Background: Incisional hernia is an undervalued complication after stoma closure, with rates
about 40%. Mesh-reinforced stoma reversal might be a simple and applicable approach to
decrease the frequency of incisional hernia. There is a current debate about efficacy of this
technique in preventing incisional hernias following stoma closure.
Methods: In this prospective clinical study, all patients with temporary stoma who admitted
to Mansoura University Hospital at the period from February 2019 to April 2021 and fulfill the
eligibility criteria were distributed into 2 groups. In group I conventional sutured fascial
closure was done while in group-II mesh reinforced fascial closure was done during stoma
reversal.
Results: Time to stoma closure had mean values of 26.76 and 24 weeks in Groups 1 and 2
respectively (p = 0.430). Surgical site infections (SSI) were encountered in 20% and 19% of
patients in the two groups (p = 0.868). The occurrence of stoma site incisional hernia (SSIH)
showed a significant increase in Group 1 (20% vs 2% in the other group – p = 0.009).
Conclusion: prophylactic mesh reinforcement throughout stoma closure significantly
reduces the incidence of stoma site incisional hernia with no significant increase in the
incidence of the stoma site wound infection.
INTRODUCTION
The expression "Stoma" refers to formation of an artificial hole into a hollow
organ to be exteriorized on the body surface (1).
In 1776, Pillore created the first reported stoma. Within gastro-intestinal
operations, stomas were frequently fashioned as a colostomy or ileostomy (2).
These might be temporary or permanent and might be created from the
bowel ending or the side of the bowel still in continuity (named as a loop
stoma) (3).
Temporary stomas are made to divert intestinal content away from a distal anastomosis or obstructing lesion, before a second
surgery to reestablish bowel continuousness. In addition
they can be a substitute to primary anastomosis in
emergency surgery in patients with bad general
condition whose primary anastomosis is unsafe (4).
The European Hernia Society defines incisional
hernia as defects in the abdominal wall that either
contain or are free of a bulge surrounding postoperative
scars. They can be seen or palpated clinically
or radiologically identified (5).
Post-operative incisional hernias are associated with
multiple morbidities affecting quality of life (QoL) of
patients and imposing economical burden on health
care system. Lethal complications as strangulation or
incarceration could occur necessitating urgent
interventions (6,7,8).
The development of incisional hernias could be
contributed to either patient related or operative
factors (9).
Mesh-reinforced stoma reversal considered a simple
and practical approach to decrease the possible
incidence of incisional hernias. In spite of various
reports validated the usage of prosthetic mesh for
incisional hernias repairing (10), there is a current
debate about its efficacy in preventing incisional
hernias development following stoma reversal.
Sensibly, many physicians are doubtful to place
prosthetic mesh in potentially contaminated wounds
given the lack of information and fear of wounds complications,
fistula establishment which may necessitate
mesh extraction or long-term anti-biotic therapy (11).
On the other hand, latest reports advocate that
these side-effects might be clarified in great portion by
technical errors in mesh placement more than wounds
contaminations (12). With advanced mesh technologies
and operative approaches, it might be probable to
decrease the frequency of SSIH with no cumulative
wounds' complications.
In the current work we are aiming to assess the role
of mesh-reinforced stoma closure in decreasing the risk
of developing SSIH without increasing the risk of surgical
site infection and to identify responsible risk factors
for incisional hernia development after stoma closure.
PATIENTS AND METHODS
In this prospective clinical study, all cases with
temporary stoma who admitted to Mansoura
University Hospital at the period from February 2019 to
April 2021 and fulfill the criteria of eligibility were
included. Informed written consent was taken from all
cases before being enrolled in this work. The study
population was randomly distributed into 2 groups:
Group I: Patients with temporary stoma in which
conventional sutured fascial closure was done during
stoma reversal. Group-II: Patients with temporary
stoma in which mesh reinforced fascial closure was
done during stoma reversal.
Method of randomization
Cases were arbitrarily allocated into 2 groups;
Group-I (conventional closure) and group-II (meshreinforced
closure). Simple randomization with 1:1 allocation
ratio has been done by means of online arbitrary
number generating package (www.randomization.com).
Arbitrarily produced treatments distributions have been
putted in sealed envelopes. After the case get the
anesthesia, the envelope was opened in the surgical
room by the circulating nurses and the case was then
assigned to one of the two treatment groups. This work
was dual-blinded as neither the cases, nor the outcome
evaluators throughout following-up were knowledgeable
of the group to which the case was allocated. The
surgeons were knowledgeable of the nature of the
research and group distributions.
Sample size calculation
The needed sample-size has been determined by
means of the IBMa-SPSSa Sample-Powera v-3.0.1 (IBMa,
USA). According to intensive literature review, the
incidence of postoperative incisional hernia in the group
of cases with mesh reinforcement, in the study conducted
by Liu et al. (2013) was 6.4% in the omentopexy group and
36.1% patients without mesh reinforcement. Entire
number of 84 cases (42 in every group) was calculated to
detect an expected difference of 10% change in the
overall frequency of postoperative incisional hernia at
95% level of significance and power of 80%.
Inclusion criteria
Patients aged above 18, patients with temporary
double barreled and simple loop ostomy, patients with
American Society of anesthesiologists (ASA) physical
status sorting 1&2.
Exclusion criteria
Patients with anastomotic leak after closure that
necessitates re-exteriorization of the bowel, patients
with midline incisional hernia from the previous
surgery, patients with end ostomy or Hartman’s
colostomy that need laparotomy for closure, patients
with permanent stoma, patients with ASA physical
status classification > 2 and patients not willing to
participate in the study.
Operative technique
Stoma reversal in both groups was carried out by
the same technique as follow: performing an opening
in the skin surrounding the stoma 3–4 mm from the
muco-cutaneous junctions. Separate the bowel loop
away from its attachment to the abdomen wall. Cut out
a rim of 0.3–0.4 cm of scarred bowel edges exposes
healthful tissue.
Closing of bowel defect can be made
by double layer of 3-0 vicryl interrupted Suture or
stapling by triangulations with 2 applications of the 55
mm linear-stapler in transverse fashion. Once the tissue
is of poor quality for simply closing, we expand the
incision in the abdomen wall and resect a section. An
end-to-end anastomosis is created using the conventional
2-layers suture method or the staple technique.
Lastly, irrigation the surgical field and reduction of the
bowel into the abdomen are carried out.
Fascial closure: Group-I: irrigating the surgical field
with a dilute anti-biotics and use an Allis clamp to grip
the mid-point of the abdomen wall on the lower and
upper edges of the defect. Then closes the opening by
continuous sutures using nylon loop size 1 (fig. 1).
Group-II: Abdominal wall closure was reinforced by
retromuscular mesh by the following technique:
Dissection through the plane amid the posterior rectus
sheath and rectus muscles until the posterior sheath
has been completely mobilized. Then closure of the
fascial defect of the posterior rectus sheath. A piece of
non-absorbable macroporus polyproprylene mesh
(ParieteneTM mesh by COVIDENTM) with mesh
coverage of 5 cm beyond defect size (15×15 in most of
cases) is placed amid the posterior rectus sheath and
the rectus muscles and fixated to the muscle layer
above with four trans-fascial polypropelene sutures in
the four angles of the mesh. Then closure of the
anterior rectus sheath by continuous suturing using
nylon loop size 1 (fig. 2, 3).
Postoperative care and follow up
Standard post-operative care, including mobilization
and fast restoration of ordinary diet. Systemic anti-biotics
aren’t given beyond the peri-operative interval except if
there were severe wound contamination throughout the
operation. Postoperative evaluation of early complications
as SSI, anastomotic leak and wound dehiscence are
done on regular weekly visits for one month. Long-term
follow up visits at 3, 6 and 9 months are done to detect
stoma site incisional hernia development or fistula
formation. Both early and long term evaluations are done
by clinical examination and radiological assessment when
clinical findings are non-conclusive.
Statistical analysis of the data: collected data
analyzed using IBM SPSS-27 program. Qualitative data
have been presented as numbers and percent.
Quantitative have been presented as median (min and
max) for non-parametric data and mean, SD for parametric
data thereafter examining normality by means
of Kolmogrov-Smirnov testing. Results was Significant
at p<0.05.
Data analysis
Qualitative data: Chi-Square testing used to
compare 2 or more groups. Monte Carlo test as correction
for Chi-Square testing when >25% of cells have
count <5 in tables (>2*2). Fischer Exact test has been
utilized as correction for Chi-Square test when >25% of
cells have count <5 in 2*2 tables. Quantitative data
between two groups: Parametric test: Student t-test
has been utilized for comparing 2 non-dependent
variables. Non-Parametric test: Mann-Whitney U test
has been utilized for comparing 2 non-dependent
variables. Wilcoxon signed rank test: has been utilized
for comparing 2 non-dependent variables. Uni-variate
and multi-variate logistic regressions analysis has been
used to assess the associations among dependent and
independent risk predictors of a binary categorical
outcome. Level of significance: results were nonsignificant
if the p > 0.05, Significant at p ? 0.05 and
highly significant at p < 0.001.
RESULTS
Starting with demographics, the ages mean of the
enrolled patients was 52 and 53.56-yrs in groups 1and
2 respectively. Males represented 56% and 54% of
patients in the same groups respectively, whereas the
remaining cases were females. In addition, BMI had
mean values of 34.67 and 35.51 kg/m2 in the same two
groups respectively. All of the previous parameters
were non significantly differed between the study
groups (p value > 0.05). The prevalence of systemic
comorbidities showed no significant difference
between the two study groups (p > 0.05). Chronic liver
disease (CLD) was present in 7% and 9% of patients,
whereas diabetes (DM) was present in 31% and 23% of
cases in the same 2 groups respectively. Time to stoma
closure had mean values of 26.76 and 24 weeks in
Groups 1 and 2 respectively, with nonsignificant
difference among the study groups (p value= 0.430)
table 1.
The indication of primary operation and stoma were
non-significantly differed among the study groups (p =
0.817). Colon cancer was the most common indication,
followed by mesenteric vascular occlusion (MVO) and
volvulus. Other indications included inflammatory
bowel disease (IBD), trauma and diverticulosis. The
type of stoma also non-significantly differed among the
study groups (p value= 0.786), as ileostomy was
performed in 53% and 51% of patients in Groups 1 and
2 respectively. However, operative time showed a
significant increase in group 2 (84.65 vs. 51.56 minutes
in group 1 – p < 0.001). The method of anastomotic
creation was also comparable between the study
groups (p = 0.191), as hand sewn anastomosis was
done in 51% and 47% of patients in the same two
groups respectively, while the remaining cases were
performed via stapler (table 2).
The duration of hospitalization was non-significantly
differed among the study groups (p = 0.991), as it had
mean values of 5.89 and 5.88 days in Groups 1 and 2
both groups (p value = 0.657), as it had mean values of
10.4 and 10.09 days in the same groups respectively
(table 3).
Surgical site infection (SSI) was encountered in 20%
and 19% of patients in the same two groups, with nonsignificant
difference among them (p value= 0.868). The
incidence of stoma site incisional hernia (SSIH) showed
a significant increase in Group 1 (20% vs 2% in the other
group – p = 0.009). Leakage was encountered in only
one case in each group, with no significant difference
on statistical analysis (table 4).
We encountered 9 cases of SSI in the first group, 6
of them were superficial infections that were treated
conservatively by culture & sensitivity with antibiotic
therapy, the other 3 cases had deep wound infections
that were treated by open wound drainage, irrigation,
antibiotic therapy and secondary wound closure after
improvement. While in the second group 8 cases had
SSI, 4 of them were superficial infections that were
treated conservatively by the same measures as the
first group. The other 4 cases had deep wound infection,
3 of them improved by open drainage irrigation
and antibiotic therapy. One case with deep retromuscular
collection needed US guided drainage and antibiotic
therapy. Meshes were preserved in all cases (table 5).
The presence of ileostomy was a risk-factor for SSI
on univariate analysis. However, this factor showed no
significance on multivariate analysis. No other parameters
showed to be a significantly associated riskfactor
for that complication (table 6).
On univariate analysis, BMI, operative time, diabetes,
colon cancer and SSI were significant risk-factors for SSIH
(p < 0.05). While both colon cancer and SSI maintained
their significance on multivariate analysis (table 7).
DISCUSSION
Up to 48 percent of cases with a stoma face
complication, like high output, prolapse, retraction, or
parastomal hernias, resulting in skin irritation, pains,
complications with stoma bag applications, restrictions
on physical activities, aesthetic complaint, and
decreased QoL (13).
The optimum way for solving those complications is
reversal of the stoma, which was done in about 66% of
temporary stomas (14). Though, stoma reversal carries
frequently undervalued rate of morbidities and
mortalities, with complications such as post-operative
bowel obstructions, wound infections, and anastomotic
leak, happening in 20- 27% of cases (15).
The current study was conducted at Mansoura
University Hospitals aiming to investigate effectiveness
and safety of prophylactic mesh placement in preventions
of SSIH. We included a total of 88 patients who
were allocated to 2 groups; Group 1 comprised 45 cases
who experienced stomal site closure without mesh,
and Group 2 included the remaining 43 patients
who had mesh reinforcement. The mean age of the
comprised patients showed nonsignificant difference
among the study groups.
In a similar report handling the same perspective,
Warren et al. reported that the included patients had
mean age of 57.3 and 54.8 years in the mesh group and
controls resp., with nonsignificant difference among
the study groups (p = 0.09) (16).
Although Liu et al. reported older age range
compared to ours (69.6 and 65 years in the mesh group
and controls resp.), statistical analysis showed nonsignificant
difference among the study groups
(p = 0.301) (17). Both of the previous studies agreed
with our findings.
In our study, BMI was comparable among the study
groups.
Pizza et al. reported comparable BMI between cases
in the mesh group and controls (p > 0.05). It had mean
values of 24 and 23 kg/m2 in the same groups respectively
(18).
In contrast, Warren et al. revealed significantly
higher BMI in the mesh than controls (p = 0.001). BMI
had mean values of 30.2 and 27.3 kg/m2 in the same
groups respectively (16).
In our study, the interval throughout which stomas
still in situ was about 6-mths in the two study groups,
which is comparable to other studies (15).
In the present work, operative time showed a
significantly longer in group 2. Of course, this time was
needed for mesh installation and fixation, which was
omitted in Group 1.
In the same context, Warren and his coworkers
reported a significant prolongation of operative time in
association with mesh installation (p < 0.001). It had
mean values of 255 and 133.5 minutes in the mesh
group and controls respectively (16). It is reasonable to
find some differences between different studies
regarding operative time, which depend on surgical
experience, stoma type (end versus loop) and available
healthcare facilities.
In the current study, the duration of hospitalization
showed nonsignificant difference among the study
groups.
Another study reported that the period of
hospitalization was comparable among the mesh group
and controls (p = 0.534), as is it had a median value of 5
days in both groups (17).
In the current study, SSI showed nonsignificant
difference between the two study groups.
Likewise, Warren et al. reported that SSI was
detected in 20% and 19.8% of patients in the mesh
group and controls respectively, with nonsignificant
change among the study groups (p = 1) (16).
Other authors reported nonsignificant difference
among the study groups regarding post-operative SSI
rates (p = 1), which was encountered in 4.3% and 2.8%
of patients in the mesh group and controls resp. (17).
Risk of SSI in mesh group could be reduced by using
slowly resorbable meshes for fascial reinforcement
(PHASIX TM mesh) due its safety in potential contaminated
surgical fields as claimed by van Rooijen and his
colleagues, but this technique needs further evaluation
in upcoming studies (19).
When it comes to our primary outcome, the
incidence of incisional hernia showed a significant
increase in Group 1. It was evident that mesh placement
is protective against that complication.
Randomized trials have validated that mesh application
reduces recurrences of incisional hernias (20);
consequently, prophylactic mesh application was
supported by some reports for reinforcing the fascia
repairs post stoma reversal (17).
In our study, leakage was encountered in only one
case in each group, with no significant difference on
statistical analysis.
Likewise, Liu and his colleagues reported that the
incidence of post-operative intraabdominal septic
complications was comparable between the two
groups (p = 1). It was encountered in 4.3% and 5.6% of
patients in the mesh group and controls respectively
(17). Another study negated the occurrence of leakage
in the mesh group while it was encountered in two
cases in the control group (3%). Nevertheless, no
significant difference was detected on statistical
analysis (p = 0.328) (21).
In the recent study conducted by Pizza and his
colleagues, anastomotic leakage was detected in 0%
and 1.7% of patients in the mesh group and controls
resp. (p > 0.05) (18). Another study confirmed the
previous findings regarding comparable incidence of
anastomotic leakage between mesh group and controls
(p = 0.25) (16).
When it comes for risk-factors for incisional hernia
after stomal closures in our work, high BMI was a
significant risk-factor for the same complication on
univariate analysis. The obesity-persuaded straight
force that raises abdomen wall tension secondary to
high intra-abdomen pressure can clarify why obesity is
a risk-factor for incisional hernias (22). The inherent
anatomic characteristics of adipose tissue, vascular
deficiency, cellular and composition modification,
oxidative stress, changes in immune intermediaries,
and nutritious shortages can as well negatively impact
wound healing (23).
In line with our findings, Schreinemacher and his
associates reported that high BMI was a significant
risk-factor for incisional hernia subsequent to stomal
closure (p = 0.02). Incisional hernia was encountered in
25.8% of patients in patients with BMI < 30 kg/m2,
whereas the same complication occurred in 59.1% of
patients with higher BMI (24). On the other hand, Liu et
al. denied any significant impact of BMI on the development
of this complication (p = 0.977). It had mean
values of 26.1 and 26.7 kg/m2 in the hernia and nonhernia
groups respectively (17).
Our findings showed that diabetes is a significant
risk-factor for incisional hernia on univariate analysis.
We think that chronic micro-vascular variations
secondary to DM damages tissue perfusions, decreasing
the influx of inflammatory cells and compounds to the
wound location, causing poor collagen depositions and
a tendency for wound dehiscence (25).
Another study confirmed our findings, as diabetes
showed significantly higher prevalence in the hernia
versus the non-hernia groups (11.2% vs. 6.4% - p = 0.03)
(26). However, another study negated any significant
impact of diabetes on the development of the same
complication (p = 0.343) (27).
In our study, the type of stoma wasn't a significant
risk-factor for incisional hernia following stoma closure.
Schreinemacher et al. reported that the type of stoma
did not have a significant impact on the development of
that complication (p = 0.92) (24). However, another
study found that loop colostomy was a significant predictor
for incisional hernia after closure (HR = 2.12) (26).
Our findings showed that colon cancer was a
significant predictor for incisional hernia after stoma
reversal on both univariate and multivariate analyses.
This could be explained by the fact that malignancy
causes mal-nutrition and poor general health, which is
combined by the immuno-suppressive impacts of
chemo-therapy (28). Another study reported that
malignancy is a significant risk-factor for incisional
hernia after stomal reversal (p = 0.032). Patients with
malignant indication constituted 93.8% and 71.6% of
patients in the hernia and non-hernia groups respectively
(17). Contrarily, Sharp and his colleagues denied
any significant impact of cancer colon on the advance
of incisional hernia after stomal closure (p = 0.32).
Colon cancer was the primary indication of surgery in
23.5% and 27.6% of patients in the hernia and nonhernia
groups respectively (26).
Our findings showed that SSI was a significant
predictor for incisional hernia after stoma reversal on
both univariate and multivariate analyses. Walming
and his associates confirmed our findings as the
presence of surgical site infection was a significant
predictor for wound dehiscence (CI 1.65–5.46 - p <
0.001) and incisional hernia (CI 2.38–5.71 - p < 0.001)
(29). Several reports also confirmed our perspectives
(28, 30).
On the other hand, Niggebrugge et al. could not find
such a relationship (31).
Surgical site infection induces abnormal collagen
metabolism, and inhibits and delays the fascial woundhealing
process, especially in the proliferative phase,
leading to an increased risk of incisional hernia (32).
In the current study, long operative time appeared
to be a significant risk-factor for incisional hernia after
stomal reversal on univariate analysis. To our knowledge,
no preceding study had made this correlation,
and we could explain it by the fact that long operative
time could be an indicator for other parameters like
obesity, which could increase herniation rates. This
parameter needs to be furtherly investigated in future
studies.
Our findings showed that the existence of ileostomy
was a risk-factor for surgical site infection on univariate
analysis. No other parameters showed to be a
significant risk-factor for that complication. Perhaps
soiling and watery content of the ileostomy could
potentiate that problem.
In another study, authors agreed with our findings
as age, BMI, diabetes, and smoking did not have a
negative impact on the development of surgical site
infection after closure. Although authors did not report
ileostomy as a risk-factor, linear incision closure was a
significant risk-factor for that complication (p = 0.007)
(33). Our work has some limitations, as it is a single
center report that comprised a comparatively small
sample size. This drawback should be well-covered in
the upcoming studies.
CONCLUSION
Prophylactic mesh reinforcement during stoma
reversal significantly decreases the incidence of stoma
site incisional hernia without significant increase in the
incidence of the stoma site wound infection.
Conflict of interest
All authors declare no conflict of interest.
Ethical approval
For this study was approval from the institutional
review board was obtained. IRB registration code:
MD.19.01.136. Informed written consent: was taken
from all cases before being enrolled in this work.
REFERENCES
1. Harries R, Torkington J. Stomal closure: strategies to prevent
incisional hernia. Frontiers in surgery. 2018;5:28. eCollection 2018.
2. Memon Z, Qureshi S, Hakeem A. Outcome of closure of transient
ileostomy at tertiary care hospital. In Med. Forum. 2019; 30(6): 123.
3. Cingi A, Cakir T, Sever A, Aktan A. Enterostomy site hernias: a
clinical and computerized tomographic evaluation. Dis Colon
Rectum. 2006;49(10):1559-63
4. Pine J, Stevenson, L. Intestinal stomas. Surgery (Oxford). 2017;
35(3):165-170.
5. Muysoms F, Miserez M, Berrevoet F, Campanelli G, Champault G,
Chelala E, et al. Classification of primary and incisional abdominal
wall hernias. Hernia. 2009;13(4):407-414.
6. van Ramshorst G, Eker H, Hop W, Jeekel J, Lange J. Impact of
incisional hernia on health-related quality of life and body image: a
prospective cohort study. Am J Surg. 2012;204(2):144-50.
7. Kassem M, El-Haddad H. Polypropylene-based composite mesh
versus standard polypropylene mesh in the reconstruction of
complicated large abdominal wall hernias: a prospective randomized
study. Hernia. 2016;20(5):691-700.
8. Sandy-Hodgetts K, Leslie G, Lewin G, Hendrie D, Carville K. Surgical
wound dehiscence in an Australian community nursing service: time
and cost to healing. J Wound Care. 2016;25(7):377-83.
9. Adell-Carceller R, Segarra-Soria M, Pellicer-Castell V, Marcote-
Valdivieso E, Gamón-Giner R, Martin-Franco M, et al. Incisional
hernia in colorectal cancer surgery. Associated risk-factors. Cir Esp.
2006;79(1):42-5.
10. Porrero J, Cano-Valderrama O, Castillo M, Marcos A, Tejerina G,
Cendrero M, et al. Importance of mesh overlap on hernia recurrence
after open umbilical hernia repair with bilayer prosthesis. Am J Surg.
2018;216(5):919-922.
11. Herbert G, Tausch T, Carter P. Prophylactic mesh to prevent
incisional hernia: a note of caution. Am J Surg. 2009;197(5):595-
8; discussion 598
12. López-Cano M, Brandsma H, Bury K, Hansson B, Kyle-Leinhase I,
Alamino J, et al. Prophylactic mesh to prevent parastomal hernia
after end colostomy: a meta-analysis and trial sequential analysis.
Hernia. 2017;21(2):177-189.
13. Krishnamurty, D, Blatnik, J, Mutch, M. Stoma complications. Clin
Colon Rectal Surg. 2017;30(3):193-200.
14. Sier, M, Van Gelder, L, Ubbink, D, Bemelman, W, Oostenbroek, R.
Factors affecting timing of closure and non-reversal of temporary
ileostomies. Int J Colorectal Dis. 2015;30(9):1185-92.
15. Schreinemacher, M, Vijgen, G, Dagnelie, P, Bloemen, J, Huizinga, B,
Bouvy, NIncisional hernias in temporary stoma wounds: a cohort
study. Arch Surg. 2011;146(1):94-9.
16. Warren, J, Beffa, L, Carbonell, A, Cull, J, Sinopoli, B, Ewing, J, et al.
Prophylactic placement of permanent synthetic mesh at the time of
ostomy closure prevens formation of incisional hernias. Surgery.
2018;163(4):839-846.
17. Liu D, Banham E, Yellapu S. Prophylactic mesh reinforcement
reduces stomal site incisional hernia after ileostomy closure. World
J Surg. 2013;37(9):2039-45.
18. Pizza F, D’Antonio D, Arcopinto M, Dell’Isola C, Marvaso A. Safety
and efficacy of prophylactic resorbable biosynthetic mesh in loopileostomy
reversal: a case–control study. Updates Surg. 2020;72(1):
103-108
19. van Rooijen MM, Jairam AP, Tollens T, Jørgensen LN, de Vries
Reilingh TS, Piessen G, et al. Outcomes of a new slowly resorbable
biosynthetic mesh (Phasix®) in potentially contaminated incisional
hernias: A prospective, multi-center, single-arm trial. Int J Surg.
2020;83:31-36.
20. Luijendijk R, Hop W, Van Den Tol M, De Lange D, Braaksma M,
IJzermans J, et al. A comparison of suture repair with mesh repair
for incisional hernia. N Engl J Med. 2000;343(6):392-8.
21. Maggiori L, Moszkowicz D, Zappa M, Mongin C, Panis Y. Bioprosthetic
mesh reinforcement during temporary stoma closure decreases the
rate of incisional hernia: a blinded, case-matched study in 94 patients
with rectal cancer. Surgery. 2015;158(6):1651-7
22. Lambert D, Marceau S, Forse R. Intra-abdominal pressure in the
morbidly obese. Obes Surg. 2005;15(9):1225-32.
23. Pierpont Y, Dinh T, Salas R, Johnson E, Wright T, Robson M, et al.
Obesity and surgical wound healing: a current review. ISRN Obes.
2014;2014:638936. eCollection 2014.
24. Schreinemacher M, Vijgen G, Dagnelie P, Bloemen J, Huizinga B,
Bouvy N. Incisional hernias in temporary stoma wounds: a cohort
study. Arch Surg. 2011;146(1):94-9.
25. van Ramshorst G, Nieuwenhuizen J, Hop W, Arends P, Boom J,
Jeekel J, et al. Abdominal wound dehiscence in adults: development
and validation of a risk model. World J Surg. 2010;34(1):20-7.
26. Sharp S, Francis J, Valerian B, Canete J, Chismark A, Lee E.
Incidence of ostomy site incisional hernias after stoma closure. Am
Surg. 2015;81(12):1244-8.
27. Lorenz A, Kogler P, Kafka-Ritsch R, Öfner D, Perathoner A. Incisional
hernia at the site of stoma reversal - incidence and risk-factors in a
retrospective observational analysis. Int J Colorectal Dis. 2019;
34(7):1179-1187.
28. Riou J, Cohen J, Johnson Jr H. Factors influencing wound dehiscence.
Am J Surg. 1992;163(3):324-30.
29. Walming S, Angenete E, Block M, Bock D, Gessler B, Haglind E.
Retrospective review of risk factors for surgical wound dehiscence
and incisional hernia. BMC Surg. 2017;17(1):19.
30. Gislason H, Søreide O, Viste A. Wound complications after major
gastrointestinal operations. The surgeon as a risk factor. Dig Surg.
1999;16(6):512-4.
31. Niggebrugge AH, Trimbos JB, Hermans J, Steup WH, Van De Velde
CJ. Influence of abdominal-wound closure technique on complications
after surgery: a randomised study. Lancet. 1999;353(9164):
1563-7.
32. Itatsu K, Yokoyama Y, Sugawara G, Kubota H, Tojima Y, Kurumiya Y,
et al. Incidence of and risk factors for incisional hernia after
abdominal surgery. Br J Surg. 2014;101(11):1439-47.
33. Yamamoto M, Tanaka K, Masubuchi S, Ishii M, Hamamoto H, Suzuki
S, et al. Risk-factors for surgical site infection after stoma closure
comparison between pursestring wound closure and conventional
linear wound closure: propensity score matching analysis. Am J
Surg. 2018;215(1):58-61.
Full Text Sources: Abstract: Views: 937
Cited by 0 articles