Preventing Parastomal Hernia With a Prosthetic Mesh

Jänes, Arthur; Cengiz, Yücel; Israelsson, Leif A.

doi:10.1001/archsurg.139.12.1356

Cited by 97 publications

(59 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Janes et al evaluated 54 patients undergoing permanent colostomy creation (27 patients with a conventional stoma and 27 with placement of a sublay large-pore light weight polypropylene and polyglactin mesh) and found a lower rate of PH 4.8 % (1/21) in the mesh group compared to 50 % (13/26) in the nonmesh group at 12-month follow-up. There were no infectious complications [50]. A 5-year follow-up study again revealed a lower rate of PH in the mesh group at 13.3 % (2/15) versus 81 % (17/21) in the nonmesh group ( p < 0.001) [9].…”

Section: Operative Considerationsmentioning

confidence: 76%

Parastomal Hernia

Garvey¹,

Harold²

2015

Gastrointestinal Surgery

View full text Add to dashboard Cite

Section: Operative Considerationsmentioning

confidence: 76%

Parastomal Hernia

Garvey¹,

Harold²

2015

Gastrointestinal Surgery

View full text Add to dashboard Cite

“…A RCT like the one from Janes et al clearly confirmed the benefit of a prophylactic mesh for the prevention of a parastomal hernia [26]. However we rarely have the chance to test a new procedure that is so powerful that it reduces the number of complications from 44% to zero.…”

Section: Future Perspective: Postoperative Outcome Surveillance By Usmentioning

confidence: 98%

Bias-Variation Dilemma Challenges Clinical Trials: Inherent Limitations of Randomized Controlled Trials and Meta-Analyses Comparing Hernia Therapies

Klinge¹,

Koch²,

Weyhe³

et al. 2014

IJCM

View full text Add to dashboard Cite

Purpose: Evaluation of hernia therapies according to the current rules of Evidence Based Medicine is widely reduced to results of RCTs or meta-analyses. RCTs have been accepted as a most important tool to confirm a superior effect of an intervention. Unfortunately, in hernia surgery, comparisons of RCTs and correspondingly their use in meta-analyses, are not, surprisingly often, able to confirm any significant impact of a specific procedure due to intrinsic restrictions in a multi-causal setting with its web of influences. Methods: Based on our own experiences of clinical studies in surgery, the present article outlines several situations, with their respective reasons, which argue the severe limitations of RCTs and meta-analysis to define an optimum treatment. Results: Metaanalyses accumulate the variations of each trial, which then may cover any clear causal relationship. RCTs usually are dealing with subgroups of standard patients thus excluding the majority of our patients. Low statistical power of current cohort sizes restricts the analysis of subgroups or of effects with low incidences. Simple comparisons of means frequently are hampered by nonlinear relationships to outcome. The relevance of a specific variable is difficult to separate from other influences. The limited surveillance period of studies ignores a delayed change in outcome. Randomization cannot guarantee a standardized patient's condition. All the arguments have to be con-* Corresponding author. U. Klinge et al. 779sidered as a crucial and fundamental consequence of the bias-variance dilemma or principle of uncertainty in medicine, and underline the many limitations of RCTs to evaluate any specific impact of hernia therapies on e.g. infection, pain or recurrence. Conclusions: Many surgical issues cannot be and should not be investigated by RCTs, in particular, if a marked patients' heterogeneity has to be considered or the low incidences of the outcome readout cannot be addressed with sufficient statistical power without getting lost in the variation mire. Registries with their non-restricted data-acquisition should be regarded as reliable alternatives for postoperative outcome quality surveillance studies.

show abstract

“…the incidence of wound failure can be reduced to nearly zero. 19,20 Recent studies by Israelsson and colleagues 21 have demonstrated that the routine use of lightweight mesh when constructing a stoma should become routine practice.…”

Section: Prevention and Prophylaxismentioning

confidence: 99%

“…55 Direct tissue repair or stoma relocation have recurrence rates of up to 50% although the use of mesh lowers this considerably to between 0-25%. 56 However, mesh placed in this onlay position around the stoma as a circumferential onlay can cause problems of erosion into the stoma or fistula formation in up to 5% of patients. 57 Jones et al 21 have recently reported the use of prophylactic mesh in the prevention of parastomal hernia by the placement of a lightweight sublay mesh at the time of stoma formation.…”

Section: Unusual Sitesmentioning

confidence: 99%

The Management of Incisional Hernia

Kingsnorth

2006

annals

View full text Add to dashboard Cite

Ann R Coll Surg Engl 2006; 88: 252-260 252Medline and Embase were searched using the search terms 'hernia' and 'incisional' alone and in combination. Publications were selected mostly in the past 5 years, but did not exclude commonly reference and highly regarded older publications. The reference list of articles was also searched, identified by the search strategy and those selected that were relevant. Selected review articles and metaanalyses were included because they provide comprehensive overviews that may be beyond the scope of this article. OverviewThe introduction of prosthetic mesh revolutionised the treatment of groin hernia but, to date, has had little impact on the treatment of incisional hernia.1 The risk factors for the development of incisional hernia include obesity, diabetes, emergency surgery, postoperative wound dehiscence, smoking and postoperative wound infection. 2,3The risks of repairing an incisional hernia which should be explained to the patient when obtaining consent include seroma formation, wound infection, injury to intraabdominal structures and recurrence. 4 Major complications which can occur in repair of large incisional hernias include mesh infection and enterocutaneous fistula which may result in prolonged morbidity and require re-operation (Fig. 1). It is now accepted that only the smallest (less than 3 cm) incisional hernias should be repaired with primary tissue approximation with sutures and this topic will not be discussed further.5 Small incisional hernias with time develop into larger incisional hernias due to the continuous presence of intra-abdominal hydrostatic pressure of 15 cm of water, diaphragmatic contractions occurring with respiration, increases in abdominal pressure occurring with coughing and straining realising pressures of over 80 cm of water and myofascial retraction of the lateral muscles. As a result, the abdominal cavity contracts and the right of domicile for the herniated visceral mass is lost. 6 Due to several previous operations, many of these patients have poor-quality abdominal wall musculature which, coupled with multiple co-morbid medical problems, present a surgical and anaesthetic challenge.Surgeons appear to have a reluctance to operate on incisional hernias perhaps because of the poor general condition of the patients but perhaps also due to lack of knowledge of how to deal with the various defects occurring as a result of incisions of the anterior abdominal wall and the operative techniques required. For instance, although it is estimated that 13% of laparotomy incisions fail in The Netherlands, only 4% of patients undergoing a laparotomy will go through additional surgery to repair an incisional hernia.7 Suture repair is likely to produce results twice as bad as mesh repair and the current techniques that surgeons are using to repair incisional hernias with prosthetic mesh continue to yield recurrence rates of greater than 20%. Many thousand laparotomy incisions are created each year and the failure rate for closure of these abdominal wou...

show abstract

Preventing Parastomal Hernia With a Prosthetic Mesh

Cited by 97 publications

References 20 publications

Parastomal Hernia

Parastomal Hernia

Bias-Variation Dilemma Challenges Clinical Trials: Inherent Limitations of Randomized Controlled Trials and Meta-Analyses Comparing Hernia Therapies

The Management of Incisional Hernia

Contact Info

Product

Resources

About