Erschienen in:
14.06.2016 | Invited Commentary
Parastomal hernia and prophylactic mesh use during primary stoma formation: a commentary
verfasst von:
J.-B. Cornille, I. R. Daniels, N. J. Smart
Erschienen in:
Hernia
|
Ausgabe 4/2016
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Excerpt
The development of a parastomal hernia following stoma formation remains a significant challenge for both the abdominal surgeon and patient alike. The past two decades have seen a shift in emphasis toward the prevention of this vexing problem, largely because of two driving factors: improved survival of rectal cancer patients and the unsatisfactory outcomes associated with parastomal hernia repair. The use of prophylactic mesh reinforcement of the abdominal wall has been the main strategy in attempting to reduce the incidence of parastomal hernia. The initial optimism associated with the earliest case series in the 1990s and subsequent randomized trials of the 2000s culminated in three systematic reviews that all advocated the technique in unequivocal terms [
1‐
3]. Despite this positive endorsement by the highest levels of evidence, mesh prophylaxis has failed to establish itself as standard practice. A critical appraisal of the situation is warranted to understand why we are in this current situation with an apparent discord between what the evidence suggests that surgeons do and what is actually being performed. …
