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Objective This study investigated the use of a modified laparoscopic repair of paraostomy hernia technique, called “D-Type parastomal hernia repair surgery” which combines abdominal wall and extraperitoneal stoma reconstruction, in patients with parastomal hernia (PSH) following colorectal stoma surgery. The aim was to determine whether D-type parastomal hernia repair surgery is a promising surgical approach compared to the traditional laparoscopic repair technique (Sugarbaker method) for patients with PSH. Methods PSH patients were selected and retrospectively divided into two groups: the study group underwent D-type parastomal hernia repair, while the control group underwent laparoscopic Sugarbaker repair. Clinical data from both groups were analyzed. Result Compared to control group ( n  = 68), the study group undergoing D-type stoma lateral hernia repair had significant increase in total operative time (98.82 ± 12.37 min vs 124.61 ± 34.99 min, p  < 0.001). The study group also showed better postoperative stoma bowel function scores in sensory ability, frequency of bowel movements, and clothing cleanliness without a stoma bag ( p  = 0.037, 0.001, 0.002). The treatment cost was significantly higher in the control group (3899.97 ± 260.00$ vs 3215.91 ± 230.03$, p  < 0.001). The postoperative recurrence rate in the control group was 26.4%, while in the study group, it was 4.3%, with a significant statistical difference ( p  = 0.024). In terms of long-term postoperative complications, the study group had an overall lower incidence compared to the control group ( p  = 0.035). Other parameters showed no significant differences between the two groups. Conclusion The study suggests that D-type parastomal hernia repair surgery is a safe and feasible procedure. Compared to traditional surgery, it can reduce the recurrence of lateral hernia, improve postoperative stoma bowel function, and save medical resources.

Background Parastomal herniation is a prevalent complication of colostomies, with rates as high as 60% at 2 years. Traditional methods, including mesh use, have shown limited success. Here, we aim to compare 1-year PSH rates and evaluate stoma-related complications using a stapled versus conventional approach. Methods This randomized controlled trial investigates the efficacy of using a circular stapler to create an end colostomy for reducing parastomal hernia (PSH) incidence compared to conventional techniques. Eligible patients (aged 18–70) undergoing end colostomy for rectal cancer at Tata Memorial Hospital will be randomized into two groups: circular stapled versus conventional cruciate incision. Primary outcomes will be 1-year PSH rates, determined clinically and radiologically, with secondary outcomes including short-term stoma-related complications and reoperation rates. Discussion The study’s findings will provide evidence on the circular stapler’s effectiveness in reducing PSH incidence, potentially offering an innovative approach to ostomy creation. If successful, this technique may improve patient outcomes and reduce long-term healthcare costs related to PSH management. Trial registration CTRI/2023/10/059362; protocol version 1.2. Registered on March 11, 2023

This study investigates the effects of topical solution of Scrophularia Striata in the healing process of peristomal skin wounds in patients attending the Stoma. One hundred participants from June 2023 to September 2023 were selected using convenience sampling and randomly assigned to two groups (experimental and control) in blocks using software. The experimental group was instructed to apply the topical solution of Scrophularia Striata once daily, saturating the ulcer area completely using an applicator on the peristomal skin, repeating this process every day for 14 consecutive days. The control group received the usual Stoma Center instructions (using chamomile ointment). The study compared the impact of topical solution of Scrophularia Striata on Ostomy Skin Tool to assess ulcer‐healing progress between the two groups. The analysis revealed that on the 21 days post‐intervention. The wound ulcer improvement in the experimental group was significantly greater than in the control group (p < 0.001). The results of the study indicate that the topical solution of Scrophularia Striata has been effective and more efficient in improving peristomal skin wounds compared to other routine treatments in these patients. Considering the impact of this solution on peristomal skin ulcer healing, its use is recommended.

Purpose The aim of this study was to assess the effect of early stoma closure on bowel function after low anterior resection (LAR) for rectal cancer. Methods Patients participating in the FORCE trial who underwent LAR with protective stoma were included in this study. Patients were subdivided into an early closure group (< 3 months) and late closure group (> 3 months). Endpoints of this study were the Wexner Incontinence, low anterior resection syndrome (LARS), EORTC QLQ-CR29, and fecal incontinence quality of life (FIQL) scores at 1 year. Results Between 2017 and 2020, 38 patients had received a diverting stoma after LAR for rectal cancer and could be included. There was no significant difference in LARS (31 vs. 30, p  = 0.63) and Wexner score (6.2 vs. 5.8, p  = 0.77) between the early and late closure groups. Time to stoma closure in days was not a predictor for LARS ( R 2  = 0.001, F (1,36) = 0.049, p  = 0.83) or Wexner score ( R 2  = 0.008, F (1,36) = 0.287, p  = 0.60) after restored continuity. There was no significant difference between any of the FIQL domains of lifestyle, coping, depression, and embarrassment. In the EORTC QLQ-29, body image scored higher in the late closure group (21.3 vs. 1.6, p  = 0.004). Conclusion Timing of stoma closure does not appear to affect long-term bowel function and quality of life, except for body image. To improve functional outcome, attention should be focused on other contributing factors.

Purpose The primary aim of this study was to investigate whether rectus abdominis muscle atrophy is associated with a lower risk of developing parastomal hernia. Secondary objectives were to assess whether the use of prophylactic mesh is a risk factor for rectus abdominis muscle atrophy and whether the position of the stoma within the rectus abdominis muscle affects the risk of parastomal hernia. Methods This retrospective study analysed patients from a prospective, randomised, multicentre trial in which rectal cancer patients were randomised to stoma creation with or without prophylactic mesh. Computed tomography at 12 months was evaluated to identify parastomal hernia, rectus abdominis muscle atrophy and position of stoma in the rectus abdominis muscle. Results Out of 149 patients, rectus abdominis muscle atrophy was observed in 9% and parastomal hernia in 42% of patients. There was no association between rectus abdominis muscle atrophy and parastomal hernia ( p  = 0.80; RR 1.07; CI 0.62–1.86), nor between prophylactic mesh and rectus abdominis muscle atrophy ( p  = 0.19; RR 2.00; CI 0.7–5.73). Stoma placement within the rectus abdominis muscle also showed no association with parastomal hernia development ( p  = 0.69; RR 0.97; CI 0.81–1.15). Conclusion This study found no statistically significant association between rectus abdominis muscle atrophy and parastomal hernia. The use of prophylactic mesh was not a risk factor for rectus abdominis muscle atrophy, and stoma placement within the rectus abdominis muscle was not associated with parastomal hernia. The previously reported association between prophylactic mesh, rectus abdominis muscle atrophy, and parastomal hernia was not confirmed in this cohort.

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.

Purpose Parastomal hernia (PSH) is a common complication after colostomy formation. Recent studies indicate that mesh implantation during formation of a colostomy might prevent a PSH. To determine if placement of a retromuscular mesh at the colostomy site is a feasible, safe and effective procedure in preventing a parastomal hernia, we performed a multicentre randomized controlled trial in 11 large teaching hospitals and three university centres in The Netherlands. Methods Augmentation of the abdominal wall with a retromuscular light-weight polypropylene mesh (Parietene Light™, Covidien) around the trephine was compared with traditional colostomy formation. Patients undergoing elective open formation of a permanent end-colostomy were eligible. 150 patients were randomized between 2010 and 2012. Primary endpoint of the PREVENT trial is the incidence of parastomal hernia. Secondary endpoints are morbidity, pain, quality of life, mortality and cost-effectiveness. This article focussed on the early results of the PREVENT trial and, therefore, operation time, postoperative morbidity, pain, and quality of life were measured. Results Outcomes represent results after 3 months of follow-up. A total of 150 patients were randomized. Mean operation time of the mesh group ( N  = 72) was significantly longer than in the control group ( N  = 78) (182.6 vs. 156.8 min; P  = 0.018). Four (2.7 %) peristomal infections occurred of which one (1.4 %) in the mesh group. No infection of the mesh occurred. Most of the other infections were infections of the perineal wound, equally distributed over both groups. No statistical differences were discovered in stoma or mesh-related complications, fistula or stricture formation, pain, or quality of life. Conclusions During open and elective formation of an end-colostomy, primary placement of a retromuscular light-weight polypropylene mesh for prevention of a parastomal hernia is a safe and feasible procedure. The PREVENT trial is registered at: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2018 .

Background Rectal cancer is a common cancer worldwide. Surgery for rectal cancer with low anterior resection often includes the formation of a temporary protective loop ileostomy. The temporary ostomy is later reversed in a separate operation. One complication following stoma closure is the development of a hernia at the former stoma site, and this has been reported in 7–15% of patients. The best method to avoid hernia after stoma closure is unclear. The most common closure is by suturing only, but different forms of mesh have been tried. Biological mesh has in a randomized trial halved hernia incidence after stoma reversal. Biosynthetic mesh and retromuscular mesh are currently being evaluated in ongoing studies. Methods The present multicenter, double-blinded, randomized, controlled study will compare standard suture closure of the abdominal wall in loop ileostomy reversal with retromuscular synthetic mesh at the stoma site. The study has been approved by the Regional Ethical Review board in Stockholm. Patients aged 18–90 years, operated on with low anterior resection and a protective loop ileostomy for rectal cancer and planned for ileostomy reversal, will be considered for inclusion in the study. Randomization will be 1:1 on the operation day with concealed envelopes. The estimated sample size is intended to evaluate the superiority of the experimental arm and to detect a reduction of hernia occurrence from 12 to 3%. The operation method is blinded to the patients and in the chart and for the observer at the 30-day follow-up. The main outcome is hernia occurrence at the stoma site within 3 years postoperatively, diagnosed through CT with strain. Secondary outcomes are operation time, length of hospital stay, pain, and 30-day complications. Discussion This double-blinded randomized controlled superiority study will compare retromuscular synthetic mesh during the closure of loop ileostomy to standard care. If this study can show a lower frequency of hernia with the use of prophylactic mesh, it may lead to new surgical guidelines during stoma closure. Trial registration ClinicalTrials.gov NCT03720262. Registered on October 25, 2018.

Purpose To estimate the incidence of and risk factors for stoma site hernia after closure of a temporary diverting ileostomy. Method In a non-comparative cohort study, charts ( n  = 216) and CT-scans ( n  = 169) from patients who had undergone loop ileostomy closure following low anterior resection for rectal cancer 2010–2015 (mainly open surgery) at three hospitals were evaluated retrospectively. Patients without hernia diagnosis were evaluated cross-sectionally through a questionnaire ( n  = 158), and patients with symptoms of bulging or pain were contacted and offered a clinical examination or a CT scan including Valsalva maneuver. Results In the chart review, five (2.3%) patients had a diagnosis of incisional hernia at the previous stoma site after 8 months (median). In 12 patients, the CT scan showed a hernia, of which 8 had not been detected previously. The questionnaire was returned by 130 (82%) patients, of which 31% had symptoms of bulging or pain. Less than one in five of patients who reported bulging were diagnosed with hernia, but the absolute majority of the radiologically diagnosed hernias reported symptoms. By combining clinical and radiological diagnosis, the cumulative incidence of hernia was 7.4% during a median follow up time of 30 months. Risk factors for stoma site hernia were male sex and higher BMI. Conclusion Hernia at the previous stoma site was underdiagnosed. Less than a third of symptomatic patients had a hernia diagnosis in routine follow up. Randomized studies are needed to evaluate if prophylactic mesh can be used to prevent hernias, especially in patients with risk factors.

Background A loop ileostomy is generally created during restorative proctocolectomy (RPC) for treating ulcerative colitis (UC), and an ostomy rod is often used to prevent stoma retraction. However, its usefulness or harmfulness has not been proven. We performed a prospective randomized control study to investigate the non-inferiority of ostomy creation without a rod to prevent stoma retraction. Methods Patients with UC who underwent RPC were enrolled and randomly divided into groups either with or without ostomy rod use. Incidences of stoma retraction and dermatitis were compared. Results Of the 320 patients in the study groups, 308 qualified for the intention-to-treat (ITT) analysis, and 257 were included in the per-protocol (PP) analysis. Ostomy retraction was recognized in 6 patients, 3 with a rod and 3 without. The difference with rod use (95% confidence interval) was 0.1 (−2.9 to 3.1)% in the PP analysis and 0.0 (−2.2 to 2.2)% in the ITT analysis. There were no significant differences in stoma retraction regardless of whether an ostomy rod was used in either analysis. Dermatitis was more common in patients with rod use (84/154) than in those without (40/154) ( p  < 0.01). Conclusions Although median body mass indices were extremely low (20 kg/m 2 ), an ostomy rod is not routinely needed as it may increase the risk of dermatitis. However, results in obese patients may differ from those shown here, which should be clarified via further studies.