ABSTRACT
AIM: Parastomal hernia (PSH) is the most common complication of an end-colostomy and about one-quarter of patients need operative repair, which is often unsuccessful. A randomized trial was carried out to compare the results of using mesh or no mesh at the time of formation of a colostomy with the clinical identification of PSH as the primary outcome. METHOD: In this two-centre randomized trial (Oslo University Hospital and Sykehuset Innlandet Hospital Trust, Norway), patients with rectal cancer undergoing open pelvic surgery were randomized to receive a retromuscular synthetic mesh (study group, n = 32) or no mesh (control group, n = 26) at the time of end-colostomy formation. Postoperative follow up was not blinded and included clinical examination and routine CT. RESULTS: The median period of follow up was 40 (range: 84) months. There were no differences in demographic variables or complications between the study and control groups. PSH developed in two patients of the study group and in 12 of the control group [OR = 0.04 (95% CI: 0.01-0.30) and hazard ratio 0.134 (95% CI: 0.030-0.603); P < 0.001]. The number needed to treat to avoid one PSH was 2.5 patients. CT demonstrated an increase over time in the size of the fascial orifice in patients with PSH without mesh prophylaxis, in contrast to a stable size in patients with mesh and in the control patients who did not develop PSH. CONCLUSION: The retromuscular insertion of synthetic mesh at the time of formation of an end-colostomy reduced the risk of PSH.
Subject(s)
Colostomy/adverse effects , Hernia, Ventral/prevention & control , Rectal Neoplasms/surgery , Surgical Mesh , Surgical Stomas/adverse effects , Age Factors , Aged , Colostomy/methods , Female , Follow-Up Studies , Hernia, Ventral/etiology , Hospitals, University , Humans , Incidence , Kaplan-Meier Estimate , Logistic Models , Male , Middle Aged , Multivariate Analysis , Norway , Proportional Hazards Models , Prospective Studies , Risk Assessment , Sex Factors , Single-Blind Method , Treatment OutcomeABSTRACT
PURPOSE: Supposing divergent aetiology, we found it interesting to investigate outcomes between primary (PH) versus incisional (IH) hernias. In addition, we wanted to analyse the effect of defect closure and mesh fixation techniques. METHODS: 37 patients with PH and 70 with IH were enrolled in a prospective cohort-study, treated with laparoscopic ventral hernia repair (LVHR) and randomised to ± transfascial sutures. In addition, we analysed results from a retrospective study with 36 PH and 51 IH patients. Mean follow-up time was 38 months in the prospective study and 27 months in the retrospective study. RESULTS: 35 % of PH's and 10 % of IH's were recurrences after previous suture repair. No late infections or mesh removals occurred. Recurrence rates in the prospective study were 0 vs. 4.3 % (p = 0.55) and the complication rates were 16 vs. 27 % (p = 0.24) in favour of the PH cohort. The IH group had a mesh protrusion rate of 13 vs. 5 % in the PH group (p = 0.32), and significantly (p < 0.01) larger hernias and adhesion score, longer operating time (100 vs. 79 min) and admission time (2.8 vs. 1.6 days). Closure of the hernia defect did not influence rate of seroma, pain at 2 months, protrusion or recurrence. An overall increased complication rate was seen after defect closure (OR 3.42; CI 1.25-9.33). CONCLUSIONS: With PH, in comparison to IH treated with LVHR, no differences were observed regarding recurrence, protrusion or complication rates. Defect closure (raphe), when using absorbable suture, did not benefit long-term outcomes and caused a higher overall complication rate. (ClinicalTrials.gov number: NCT00455299).
Subject(s)
Hernia, Ventral/surgery , Herniorrhaphy/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Laparoscopy , Male , Middle Aged , Prospective Studies , Recurrence , Reoperation , Retrospective Studies , Suture TechniquesABSTRACT
OBJECTIVES: The aim of this investigation was to estimate the site-specific cancer incidence rates in Arkhangelskaja Oblast (AO), and to make a comparison with the incidence in Norway. STUDY DESIGN: AO is an administrative unit in Northwestern Russia with 1.3 million inhabitants. A population-based cancer registry covering the whole population of the oblast was set up at the central oncological hospital. All new cancer cases in the period 1993 - 2001 among official residents of AO were registered in the registry and included in the study. The annual gender- and age-group-specific population figures for AO were obtained from the regional statistics office. Gender- and site-specific frequencies cancer figures from Norway were obtained from the Norwegian Cancer Registry. RESULTS: A total of 34,697 cases of primary cancers in AO were included. The age-adjusted incidence rate for all sites combined was 164/100,000 for women and 281/100,000 for men. The incidence among women was 31% lower than in Norway, while the rate among men was the same. Among men, the incidence of stomach, lung, oesophagus, larynx, liver and pancreas cancer was markedly higher in AO than in Norway, while the incidence of cancer in the prostate, colon, bladder, testicle and melanoma was markedly lower in AO. For women, of the common cancer sites only the incidence of stomach cancer was higher in AO. Cancers of the lung, colon, rectum and ovaries were markedly lower. CONCLUSIONS: The incidence of most major cancer types appears to have been quite different in a northern Russian population than in Norway. The incidence among women was relatively low, except for stomach cancer.
