Vinh Ngoc Truong Pham, Triet Minh Le, Huy Duc Tran, Viet Van Ung, Thinh Huu Nguyen
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引用次数: 0
Abstract
Background: Parastomal hernia is a common and time-dependent complication after permanent colostomy following laparoscopic abdominoperineal resection (APR) for rectal cancer. Although prophylactic mesh placement using the Sugarbaker technique has shown favorable short-term results, long-term real-world evidence remains limited.
Methods: This was an ambispective observational cohort study consisting of a retrospective historical cohort (2018-2021) and a prospectively followed cohort (2021-2025) after the introduction of prophylactic mesh. This study included patients undergoing elective laparoscopic APR with permanent end colostomy between 2018 and 2025. Laparoscopic APR was performed according to a standardized institutional step-by-step protocol that remained unchanged throughout the study period. Patients were categorized into a prophylactic mesh group using the Sugarbaker technique and a non-mesh group, based on study period and patient preference. The primary outcome was the cumulative incidence of parastomal hernia assessed radiologically during follow-up. Time-to-event data were analyzed using the Kaplan-Meier method and compared using the log-rank test.
Results: A total of 84 patients were included, comprising 40 patients in the mesh group and 44 in the non-mesh group. Baseline demographic and clinical characteristics were comparable between groups. During a follow-up period of up to 4 years, the cumulative incidence of parastomal hernia was consistently lower in the mesh group at all time points. Kaplan-Meier analysis demonstrated a significantly lower incidence of parastomal hernia in the Sugarbaker group compared with the non-mesh group (log-rank p = 0.00018). The absolute risk reduction at 4 years was 47.0%, corresponding to a number needed to treat (NNT) of approximately 2.1. No mesh-related complications were observed during follow-up.
Conclusion: Prophylactic mesh placement using the Sugarbaker technique during laparoscopic APR was associated with a sustained reduction in PSH risk over 4 years, without evidence of increased perioperative or mesh-related morbidity. These findings suggest that prophylactic mesh may be beneficial in selected patients.
背景：造口旁疝是直肠癌腹腔镜腹会阴切除术（APR）后永久性结肠造口术后常见的时间依赖性并发症。尽管使用Sugarbaker技术的预防性补片放置已显示出良好的短期效果，但长期的实际证据仍然有限。方法：这是一项双视角观察队列研究，包括引入预防性补片后的回顾性历史队列（2018-2021）和前瞻性随访队列（2021-2025）。该研究包括2018年至2025年间接受选择性腹腔镜APR并永久性末端结肠造口术的患者。腹腔镜APR按照标准化的机构分步方案进行，在整个研究期间保持不变。根据研究时间和患者偏好，将患者分为使用Sugarbaker技术的预防性补片组和非补片组。主要结局是在随访期间用放射学评估造口旁疝的累积发生率。使用Kaplan-Meier方法对事件时间数据进行分析，并使用log-rank检验进行比较。结果：共纳入84例患者，其中补片组40例，非补片组44例。两组间的基线人口学和临床特征具有可比性。在长达4年的随访期间，补片组在所有时间点的造口旁疝累积发生率始终较低。Kaplan-Meier分析显示，与非补片组相比，Sugarbaker组造口旁疝的发生率显著降低（log-rank p = 0.00018）。4年的绝对风险降低率为47.0%，对应于需要治疗的数字（NNT）约为2.1。随访期间未见补片相关并发症。结论：在腹腔镜APR期间，使用Sugarbaker技术预防性放置补片与PSH风险持续降低4年相关，无证据表明围手术期或补片相关发病率增加。这些发现表明预防性补片可能对特定患者有益。
期刊介绍：
Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery.
Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.
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