patients was 70%. No differences were seen in global QoL between the groups. Mesh patients reported significantly less stoma-related problems (p = 0.014) but more sexual problems in males (p = 0.022). When excluding patients with a clinical diagnosis of PSH, the difference in stoma-related problems remained while no significant difference was seen regarding sexual problems in males. CONCLUSIONS When forming an end colostomy, prophylactic synthetic mesh in a sublay position did not affect global QoL at 1-year follow-up, but stoma-related problems were fewer even in the presence of a clinically diagnosed PSH. TRIAL REGISTRATION NCT00917995.
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Affiliation(s)
- Simon Näverlo
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, SE-901 88, Umeå, Sweden.
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, SE-901 88, Umeå, Sweden
| | - Karin Strigård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, SE-901 88, Umeå, Sweden
| | - Pia Näsvall
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, SE-901 88, Umeå, Sweden.,Sunderby Research Unit, Umeå University, Luleå, Sweden
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Parastomal hernias causing symptoms or requiring surgical repair after colorectal cancer surgery-a national population-based cohort study. Int J Colorectal Dis 2019; 34:1267-1272. [PMID: 31147771 DOI: 10.1007/s00384-019-03292-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Parastomal hernia is a complication with high morbidity that affects the patient's quality of life. The aim of this study was to assess the cumulative incidence of parastomal hernia in patients who have undergone colorectal cancer surgery and to identify potential risk factors that could predispose to the development of this type of hernia in a large population-based cohort over a long follow-up period. METHODS The Swedish Colorectal Cancer Registry and the National Patient Register were used to collect study cohort data between January 2007 and September 2013. All patients undergoing colorectal cancer surgery including a permanent stoma were included in the study group. RESULTS A total of 39,984 patients were registered during the study period. Of these, 7649 received a permanent stoma. Multivariate proportional hazard analysis, based on 6329 patients for whom all covariates could be retrieved, showed that the only independent risk factor for developing a parastomal hernia was BMI ≥ 30 (HR 1.49; 95% CI 1.02-2.17; p < 0.037). A slightly elevated hazard ratio was found for preoperative radiotherapy (HR 1.36; 95% CI 0.96-1.91; p < 0.070). The cumulative incidence of patients diagnosed or surgically treated for parastomal hernia over a follow-up period of 5 years was 7.7% (95% CI 6.1-9.2%). CONCLUSIONS The cumulative incidence of parastomal hernia causing symptoms or requiring surgery after 5 years was at least 7.7%. Obesity increases the risk of developing parastomal hernia.
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