Onlay Mesh Repair May Reduce the Incidence of Incisional Hernia after Diverting Colostomy Closure

Purpose. Incisional hernia is a common complication that occurs after diverting colostomy closure. The mesh repairs had been usually used for wound closures in recent years to avoid incisional hernias. So we designed this study to evaluate the effects of mesh repair for the prevention of incisional hernia during colostomy closure. Methods. The patients underwent diverting stoma closure from January 2015 to August 2021 were divided into two groups: the mesh group, which included patients underwent onlay mesh repair during colostomy closure concurrently, and the simple group, which included patients underwent wound primary closure during colostomy closure. We compared and analyzed the clinical outcomes between these two groups. Results. Twenty-two patients were excluded from this study. There were 33 patients in the mesh group and 32 patients in the simple group. The clinical data including age, gender distribution, ASA, hospital stay, follow- up interval, ratio of image studies and the complications between two groups was analyzed and no statistically significant difference was noted. The average operation time duration was prolonged in the mesh group (125.1 vs. 98.9 minutes, p = 0.003) and more blood loss in the mesh group (41.8 ml vs. 24.2 ml, p = 0.046). Two patients had detectable incisional hernia in the mesh group and seven patients in the simple group had detectable incisional hernia (p = 0.065). Conclusions. Onlay mesh wound repair is safe and feasible for patients undergoing colostomy closure. It might decrease the rate of incisional hernias postoperatively.

關鍵字

Mesh ； Incisional hernia ； Colostomy closure ； Colorectal surgery

並列摘要

目的：切口疝氣是結腸造口閉合術後常見的併發症。網膜修補於近年來常常被應用於傷口閉合，以減少切口疝氣的發生。因此我們設計了這個實驗，來評估網膜修補對於預防切口疝氣的效果。方法：從2015年1月到2021年8月，於本院接受結腸造口閉合手術的病人被分成兩組：網膜組，病人在關閉造口時同時接受覆蓋式網膜修補；單純組，病人在造口閉合時僅接受一般的傷口關閉。我們比較了兩組之間臨床成績的差異並加以分析。結果：在排除了22個病人後，網膜組分配到33個病人而單純組有32個。兩組間進行了臨床資料的分析，在年齡、性別、ASA、住院天數、追蹤時間、e接受影像學檢查的比例和併發症上都沒有統計學上的差異。網膜組的平均手術時間較長（125.1比98.9分鐘，p=0.003）而且有著較多的流血量（41.8ml比24.2ml, p=0.046）。在網膜組有兩個病人發生切口疝氣，而在單純組則有七個（p=0.065）。結論：在造口閉合的病人身上使用覆蓋式網膜修補，是安全而且可行的方式，可以預防降低術後生切口疝氣的機率。

並列關鍵字

網膜；切口疝氣；結腸造口閉合；結腸直腸手術

參考文獻

Kaneko T, et al. Incidence of and risk factors for incisionalhernia after closure of temporary ileostomy for colorectal malignancy. Hernia 2019;23(4):743-8.

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Ramirez-Giraldo C, et al. When to use a prophylactic meshafter stoma closure: a case-control study. Hernia 2022;26(2):467-72.

Berrevoet F. Prevention of incisional hernias after open abdomentreatment. Front Surg 2018;5:11.

Richard F, et al. Polypropylene mesh closure of the complicatedabdominal wound. Am J Surg 1995;170:15-8.

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