Preventing Parastomal Hernia Using a Modified Sugarbaker Technique With Composite Mesh During Laparoscopic Abdominoperineal Resection: A Randomized Controlled Trial. Issue 6 (December 2016)

• Record Type: Journal Article
• Authors: López-Cano, Manuel; Serra-Aracils, Xavier; Mora, Laura; Sánchez-García, José Luis; Jiménez-Gómez, Luis Miguel; Martí, Marc; Vallribera, Francesc; Fraccalvieri, Domenico; Serracant, Anna; Kreisler, Esther; Biondo, Sebastiano; Espín, Eloy; Navarro-Soto, Salvador; Armengol-Carrasco, Manuel
• Is Part Of: Annals of surgery. Volume 264:Issue 6(2016:Dec.)
• Publication Date: 2016-12
• Subjects: abdominal wall -- hernia -- modified Sugarbaker technique -- parastomal hernia -- prevention -- surgery; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000001684
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: The aim of this study was to assess the reduction in the incidence of parastomal hernia (PH) after placement of prophylactic synthetic mesh using a modified Sugarbaker technique when a permanent end-colostomy is needed. Summary of Background Data: Prevention of PH formation is crucial given the high prevalence of PH and difficulties in the surgical repair of PH. Methods: A randomized, prospective, double-blind, and controlled trial. Rectal cancer patients undergoing laparoscopic abdominoperineal resection with permanent colostomy were randomized (1 : 1) to the mesh and nonmesh arms. In the mesh group, a large-pore lightweight composite mesh was placed in the intraperitoneal/onlay fashion using a modified Sugarbaker technique. PH was detected by computed tomography (CT) after a minimum follow-up of 12 months. Analysis was per-protocol. Results: The mesh group included 24 patients and the control group 28. Preoperative data, surgical time, and postoperative morbidity were similar. The median follow-up was 26 months. After CT examination, 6 of 24 PHs (25%) were observed in the mesh group compared with 18 of 28 (64.3%) in the nonmesh group (odds ratio 0.39, 95% confidence interval 0.18–0.82; P = 0.005). The Kaplan-Meier curves showed significant differences in favor of the mesh group (long-rank = 4.21, P = 0.04). The number needed to treat was 2.5, which confirmed the effectiveness of the intervention. Conclusions: Placement of a prosthetic mesh by the laparoscopic approach following the modified Sugarbaker technique is safe and effective in the prevention of PH, reducing significantly the incidence of PH. Abstract : Supplemental Digital Content is available in the text