A pilot single‐centre randomized trial assessing the safety and efficacy of lateral pararectus abdominis compared with transrectus abdominis muscle stoma placement in patients with temporary loop ileostomies: the <scp>PATRASTOM</scp> trial

Hardt, Julia; Seyfried, Steffen; Weiß, Christel; Post, Stefan; Kienle, Peter; Herrle, Florian

doi:10.1111/codi.13251

Cited by 40 publications

(32 citation statements)

References 37 publications

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“…). The median time from ileostomy placement to ileostomy reversal was 127 days (range 57–306 days) in the lateral pararectal arm and 112 days (range 15‐642 days) in the transrectal arm ( P = 0.549) .…”

Section: Resultsmentioning

confidence: 99%

Incisional hernia rate after ileostomy closure in lateral pararectal stoma versus transrectal stoma placement: follow‐up of the randomized PATRASTOM trial

et al. 2019

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Aim Because damage to the rectus abdominis muscle during ileostomy placement and reversal might be a risk factor for the development of stoma‐site incisional hernia (SSIH), we hypothesized that positioning of the stoma lateral to the rectus abdominis muscle might prevent SSIH. Method To investigate whether a lateral pararectal stoma position lowers the incidence of SSIH in comparison with a transrectal position, a follow‐up study of the PATRASTOM trial, which had randomized stoma placement (lateral pararectal versus transrectal), was conducted. All former participants were invited simultaneously for a follow‐up visit in September 2016, 2 years after database closure of the PATRASTOM trial. For patients who were not able to attend the follow‐up, the electronic chart as well as MRI/CT scans were reviewed with regard to the presence of SSIH. Results Follow‐up – either clinical or radiological – was available for 47 of the 60 PATRASTOM participants. The median duration of follow‐up was 3.4 years (interquartile range 3.0–4.1 years). SSIH occurred in 3 of 23 patients (13.0%) in the lateral pararectal group compared with 7 of 24 patients (29.2%) in the transrectal group (P = 0.287). Four of the 10 patients diagnosed with SSIH had already undergone or were scheduled for hernia repair. Of the patient and procedure characteristics which may have an impact on the development of incisional hernia none was a significant risk factor for SSIH. Conclusion In the present follow‐up study, no difference in the incidence of SSIH was found between lateral pararectal and transrectal stoma construction in an elective setting.

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Section: Resultsmentioning

confidence: 99%

Incisional hernia rate after ileostomy closure in lateral pararectal stoma versus transrectal stoma placement: follow‐up of the randomized PATRASTOM trial

et al. 2019

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“…Patient-related risk factors for parastomal hernia include female sex; age >60 years; obesity (waist circumference of >100 cm or body mass index of >25 kg/m 2 ); smoking; comorbidities such as hypertension, chronic respiratory disease, and ascites; poor nutritional status; inlammatory bowel disease; immunosuppression; corticosteroid use; postoperative sepsis; concomitant incisional hernia; and increases in intra-abdominal pressure [8,10,11,14,15]. Surgery or technique-speciic factors that should be taken into consideration include emergency stoma placement, the type of stoma (Table 1), surgical technique for ostomy construction, the diameter of the trephine, or size of the aperture in the abdominal wall, bringing the stoma out through the resection site, placement of prophylactic mesh, and position of the stoma [2,6,7,10,16]. However, the exact pathogenesis of PSH formation remains unclear.…”

Section: Incidence and Risk Factorsmentioning

confidence: 99%

“…Most patients with PSH are usually asymptomatic; therefore, they can be managed conservatively [1,2,6,13,16,25]. Conservative management is preferred because surgical treatment can be challenging, with no guarantee of success.…”

Section: Conservative Managementmentioning

confidence: 99%

“…For repair, there is no single technique that is superior to another [1,6,31]. These surgical techniques include local repair of enlarged fascial defects, relocation of stoma to a new site, and prosthetic mesh repair via laparotomy or laparoscopic approach [2,8,10,16,17,31,32]; all are associated with high rates of hernia recurrence (57.6-69.4% vs. 24-86% vs. 6.9-17.8%, respectively) and high rates of overall complication ranging from 24-88% [7,8,30,31,33].…”

Section: Surgical Treatmentmentioning

confidence: 99%

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Parastomal Hernia

Çelik¹,

Kocaay²,

Akyol³

2017

Hernia

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Parastomal hernia (PSH) is a type of incisional hernia deined as a protrusion of abdominal contents through a weakness in the abdominal wall. PSH is the most common and signiicant complication following enterostomy construction, with an incidence of 30-50%. The risk is higher in colostomies than in ileostomies. Diagnosis of PSH is based on clinical examination or imaging. Most patients with PSH are usually asymptomatic. On the other hand, PSHs may afect an individual's physical function and decrease their quality of life. Surgical repair is indicated in 10-30% of patients with PSH. For repair, no single technique is superior to another. Therefore, several surgical methods have been developed and atempted, including primary repair, stoma relocation, and repair with diferent types of mesh either via the open or laparoscopic approach. However, high recurrence rates have been reported after repair. Because this is a diicult and problematic entity, the prevention of PSH occurrence is clearly the most appropriate management approach.

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“…Sjodahl et al 21 refieren que la exteriorización del estoma a través del mús-culo recto abdominal, y no lateral a este, está asociado a una menor incidencia de HP, pero en un estudio prospectivo aleatorizado, Hardt et al 22,23 no han demostrado diferencias estadísticamente significativas entre ambas técnicas; d) El tamaño del orificio cutáneo y aponeurótico del estoma también es importante, ya que debe ser suficientemente ancho para permitir el paso del intestino, pero no demasiado para evitar el riesgo de herniación 7 . Se estima que el orificio no debe sobrepasar los 3 cm en colostomías y los 2.5 cm en ileostomías 3,8,15,24 ; e) La fijación del intestino a la aponeurosis no reduce el riesgo de herniación 3,7,9 ; f) No queda claro el papel de la laparoscopia para disminuir el riesgo de HP 3,8 .…”

Section: Factores Relacionados Con La Técnica Quirúrgicaunclassified

Actualización de las hernias paraestomales: diagnóstico, tratamiento y prevención

Pallisera‐Lloveras

Serra‐Aracil²,

Mora³

et al. 2017

Rev Hispanoam Hernia

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La hernia paraestomal es una complicación frecuente, con una prevalencia real difícil de estimar debido a la heterogeneidad de los estudios. Existe cierta falta de consenso en cuanto a su tratamiento. Por eso, su prevención es un asunto controvertido y de amplio interés, y se considera la mejor estrategia ante la realización de un estoma permanente.Este trabajo pretende realizar una actualización en el diagnóstico, tratamiento y prevención de esta patología y una comparación con la experiencia del grupo. La elección de la técnica quirúrgica dependerá de la urgencia quirúrgica. En cirugía urgente, si el estado del paciente es crítico o existe necrosis intestinal, se aconseja reparación simple del defecto. Para el resto de los escenarios, el tratamiento con malla es el recomendado. En caso de cirugía electiva en un grupo con experiencia, se aconseja la reparación laparoscópica intraperitoneal mediante la técnica Sugarbaker. En caso de urgencias o cirugía electiva abierta, los resultados entre las técnicas keyhole y Sugarbaker son similares. En cuanto a la prevención, el papel del estomatoterapeuta es de gran importancia: permite un correcto marcaje del estoma, la aplicación de medidas preventivas y el inicio de un tratamiento conservador precoz. A falta de estudios defi nitivos, creemos que la prevención con malla intraperitoneal laparoscópica mediante la técnica de Sugarbaker es la técnica recomendada. Aún así, se necesitan ensayos prospectivos aleatorizados que comparen las diferentes técnicas, que estratifi quen el riesgo de hernia paraestomal y que identifi quen aquellos pacientes tributarios de colocación de una malla profi láctica.

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A pilot single‐centre randomized trial assessing the safety and efficacy of lateral pararectus abdominis compared with transrectus abdominis muscle stoma placement in patients with temporary loop ileostomies: the PATRASTOM trial

Abstract: The incidence of parastomal herniation and other stoma-related complications did not differ between the groups. However, due to the limited sample size a small difference in favour of one of the two stoma placement techniques cannot be entirely ruled out.

Cited by 40 publications

References 37 publications

Incisional hernia rate after ileostomy closure in lateral pararectal stoma versus transrectal stoma placement: follow‐up of the randomized PATRASTOM trial

Incisional hernia rate after ileostomy closure in lateral pararectal stoma versus transrectal stoma placement: follow‐up of the randomized PATRASTOM trial

Parastomal Hernia

Actualización de las hernias paraestomales: diagnóstico, tratamiento y prevención

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