Warren JA, et al. - In this retrospective review, researchers investigated the outcomes of a series of prophylactic mesh reinforcements with retromuscular, large-pore polypropylene at the time of enterostomy reversal. They noticed that at the time of enterostomy reversal, retromuscular placement of permanent synthetic mesh was efficacious in preventing development of incisional hernia without increased risk of surgical site occurrence (SSO) or surgical site infection (SSI).

Methods

• Researchers reviewed all ostomy reversals retrospectively.
• From a prospectively maintained, hernia database, they identified all cases with placement of synthetic mesh reinforcement.
• For this study, primary endpoints were surgical site occurrence (SSO), surgical site infection (SSI), and hernia occurrence.

Results

• Three-hundred-fifty-nine patients underwent ostomy reversal; 91 were reinforced with mesh and 268 without mesh.
• Researchers noticed that 56.5% of the patients underwent colostomy and 43.5% underwent ileostomy.
• A greater BMI and a greater incidence of COPD were observed in the mesh group, otherwise the groups were similar.
• The mesh group indicated a midline incisional hernia in 45% compared to 4.5% in the controls.
• Mesh and control groups were similar in terms of SSO and SSI Incidence (21 vs 22.8%; P=0.82 and 20 vs 19.8%; P=1.000; respectively).
• Lower superficial SSI rate was observed with mesh(8 vs 16.4%; P=0.039).
• With mesh, hernia incidence at the stoma site (1.% vs 17.2%; P < 0.001) and the occurrence of a midline hernia (6% v 19%; P=0.004) were reduced significantly.
• In 29.7% of cases, prophylac mesh placement was performed across the midline, which decreased midline hernia formation from 24.1% to 4% (P=0.019).