Funnel-Shaped Mesh Placement Is Effective for Prevention of Parastomal Hernia

Makarainen E, Wiik H, Nikberg M, et al. Parastomal Hernia Prevention Using Funnel-Shaped Intra-Abdominal Mesh Compared to No Mesh: The Chimney Randomized Clinical Trial. JAMA Surg. 2024; in press.

Anwar IJ, Greenberg JA. Successful Prevention of Parastomal Hernia Formation With Intra-Abdominal Funnel-Shaped Mesh. JAMA Surg. 2024; in press.

Clinical practice guidelines recommend mesh reinforcement using the keyhole technique to reduce the risk of parastomal hernia following colostomy formation. Unfortunately, available data have shown that the keyhole technique is not associated with a reduced risk for parastomal hernia.

This article reported a randomized trial (n = 143) comparing rates of parastomal hernia confirmed by CT imaging in patients who received funnel-shaped mesh placement (procedure clearly described in the article) or no mesh placement during abdominoperineal resection or Hartmann procedure for rectal cancer. Patients were treated in five hospitals in Finland and Sweden, and included patients were followed for a minimum of 12 months after the surgical procedure.

Parastomal hernia was confirmed by imaging in 10% of the mesh group and 37% of the non-mesh group. A clinical (visible on physical examination) hernia occurred in 2% of the mesh group and 43% of the non-mesh group. Rate of postoperative ileus was higher in the mesh group.

The authors concluded that funnel-shaped mesh placement was effective for prevention of parastomal hernia.

In the editorial that accompanied the article, Anwar and Greenberg agreed that these findings are encouraging but emphasized the need for long-term follow-up data.