Mesh Prevention of Parastomal Hernia After Permanent End Colostomy

Aim: Parastomal hernia (PSH) is a very frequent complication after creation of a permanent colostomy. The aim of that study is to assess the efficacy and safety of an Intra Peritoneal Onlay Mesh (IPOM) positioned at the time of primary stoma formation to prevent PSH occurrence.Material and methods: That multicentre prospective study concerned 27 consecutive patients operated for low rectal carcinoma between 2008 and 2014. There were 12 men and 15 women with a median age of 69 years (range: 39-88) and a BMI of 27 (range: 21-43). All the patients had potentially curative abdominoperineal excision associated with IPOM reinforcement of the abdominal wall with a round non-slit composite mesh centred on the stoma site and covering the lateralised colon. The major outcomes analysed were operative time, complications related to mesh and PSH occurrence. At least every 12 months, patients were controlled by physical examination and CT-scan. For PSH evaluation, we used the classification of Moreno-Matias. Results: Surgery was performed by laparoscopy in 23 patients and by laparotomy in 4, 15 had a transperitoneal colostomy and 12 an extraperitoneal colostomy. The median size of the mesh was 15 cm (range: 12-30), the operative time 225 min. (range: 175-311) and the specific time for mesh placement 15 min. (range: 12-30). With a median follow-up of 51 months (range: 6-82), no mesh infection or complication requiring mesh removal were recorded. No patient developed a true PSH; two of them had a type Ia PSH (only containing the bowel forming the colostomy with a sac < 5 cm) and were totally asymptomatic. Conclusion: With 93% of excellent results, IPOM reinforcement at the time of end colostomy formation is a very promising technique that address the issues related to the occurrence of PSH.