Prophylactic Hernia Mesh Placement Through IOPM Approach During Miles' Operation In Prevention Of Parastomal Hernia

Objective Colorectal cancer patients showed increasing trend year by year,of which the low rectal cancer occupies a higher proportion.For the standard operation for patients with low rectal cancer and anal canal cancer at present is still Miles operation(Abdominoperineal Radical Operation of Rectal Cancer),and also it is almost the only way can achieve a radical cure.The most important feature of this type of surgery is to build artificial anus in the patient's abdominal wall.Although the patient's life is extended,but the appearance of stoma also brings a series of postoperative complications,such as bleeding,necrosis,infection,obstruction,stenosis and Parastomal hernia(PSH)and so on.And PSH is a common complication after sigmoid colostomy,which seriously affects the patient's postoperative quality of life.Prevention of PSH formation is crucial,given the high prevalence(up to 50%)and difficulties in the surgical repair of PSH.There are many factors that affect the occurrence of PSH,and self-related factors such as age,sex,obesity,malnutrition,chronic cough,and so on;and surgical-related factors are: stoma location,stoma size and surgical procedure typeand so on.Although the surgeon has done a lot of work to prevent the occurrence of PSH,but its incidence is still high.Recent foreign studies reported in the colostomy through the implantation of hernia mesh to strengthen the abdominal wall strength around the stoma can effectively prevent the occurrence of PSH.In this study,the use of IPOM method(ie,intraperitoneal fixation)was performed in Miles operation and intraoperative sigmoid stoma in patients with low rectal cancer.The effect of preset hernia patch on the prevention of ostomy hernia.The purpose of this study is to perform Miles operation in patients with low rectal cancer and to use the IPOM approach(Intraperitoneal Onlay Mesh Technique) to implant the Bard CK hernia mesh around sigmoid stoma,to explore the effect of prophylactic?Methods 50 patients were selected to undergone Miles operation and sigmoidostomy through rectus abdominis muscle from June 2014 to June 2015 in our department of anorectal surgery,they Were randomly divided into two groups,each group include 25 patients.The experimental group used IPOM method to preset professional Bard CK hernia mesh in the abdominal wall stoma,the control group directly in the abdominal wall to complete the stoma production.In the experimental group,there were 14 males and 11 females,aged 45-69 years,with an average age of 56.2 years.Among the 25 patients in the control group,13 were male and 12 were female.46-72 years old,the average age of 57.4 years old.Preoperative by the stoma therapist and the doctor co-selected stoma location,and marked.Postoperative stoma was observed and maintained by stoma therapists.Postoperative patients wore an abdominal belt device fixed for 3 months,and avoided big laughter and high intensity manual work.Follow-up patients,accomplish abdominal CT scan to confirm whether or not PSH occurred.Results 50 patients were followed up for a period of 18 to 30 months,an average of 26.8 months.There are 2 patients in the experimental group with abdominal wall foreign body sensation and local tingling feeling,within 1 months this uncomfortable sensation are gone.And 1 patient with dermatitis around the stoma,symptomatic treatment after recovery.The remaining patients were no stoma bleeding,infection,dermatitis,necrosis and other complications.The control group had postoperative 2 stoma around the mouth,symptomatic treatment after recovery.The incidence of postoperative complications was indifference in both groups(P >0.05).All patients received physical examination and abdominal CT scan,asked patients after discharge.6 patients in the control group were examined by CT scan to confirm the occurrence of PSH,and the experimental group did not appear(P<0.05).Conclusion Performing prophylactic Bard CK mesh placement through IPOM approach during Milesge.6 patients in the control group were examined by CTciently prevent parastomal hernia,and not increase the incidence of total complications.Prophylactic hernia mesh placement technology has great application prospects.Domestic researcher needs more multi-center,large sample of prospective randomized controlled study,the accumulation of research data,for the early promotion of this technology,so that patients get better prognosis and quality of life.