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Prophylactic stoma mesh did not prevent parastomal hernias
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Vastmanlands Hosp Vasteras, Dept Surg, S-72189 Vasteras, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Vastmanlands Hosp Vasteras, Dept Surg, S-72189 Vasteras, Sweden..
Vastmanlands Hosp Vasteras, Dept Surg, S-72189 Vasteras, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Vastmanlands Hosp Vasteras, Dept Surg, S-72189 Vasteras, Sweden..
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2015 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 30, no 9, p. 1217-1222Article in journal (Refereed) Published
Abstract [en]

Parastomal herniation is reported in up to 50 % of patients with a colostomy. A prophylactic stoma mesh has been reported to reduce parastomal hernia rates. The aim of the study was to evaluate the rate of parastomal hernias in a population-based cohort of patients, operated with and without a prophylactic mesh at two different time periods. All rectal cancer patients operated with an abdominoperineal excision or Hartmann's procedure between 1996 and 2012 were included. From 2007, a prophylactic stoma mesh was placed in the retro-muscular plane. Patients were followed prospectively with clinical and computed tomography examinations. There were no differences with regard to age, gender, pre-operative albumin levels, ASA score, body mass index (BMI), smoking or type of surgical resection between patients with (n = 71) and without a stoma mesh (n = 135). After a minimum follow-up of 1 year, 187 (91 %) of the patients were alive and available for analysis. At clinical and computed tomography examinations, exactly the same parastomal hernia rates were found in the two groups, viz, 25 and 53 %, respectively (p = 0.95 and p = 0.18). The hernia sac contained omentum or intestinal loops in 26 (81 %) versus 26 (60 %) patients with and without a mesh, respectively (p = 0.155). In the multivariate analyses, high BMI was associated with parastomal hernia formation. A prophylactic stoma mesh did not reduce the rate of clinically or computed tomography-verified parastomal hernias. High BMI was associated with an increased risk of parastomal hernia formation regardless of prophylactic stoma mesh.

Place, publisher, year, edition, pages
2015. Vol. 30, no 9, p. 1217-1222
Keywords [en]
Parastomal hernia, Mesh, Surgery, Rectal cancer, Colostomy
National Category
Cancer and Oncology Surgery Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:uu:diva-262964DOI: 10.1007/s00384-015-2293-8ISI: 000360542000009PubMedID: 26099319OAI: oai:DiVA.org:uu-262964DiVA, id: diva2:856446
Available from: 2015-09-24 Created: 2015-09-23 Last updated: 2018-10-08Bibliographically approved
In thesis
1. Rectal cancer: Aspects of post-operative complications
Open this publication in new window or tab >>Rectal cancer: Aspects of post-operative complications
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to study post-operative complications in patients with rectal cancer.

Methods: Post-operative complications in patients operated for rectal cancer was retrospectively analyzed in three prospective registers; the local rectal cancer registry in the Västmanland County, Sweden, the Swedish Colorectal Cancer Registry (SCRCR) and the National Prostate Cancer Registry (NPCR). In Papers I and II, the focus was on the complication pattern after Hartmann’s procedure (HP). In Paper III, the incidence of parastomal hernia was assessed during a period when no prophylactic mesh was used (1996-2006) compared with a period when a prophylactic mesh was routinely used (2007-2012). In Paper IV, the anastomotic leakage (AL) rate after anterior resection (AR) for rectal cancer patients who had previously received RT for prostate cancer was assessed with combined data from the SCRCR and the NPCR.

Results: In Paper I, patients operated with a HP were significantly older, had a higher ASA-score, a poorer WHO performance score and lower serum albumin levels. Few developed pelvic complications. In Paper II, the intra-abdominal infection rate was 8% and the re-laparotomy rate was 10%. Multi-variable logistic regression analysis identified pre-operative radiotherapy as a risk factor for intra-abdominal infections. In Paper III, we found no difference in the rate of parastomal hernia between patients with and without a prophylactic stoma mesh. In Paper IV, we identified 59 out of 188 patients who had undergone previous radiation therapy for prostate cancer who had been operated with AR. Twelve (20%) developed an AL, of whom only one underwent re-laparotomy and there was no 90-day mortality.

Conclusion: The rate of serious post-operative complications was low after HP and it seems to be a safe and appropriate alternative in old and frail patients. Pre-operative radiotherapy was a risk factor for intra-abdominal infections in rectal cancer patients operated with a HP. A prophylactic stoma mesh did not reduce the rate of parastomal hernias. In patients that had previously been irradiated for prostate cancer, a minority underwent an AR. These patients were healthy with early cancer stages and, in this selected group of patients, the AL rate was much lower than previously reported.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 59
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1505
Keywords
Rectal cancer, Complications, Anastomotic leakage, Abscess, Parastomal hernia, Prostate cancer, Radiation therapy
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-362704 (URN)978-91-513-0469-4 (ISBN)
Public defence
2018-11-29, Aulan, entrance 21, Västmanlands Hospital, Västerås, Västerås, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-11-06 Created: 2018-10-08 Last updated: 2018-11-19

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Nikberg, MaziarSverrisson, IngvarChabok, AbbasSmedh, Kenneth

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