R D Shaw1, J L Goldwag1, L R Wilson1,2, S J Ivatury3, M J Tsapakos2,4, E M Pauli5, M Z Wilson6,7. 1. Department of Surgery, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA. 2. Geisel School of Medicine, Hanover, NH, USA. 3. Dell Medical School, UT Health, Austin, TX, USA. 4. Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. 5. Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA. 6. Department of Surgery, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA. matthew.z.wilson@hitchcock.org. 7. Geisel School of Medicine, Hanover, NH, USA. matthew.z.wilson@hitchcock.org.
Abstract
PURPOSE: Loop ileostomy (LI) is commonly employed during colorectal surgeries to reduce the consequences of anastomotic leak. Unfortunately, LI is associated with a 10-30% incisional hernia (IH) rate after closure. We hypothesized that prophylactic mesh reinforcement during LI takedown would safely prevent subsequent IH formation. METHODS: This single-center, phase I/II prospective study evaluated adult patients undergoing LI closure after left-sided colorectal cancer procedures. After LI closure, the posterior rectus sheath was mobilized and reapproximated with absorbable suture. A reduced-weight, macroporous, polypropylene mesh (Softmesh, BD) was placed in the retrorectus position to allow 3 cm of overlap and secured with fibrin sealant. The anterior fascia was closed with slowly absorbable suture. CT images obtained for cancer surveillance were reviewed by a radiologist blinded to the study intervention to evaluate for evidence of hernia or surgical site occurrence (SSO). RESULTS: Twenty patients were included with mean defect and mesh sizes of 11.2 cm2 and 64.2 cm2, respectively. Mean operative time for LI takedown and mesh augmented closure was 84 min with mesh implantation time being 16.4 min. Two patients were readmitted within 30 days for ileus, no patient required procedural intervention. Over a mean follow-up period of 20 ± 7 months, no SSO or hernias were observed clinically or on CT imaging. CONCLUSION: In our small series, retromuscular mesh reinforcement of LI closure appears feasible, safe and effective. This mesh reinforcement approach should be further investigated to evaluate its long-term effectiveness.
PURPOSE: Loop ileostomy (LI) is commonly employed during colorectal surgeries to reduce the consequences of anastomotic leak. Unfortunately, LI is associated with a 10-30% incisional hernia (IH) rate after closure. We hypothesized that prophylactic mesh reinforcement during LI takedown would safely prevent subsequent IH formation. METHODS: This single-center, phase I/II prospective study evaluated adult patients undergoing LI closure after left-sided colorectal cancer procedures. After LI closure, the posterior rectus sheath was mobilized and reapproximated with absorbable suture. A reduced-weight, macroporous, polypropylene mesh (Softmesh, BD) was placed in the retrorectus position to allow 3 cm of overlap and secured with fibrin sealant. The anterior fascia was closed with slowly absorbable suture. CT images obtained for cancer surveillance were reviewed by a radiologist blinded to the study intervention to evaluate for evidence of hernia or surgical site occurrence (SSO). RESULTS: Twenty patients were included with mean defect and mesh sizes of 11.2 cm2 and 64.2 cm2, respectively. Mean operative time for LI takedown and mesh augmented closure was 84 min with mesh implantation time being 16.4 min. Two patients were readmitted within 30 days for ileus, no patient required procedural intervention. Over a mean follow-up period of 20 ± 7 months, no SSO or hernias were observed clinically or on CT imaging. CONCLUSION: In our small series, retromuscular mesh reinforcement of LI closure appears feasible, safe and effective. This mesh reinforcement approach should be further investigated to evaluate its long-term effectiveness.
Authors: Mylan T Nguyen; Uma R Phatak; Linda T Li; Stephanie C Hicks; Jennifer M Moffett; Nestor A Arita; Rachel L Berger; Lillian S Kao; Mike K Liang Journal: J Surg Res Date: 2014-01-29 Impact factor: 2.192
Authors: G De Keersmaecker; R Beckers; E Heindryckx; I Kyle-Leinhase; P Pletinckx; D Claeys; E Vanderstraeten; E Monsaert; F Muysoms Journal: Hernia Date: 2015-09-08 Impact factor: 4.739
Authors: Rocco Ricciardi; Beth A Virnig; Robert D Madoff; David A Rothenberger; Nancy N Baxter Journal: Dis Colon Rectum Date: 2007-08 Impact factor: 4.585
Authors: Massimo Sartelli; Dieter G Weber; Yoram Kluger; Luca Ansaloni; Federico Coccolini; Fikri Abu-Zidan; Goran Augustin; Offir Ben-Ishay; Walter L Biffl; Konstantinos Bouliaris; Rodolfo Catena; Marco Ceresoli; Osvaldo Chiara; Massimo Chiarugi; Raul Coimbra; Francesco Cortese; Yunfeng Cui; Dimitris Damaskos; Gian Luigi De' Angelis; Samir Delibegovic; Zaza Demetrashvili; Belinda De Simone; Francesco Di Marzo; Salomone Di Saverio; Therese M Duane; Mario Paulo Faro; Gustavo P Fraga; George Gkiokas; Carlos Augusto Gomes; Timothy C Hardcastle; Andreas Hecker; Aleksandar Karamarkovic; Jeffry Kashuk; Vladimir Khokha; Andrew W Kirkpatrick; Kenneth Y Y Kok; Kenji Inaba; Arda Isik; Francesco M Labricciosa; Rifat Latifi; Ari Leppäniemi; Andrey Litvin; John E Mazuski; Ronald V Maier; Sanjay Marwah; Michael McFarlane; Ernest E Moore; Frederick A Moore; Ionut Negoi; Leonardo Pagani; Kemal Rasa; Ines Rubio-Perez; Boris Sakakushev; Norio Sato; Gabriele Sganga; Walter Siquini; Antonio Tarasconi; Matti Tolonen; Jan Ulrych; Sannop K Zachariah; Fausto Catena Journal: World J Emerg Surg Date: 2020-05-07 Impact factor: 5.469