Hernia Clinical Trial
Official title:
Laparoscopic Parastomal Hernia Repair Using an Innovative Composite Polypropylene Mesh - A Prospective Study
The purpose of the study is to evaluate a new laparoscopic technique for parastomal hernia repair using an intraperitoneally placed Proceed mesh, looking at postoperative complications, recurrence rate and postoperative pain and quality of life.
Parastomal hernia affects up to 50% of all patients following formation of a stoma, most
often in patients with a colostomy. About 20% of the patients need surgical correction of
their parastomal hernia. Symptoms associated with parastomal hernias goes from mild physical
(pain) and cosmetic discomfort to life threatening conditions with obstruction,
strangulation and perforation. Parastomal hernias have big socioeconomic consequences and
remain a considerable clinical problem.
The surgical treatment of parastomal hernias is controversial. The best way to treat it is
to restore the continuity of the intestine, but in permanent stomas, this is not an option.
Many surgical techniques have been described when intervention is required, but the results
are unacceptable. The traditional open techniques are local simple suturing of the fascia
defect, stoma relocation, or repair with a prosthetic material either intraperitoneally or
extraperitoneally (subfascial or onlay). Overall, the results of all methods are poor with
high recurrence rates and high morbidity and mortality. Mesh repair has the lowest
recurrence rate (0-39%) and stoma relocation and simple suture has reported recurrence rates
on 0-76% and 46-100%, respectively. Laparoscopic repair of parastomal hernias with a
prosthetic mesh inserted intraperitoneally is a new method described in a few small series.
The results so far are encouraging, but the follow-up period is short.
Looking at the disappointing results from the traditional open techniques in the treatment
of parastomal hernias together with the enormous success in laparoscopic ventral hernia
repair and laparoscopy overall, we believe that laparoscopic parastomal hernia repair with
mesh will be an effective treatment option in the future. Therefore, we find it interesting
to investigate the technique in a prospective study
;
Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
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