Application value of DynaMesh-IPST stoma dedicated mesh in parastomal hernia repair / 中华消化外科杂志

ABSTRACT

Objective To investigate the application value of DynaMesh-IPST stoma dedicated mesh in parastomal hernia repair.Methods The retrospective cohort study was conducted.The clinical data of 281 patients with parastomal hernia of abdominal wall who were admitted to Beijing Chao-Yang Hospital of Capital Medical University between March 2013 and April 2017 were collected.Of 281 patients undergoing laparoscopic combined with open parastomal hernia repair with artificial materials,151 using DynaMesh-IPST stoma dedicated mesh and 130 using ordinary anti-adhesive mesh were respectively allocated into the DynaMesh-lPST mesh group and ordinary mesh group.Observation indicators(1) intra-and post-operative situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect hernia recurrence and long-term complications at 1-,3-,6-month and 1 year postoperatively up to June 2018.Measurement data with normal distribution were represented as (x)±s and comparison between groups was done by the t test.Measurement data with skewed distribution were described as M (P25,P75) and M (range),and comparison between groups was done using rank sum test.Comparison of count data between groups was analyzed using the chi-square test.Results (1) Intra-and post-operative situations281 patients underwent successfully laparoscopic combined with open parastomal hernia repair with artificial materials.The operation time,volume of intraoperative blood loss and duration of postoperative hospital stay were 100 minutes (60 minutes,120 minutes),(34± 15)mL,17 days (13 days,24 days) in the DynaMesh-IPST mesh group and 100 minutes (85 minutes,120 minutes),(42± 36)mL and 20 days (16 days,25 days) in the ordinary mesh group,with statistically significant differences between groups (Z=2.166,t=2.654,Z=2.795,P＜0.05).The postoperative incisional infection and intestinal leakage were respectively detected in 18 and 2 patients in the DynaMesh-IPST mesh group and 36 and 7 patients in the ordinary mesh group,showing a statistically significant difference of incisional infection between groups (x2 =11.194,P＜0.05),and no statistically significant difference of intestinal leakage between groups (x2 =4.234,P＞ 0.05).Of 54 patients with postoperative incisional infection,4 were cured after removing mesh and clearing up infection,50 were cured after dressing change,local debridement and drainage.(2) Follow-up279 of 281 patients including 149 in the DynaMesh-IPST mesh group and 130 in the ordinary mesh group were followed up for 20-44 months with a median time of 32 months.During the follow-up,10 patients had hernia recurrence including 4 in the DynaMesh-IPST mesh group and 6 in the ordinary mesh group.Six of them underwent reoperation (4 with keyhole hernia recurrence,1 with mesh bulging out because of abdominal weakness at stoma,1 with parastomal recurrence after mesh removal due to intestinal leakage) and 4 had regular reexamination after fixation with abdominal belt.There was no statistically significant difference of hernia recurrence between groups (x2 =0.318,P＞0.05).Twenty-seven patients (14 in the DynaMesh-IPST mesh group and 13 in the ordinary mesh group) with intestinal obstruction were improved by conservative treatment,showing no statistically significant difference between groups (x2 =0.043,P＞0.05).Ten patients (6 in the DynaMesh-IPST mesh group and 4 in the ordinary mesh group) with stoma stenosis were improved after local stoma remodeling,showing no statistically significant difference between groups (x2=0.007,P＞ 0.05).Ninteen patients (4 in the DynaMesh-IPST mesh group including 1 complicated with hernia recurrence and 15 in the ordinary mesh group including 2 complicated with hernia recurrence) with stoma prolapse were improved after local stoma remodeling,showing a statistically significant difference between groups (x2 =8.756,P ＜ 0.05).Conclusion Parastomal hernia repair with DynaMesh-IPST stoma dedicated mesh is safe and feasible,with satisfactory effects.