Prophylactic Mesh Reinforcement Reduces Stomal Site Incisional Hernia after Ileostomy Closure
- David Shi Hao Liu,
- Elisabeth Banham,
- Srinivasa Yellapu
- … show all 3 hide
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Background
Stomal site incisional hernia is a common complication following ileostomy closure. The effectiveness of prophylactic mesh placement at the time of stomal closure is unknown because of fear of mesh infection and subsequent wound complications. The present study investigated whether prophylactic mesh placement reduces the rate of incisional hernia after ileostomy closure without increasing wound complications. The study was based on retrospective review of consecutive ileostomy closures undertaken at a tertiary referral center between January 2007 and December 2011. Hernias were identified through clinical examination and computed tomography.
Results
Eighty-three cases of ileostomy closure were reviewed; 47 patients received mesh reinforcement, and 36 underwent non-mesh closure (controls). In total, 16 (19.3 %) patients developed incisional hernia, 13 (36.1 %) of which occurred in the control group; 3 (6.4 %), in the mesh group [odds ratio (OR): 8.29; 95 % confidence interval (CI) 2.14–32.08; p = 0.001]. Incisional hernia repair was performed in 3 (23 %) patients in the control group; no hernias in the mesh group required surgery. There was no significant difference in wound infection rates between mesh (2 patients, 4.3 %) and control (1 patient, 2.8 %) groups. No mesh infection was found. Multivariate analysis demonstrated that malignancy (OR: 21.93, 95 % CI 1.58–303.95; p = 0.021) and diabetes (OR: 20.98, 95 % CI 3.23–136.31; p = 0.001) independently predicted incisional herniation, while mesh reinforcement prevented hernia development (OR: 0.06, 95 % CI 0.01–0.36; p = 0.002).
Conclusions
Mesh placement significantly reduced the incidence of incisional hernia following ileostomy closure, but without increasing complication rates. This technique should be strongly considered in patients at high risk of hernia development.
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- Title
- Prophylactic Mesh Reinforcement Reduces Stomal Site Incisional Hernia after Ileostomy Closure
- Journal
-
World Journal of Surgery
Volume 37, Issue 9 , pp 2039-2045
- Cover Date
- 2013-09-01
- DOI
- 10.1007/s00268-013-2109-3
- Print ISSN
- 0364-2313
- Online ISSN
- 1432-2323
- Publisher
- Springer US
- Additional Links
- Topics
- Industry Sectors
- Authors
-
- David Shi Hao Liu (1) (2)
- Elisabeth Banham (2) (3)
- Srinivasa Yellapu (2) (3)
- Author Affiliations
-
- 1. Department of Surgery, Austin Hospital, Level 8, 145 Studley Street, Heidelberg, VIC, 3084, Australia
- 2. School of Medicine, University of Tasmania, Level 3, 48 Liverpool Street, Hobart, TAS, 7001, Australia
- 3. Department of General Surgery, Royal Hobart Hospital, Level 2, 48 Liverpool Street, Hobart, TAS, 7001, Australia