Invited comment to: European Hernia Society guidelines on prevention and treatment of parastomal hernias

Faylona, José Macario

doi:10.1007/s10029-017-1717-5

Cited by 25 publications

(47 citation statements)

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“…This significant decrease in size leads to an insufficient parietal coverage and may induce PSH. Intraperitoneal location is not always simple and requires training, although the Sugarbaker technique is largely performed for PSH repair 5,6 . However, this technique, without mesh opening, should theoretically reduce the risk of shrinkage and PSH.…”

Section: Discussionmentioning

confidence: 99%

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End Colostomy With or Without Mesh to Prevent a Parastomal Hernia (GRECCAR 7)

et al. 2021

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Objective: To evaluate whether systematic mesh implantation upon primary colostomy creation was effective to prevent PSH. Summary of Background Data: Previous randomized trials on prevention of PSH by mesh placement have shown contradictory results. Methods: This was a prospective, randomized controlled trial in 18 hospitals in France on patients aged !18 receiving a first colostomy for an indication other than infection. Participants were randomized by blocks of random size, stratified by center in a 1:1 ratio to colostomy with or without a synthetic, lightweight monofilament mesh. Patients and outcome assessors were blinded to patient group. The primary endpoint was clinically diagnosed PSH rate at 24 months of the intention-to-treat population. This trial was registered at ClinicalTrials.gov, number NCT01380860. Results: From November 2012 to October 2016, 200 patients were enrolled. Finally, 65 patients remained in the no mesh group (Group A) and 70 in the mesh group (Group B) at 24 months with the most common reason for dropout being death (n ¼ 41). At 24 months, PSH was clinically detected in 28 patients (28%) in Group A and 30 (31%) in Group B [P ¼ 0.77, odds ratio ¼ 1.15 95% confidence interval ¼ (0.62;2.13)]. Stoma-related complications were reported in 32 Group A patients and 37 Group B patients, but no mesh infections. There were no deaths related to mesh insertion. Conclusion:We failed to show efficiency of a prophylactic mesh on PSH rate. Placement of a mesh in a retro-muscular position with a central incision to allow colon passage cannot be recommended to prevent PSH. Optimization of mesh location and reinforcement material should be performed.

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Section: Discussionmentioning

confidence: 99%

“…The morbidity of these procedures varies from 10% to 30%, and recurrence rates up to 75% have been reported if no mesh is used 2 . The most effective technique is certainly the Sugarbaker technique, 5 but it requires insertion of a mesh in an underlay position (intraperitoneally) that may induce bowel adhesion or erosion 6 …”

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confidence: 99%

End Colostomy With or Without Mesh to Prevent a Parastomal Hernia (GRECCAR 7)

et al. 2021

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“…Similarly, in parastomal hernias, the correct use of mesh is less established. The most recent guidelines for the treatment of parastomal hernias are the European hernia society guidelines on the prevention and treatment of parastomal hernias 9 . Here they recommend against a simple suture repair in elective parastomal hernia repair, but do not give any recommendations for emergency repair.…”

Section: Discussionmentioning

confidence: 99%

Emergency hernia repair: a retrospective cross‐sectional study on the treatment modalities and adherence to guidelines in a tertiary public hospital

Seppey

Benjamin

Lambrakis

2023

ANZ Journal of Surgery

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Background: Emergency presentations of hernias can pose significant morbidity. In addition, providing optimal surgical intervention can be challenging due to patient and disease factors with multiple treatment modalities available. Recently there have been several guidelines written to help standardize practices in hernia management. The aim of our study was to review emergency hernia operations at our tertiary level teaching hospital, the method of repair and how this matched to international guidelines. Methods: We performed a retrospective chart review of all the patients who underwent emergency hernia surgery for strangulated/incarcerated hernias in our department over a 3-year period. Adherence to guidelines was assessed looking at appropriateness of mesh utilization, as well as the appropriateness of antibiotic usage. Results: A total of 184 cases from April 1st 2018 to March 31st 2021 were included. Of these hernias 12% contained necrotic or perforated bowel, 42% contained viable incarcerated bowel, and 45% contained just incarcerated fat. The compliance to the appropriate use of mesh overall was 85%, with a variation by hernia type. The global compliance to appropriate antibiotic therapy was high, at 89.7%. With antibiotic use compliance being very high in clean wounds (95.6%), and dirty wounds (100%). But lower in clean/contaminated or contaminated wounds (36.8%). Conclusion: Compliance at our hospital was globally good. Areas of decreased compliance seem to be mostly regarding mesh use and antibiotic use in potentially contaminated fields and the concept of risk of bacterial translocation versus actual contamination, as well as in mesh use in smaller umbilical hernias. MethodsWe performed a retrospective chart review of all the patients who underwent emergency hernia surgery for strangulated/incarcerated hernias in our department over a 3-year period. All paediatric patients (age under 18) were excluded.

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“…To date, there is still no consensus on the utility of permanent sigmoidostomy in the prevention of PSH. The European Hernia Association argues that there is insufficient evidence supporting that extraperitoneal colostomy has an advantage in reducing the incidence of PSH compared with transperitoneal colostomy 11 . However, some meta‐analyses have indicated that the technique of extraperitoneal colostomy significantly lowers the incidence of PSH 12,13 …”

Section: Introductionmentioning

confidence: 99%

The same parastomal hernia repairs rate in the different approaches to colostomy

Xiao

Shen

Yang

et al. 2023

Journal of Surgical Oncology

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Purpose This study aimed to compare the parastomal hernia repairs rate in the different approaches to colostomy and investigate the risk factors for parastomal hernia formation in patients with permanent colostomies. Methods Consecutive rectal cancer patients who underwent abdominoperineal resection from June 2014 to July 2020 in West China Hospital were divided into two groups according to their surgical approach for permanent colostomies. The impact of different approaches to colostomy on parastomal hernia repairs was determined by comparing a group of patients receiving an extraperitoneal route to colostomy with a group receiving transperitoneal. Potential variables were evaluated first with univariate and then multivariate analyses to identify the risk factors for the formation of parastomal hernia. Results Two hundred two subjects in the transperitoneal group and 103 in the extraperitoneal group attended the follow‐up visit with a median follow‐up period of 33 (25th–75th percentiles, 17–46) months. Clinically and radiologically detectable parastomal hernias were present in 76 of 202 (37.6%) and 14 of 103 (13.6%) subjects in the transperitoneal and extraperitoneal groups during the follow‐up period (p＜0.01). Besides, 10 of 76 (13.1%) subjects in the transperitoneal group and 2 of 14 (14.3%) subjects in the extraperitoneal group underwent a parastomal hernia operation during the follow‐up (p = 0.82). In addition, the transperitoneal approach of colostomy (p = 0.002), older age (p＜0.001), and higher body mass index (p = 0.013) were identified as independent risk factors for the occurrence of parastomal hernia. Conclusions Extraperitoneal colostomy decreased the detectable parastomal hernias but did not reduce the surgical repair rate of parastomal hernias.

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Invited comment to: European Hernia Society guidelines on prevention and treatment of parastomal hernias

Cited by 25 publications

References 0 publications

End Colostomy With or Without Mesh to Prevent a Parastomal Hernia (GRECCAR 7)

End Colostomy With or Without Mesh to Prevent a Parastomal Hernia (GRECCAR 7)

Emergency hernia repair: a retrospective cross‐sectional study on the treatment modalities and adherence to guidelines in a tertiary public hospital

The same parastomal hernia repairs rate in the different approaches to colostomy

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