Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2024; 16(3): 823-832
Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.823
Reinforced tissue matrix to strengthen the abdominal wall following reversal of temporary ostomies or to treat incisional hernias
Spencer P Lake, Corey R Deeken, Amit K Agarwal
Spencer P Lake, Mechanical Engineering & Materials Science, Washington University in St. Louis, St. Louis, MO 63130, United States
Corey R Deeken, Covalent Bio, LLC, St. Louis, MO 63025, United States
Amit K Agarwal, Department of Surgery, McGovern Medical School at UTHealth, Houston, TX 77026, United States
Author contributions: Agarwal AK designed the study; Agarwal AK performed the research; Agarwal AK, Lake SP, and Deeken CR analyzed the data and wrote the manuscript; and all authors have read and approve the final manuscript.
Institutional review board statement: This study was reviewed and approved by the UT Health Houston Institutional Review Board (approval No. HSC-MS-23-0471).
Informed consent statement: All study participants, or their legal guardian, provided consent prior to study enrollment.
Conflict-of-interest statement: This project was sponsored by TELA Bio of Malvern, PA (USA). Dr. Deeken is the owner of Covalent Bio, LLC, which received consulting fees from TELA Bio for this project, as well as other unrelated projects. Dr. Deeken also reports consulting fees from C.R. Bard, Inc./Davol/Becton, Dickinson and Company, Johnson & Johnson, Medtronic, SurgiMatrix, Tissium, Surgical Innovation Associates, Americas Hernia Society Quality Collaborative, Colorado Therapeutics, TELA Bio, Osteogenics, Polynovo, MedSkin Solutions, and Aran Biomedical outside the submitted work. In addition, Dr. Deeken holds the following issued patents: 2009293001, 2334257, 2,334,257UK, 602009046407.8, 2,334,257FR, 16/043,849 and 2,737,542. Dr. Lake is a consultant for Covalent Bio LLC and has received consulting fees from TELA Bio for the conduct of this study, as well as outside of the current work. Dr. Agarwal is a paid consultant for TELA Bio.
Data sharing statement: Dataset available from the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Amit K Agarwal, FACS, FASCRS, MD, Associate Professor, Department of Surgery, McGovern Medical School at UTHealth, 5656 Kelley Street, General Surgery Office, Houston, TX 77026, United States. amit.k.agarwal@uth.tmc.edu
Received: October 27, 2023
Peer-review started: October 27, 2023
First decision: December 6, 2023
Revised: January 3, 2024
Accepted: February 25, 2024
Article in press: February 25, 2024
Published online: March 27, 2024
Processing time: 146 Days and 24 Hours
ARTICLE HIGHLIGHTS
Research background

Abdominal wall deficiencies are a common complication of temporary ostomies, and incisional hernias frequently develop after colostomy or ileostomy takedown. Synthetic and biologic meshes have been successfully leveraged to reinforce the abdominal wall and treat incisional hernias. Reinforced tissue matrices (RTMs) combine advantages of both biologic and synthetic scaffolds, but have not yet been used to strengthen the abdominal wall following stoma reversal.

Research motivation

To determine if RTMs could be successfully used to strengthen the abdominal wall after removal of temporary colostomies/ileostomies and treat incisional hernias that develop in previous stoma sites.

Research objectives

To determine rates of primary (i.e., hernia recurrence) and secondary (i.e., length of hospital stay, time to return to work, hospital readmissions) outcomes after using RTM to reinforce the abdominal wall or repair an incisional hernia after removal of a temporary stoma.

Research methods

Twenty-eight patients were selected with a parastomal and/or incisional hernia who had received a temporary ileostomy or colostomy. RTM was placed using a laparoscopic, robotic, or open surgical approach. Post-operative follow-up was performed at 1 month and 1 year.

Research results

At 1-month and 1-year follow-ups, there were no hernia recurrences (0%). Average hospital stays were 2.1 d ± 1.2 d and return to work occurred at 8.3 post-operative days ± 3.0 post-operative days. Three patients (10.7%) were readmitted before the 1-month follow up due to mesh infection and/or gastrointestinal issues. Fistula and mesh infection were observed in two patients each (7.1%), leading to partial mesh removal in one patient (3.6%). There were no complications between 1 month and 1 year (0%).

Research conclusions

RTMs were used successfully to treat parastomal and incisional hernias at ileostomy reversal, with no hernia recurrences and favorable outcomes after 1-month and 1-year.

Research perspectives

Future examination of larger and more heterogeneous patient populations, more standardized surgical techniques, and longer evaluation endpoints could further demonstrate the utility of this approach in limiting the negative impacts of hernias for patients with abdominal stomas.