Effect and safety of preset preperitoneal mesh during Miles surgery for rectal cancer to prevent parastomal hernia

doi:10.3877/cma.j.issn.1674-392X.2024.03.007

Abstract

Abstract:

Objective

To evaluate the incidence, corresponding surgical risks, and prognosis of parastomal hernia after abdominal and perineal resection for rectal cancer under different intervention methods during surgery.

Methods

A total of 56 patients who underwent Miles surgery for rectal cancer in the Department of General Surgery, Beijing Luhe Hospital Affiliated to Capital Medical University from January 2014 to December 2018 were included. After preoperative discussions between doctors and patients, patients were divided into control group (no preset mesh, n=32) and experimental group (preset mesh, n=24) based on different surgical methods. In the experimental group, artificial mesh was placed under the sheath of the rectus abdominis, while in the control group, sigmoid colostomy was routinely performed. The incidence of parastomal hernia, short and long term surgery-related risks were observed at a follow-up of ≥6 months.

Results

After 5 years of follow-up (some cases died or lost contact), the overall incidence of parastomal hernia in the experimental group was 41.70%, which was lower than that in the control group (71.90%), (P=0.045). The incidence of H2 type parastomal hernia was 12.50% versus 43.75%, with statistical significant difference (P=0.026). The postoperative occurrence time of parastomal hernia in the experimental group was significantly later than that in the control group (48 months vs 10 months; P<0.001). In terms of safety, there was no significant difference in postoperative complications such as stoma infection, subcutaneous effusion, stoma stenosis, stoma prolapse, intestinal obstruction, and intestinal leakage between the two groups (P=0.798). But after long-term observation, we found that the preset mesh group has an increased risk of acute incarcerated parastomal hernia (H2 type).

Conclusion

Prophylactic mesh placement significantly reduces the incidence of postoperative parastomal hernia and significantly delays its appearance, and dose not increase short term surgical complications. However, the long-term risks are worth paying attention to.

Key words: Rectal cancer, Parastomal hernia, Preset mesh, Incidence, Surgical risk

Xu Gao, Ruofan Li, Lixin Sun, Zuojun Liu, Guangjian Tian. Effect and safety of preset preperitoneal mesh during Miles surgery for rectal cancer to prevent parastomal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(03): 266-272.

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References 47

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组别	例数	性别[例(%)]		年龄(岁,±s)	体重指数(kg/m²,±s)	美国癌症联合委员会TNM分期[例(%)]
组别	例数	女性	男性	年龄(岁,±s)	体重指数(kg/m²,±s)	Ⅰ期	Ⅱ期	Ⅲ期	Ⅳ期
试验组	24	6 (25)	18 (75)	65.42±12.9	24.8±2.1	6 (25)	9 (37.5)	9 (37.5)	0 (0)
对照组	32	12 (37)	20 (63)	65.53±11.8	24.8±3.3	8 (25)	8 (25)	15 (46.87)	1 (3.13)
t/χ²值		-5.000		1.052	0.078	0.582
P值		0.126		0.970	0.978	0.730

组别	例数	性别[例(%)]		年龄(岁,±s)	体重指数(kg/m²,±s)	美国癌症联合委员会TNM分期[例(%)]
组别	例数	女性	男性	年龄(岁,±s)	体重指数(kg/m²,±s)	Ⅰ期	Ⅱ期	Ⅲ期	Ⅳ期
试验组	24	6 (25)	18 (75)	65.42±12.9	24.8±2.1	6 (25)	9 (37.5)	9 (37.5)	0 (0)
对照组	32	12 (37)	20 (63)	65.53±11.8	24.8±3.3	8 (25)	8 (25)	15 (46.87)	1 (3.13)
t/χ²值		-5.000		1.052	0.078	0.582
P值		0.126		0.970	0.978	0.730

组别	例数	手术时间(min)	术中出血量(ml)	术后首次排气时间(h)	术后住院时间(d)
试验组	24	257.71±57.50	63.75±18.83	15.02±5.10	7.75±1.70
对照组	32	262.32±69.65	66.52±18.97	14.65±4.26	7.43±0.95
t值		0.481	-0.768	-0.017	0.447
P值		0.635	0.450	0.986	0.695

组别	例数	手术时间(min)	术中出血量(ml)	术后首次排气时间(h)	术后住院时间(d)
试验组	24	257.71±57.50	63.75±18.83	15.02±5.10	7.75±1.70
对照组	32	262.32±69.65	66.52±18.97	14.65±4.26	7.43±0.95
t值		0.481	-0.768	-0.017	0.447
P值		0.635	0.450	0.986	0.695

组别	例数	造口感染	造口皮下积液	造口狭窄	造口脱垂	肠梗阻	肠漏	总体并发症
试验组	24	1	2	2	1	1	0	7(29.17)
对照组	32	2	1	1	2	2	0	8(25.00)

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