Long-term outcome of prophylactic biosynthetic mesh reinforcement at the time of loop ileostomy reversal for colorectal cancer- results of a case-matched study.

Abstract

<h4>Purpose</h4>Stoma site incisional hernia (SSIH) is a frequent complication following ileostomy closure but can be potentially decreased by prophylactic mesh reinforcement. The aim was to assess if the use of a slowly absorbable biosynthetic mesh at the time of ileostomy reversal could reduce the incidence of SSIH.<h4>Methods</h4>Outcomes of consecutive patients receiving prophylactic biosynthetic mesh (poly-4-hydroxybutyrate Phasix^®, BD) implantation at the time of ileostomy reversal for colorectal cancer were prospectively collected in the Club Hernie database. Outcomes were compared with those of matched patients from a historical cohort of patients undergoing ileostomy reversal without mesh augmentation.<h4>Results</h4>A total of 100 patients underwent ileostomy reversal: 50 with biosynthetic mesh augmentation (mesh group) and 50 with standard fascial closure without mesh (control group). Mesh augmentation did not increase the operating time (mesh group 49.8 min vs. control group 60.5 min, p < 0.01), the incidence of surgical site infection (mesh group 4% vs. control group 6%, p = 1) or the length of hospital stay (mesh group 5 days vs. control group 6 days, p = 0.28). After a mean follow-up of 4 years, the rate of SSIH, diagnosed by CT scan, was significantly lower in the mesh group (mesh group 8% vs. control group 24%, p = 0.029).<h4>Conclusion</h4>Prophylactic use of a slowly absorbable biosynthetic mesh at the time of ileostomy reversal for colorectal cancer was safe and effective in reducing the rate of SSIH without increasing surgical site infection.