Preventing Parastomal Hernia with a Prosthetic Mesh: A 5‐Year Follow‐up of a Randomized Study

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Abstract
Background: Parastomal hernia is a major clinical problem. In a randomized, clinical trial, a prosthetic mesh in a sublay position at the index operation reduced the rate of parastomal hernia at 12‐month follow‐up, without any increase in the rate of complications. This study was designed to evaluate the rate of complications after 5 years.Methods: Between January 2001 and April 2003, 54 patients who had a permanent ostomy were randomized to a conventional stoma or to a stoma with the addition of a mesh in a sublay position. A large‐pore, lightweight mesh with a reduced polypropylene content and a high proportion of absorbable material was used.Results: After 5 years, 21 patients with a conventional stoma were alive and parastomal herniation was recorded in 17 patients, of whom repair had been demanded in 5. In 15 patients operated on with the addition of a mesh herniation, that did not require repair, was present in 2 (P < 0.001). No fistulas or strictures developed. No mesh infection was noted and no mesh was removed during the study period.Conclusions: At stoma formation, a prophylactic low‐weight mesh in a sublay position is a safe procedure that reduces the rate of parastomal hernia.

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