Parastomal hernias present a huge problem for our patients. Apart from being unsightly they can become uncomfortable. Many patients have problems getting stoma bags to fit and, occasionally, serious complications such as obstruction or strangulation require emergency surgery. Surgery to repair parastomal hernias is not easy and recurrence rates are high.
So how do we avoid the development of parastomal hernia in the first place? Good surgical technique may simply not be enough. In some cases patient factors are undoubtably important; obesity and smoking put patients at greater risk of getting a hernia.
Hernias are more common when stomas are made during an emergency operation as the bowel may be thickened or widened. When it shrinks back to its normal size the space left behind can easily give rise to a hernia.
One way of preventing hernias during a routine operation might be reinforcement of the abdominal wall with mesh material placed behind the muscles. A group of researchers from the Netherlands using this technique have recently published their one year results in the Annals of Surgery. In their study -the PREVENT trial- patients were randomised to have no mesh, or a light weight polypropylene mesh placed behind the muscle of the abdominal wall at the time of surgery. The researchers found that in the 66 patients who had a mesh inserted, only 3 developed a hernia (4.5%) when compared with 16 out of the 67 patients (24.2%) where no mesh was used. They also found that skin problems, leakage and pain were less common in patients where mesh had been used.
The researchers concluded that the use of a lightweight mesh was feasible, effective and safe in preventing parastomal hernias. In this study the researches did not identify any issues with mesh erosion, strictures or infection although these complications can arise when meshes are used.
It will be interesting to see if these promising results are continued as the study continues to follow these patients over 5 years.