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- Title
Open Retromuscular Sugarbaker vs Keyhole Mesh Placement for Parastomal Hernia Repair: A Randomized Clinical Trial.
- Authors
Maskal, Sara M.; Ellis, Ryan C.; Fafaj, Aldo; Costanzo, Adele; Thomas, Jonah D.; Prabhu, Ajita S.; Krpata, David M.; Beffa, Lucas R. A.; Tu, Chao; Zheng, Xinyan; Miller, Benjamin T.; Rosen, Michael J.; Petro, Clayton C.
- Abstract
This randomized clinical trial compared 2 mesh placement techniques for open retromuscular parastomal hernia repair in 150 patients with a permanent stoma to determine which was better at preventing parastomal hernia recurrence. Key Points: Question: During open retromuscular parastomal hernia repair, is the retromuscular Sugarbaker mesh placement technique superior to the keyhole technique? Findings: In this randomized clinical trial, the open retromuscular Sugarbaker mesh placement technique was not superior to the keyhole technique in regard to 2-year parastomal hernia recurrence. Meaning: The use of either retromuscular mesh placement technique based on patient anatomy and surgeon expertise is reasonable. Importance: Durable parastomal hernia repair remains elusive. There is limited evidence comparing the durability of the open retromuscular Sugarbaker and keyhole mesh configurations. Objective: To determine if the open retromuscular Sugarbaker mesh placement technique would lower parastomal hernia recurrence rates. Design, Setting, and Participants: In this single-center, randomized clinical trial, 150 patients with a permanent stoma and associated parastomal hernia who were candidates for open retromuscular parastomal hernia repair were enrolled and randomized from April 2019 to April 2022 and followed up for 2 years. Interventions: Following intraoperative assessment to determine the feasibility of either technique, enrolled patients were randomized to receive either retromuscular Sugarbaker or keyhole synthetic mesh placement. Main Outcomes and Measures: The primary outcome was parastomal hernia recurrence at 2 years. Secondary outcomes included mesh-related complications, wound complications, reoperations, as well as patient-reported pain, abdominal wall–specific quality of life, stoma-specific quality of life, and decision regret at 1 year and 2 years. Results: A total of 150 patients were randomized, and with 91% follow-up at 2 years, there were 13 (17%) parastomal hernia recurrences in the retromuscular Sugarbaker arm and 18 (24%) in the keyhole arm (adjusted risk difference, −0.029; 95% CI, −0.17 to 0.153, and adjusted risk ratio, 0.87; 95% CI, 0.42 to 1.69). There were no statistically significant differences between the Sugarbaker and keyhole groups regarding reoperations for recurrence (2 vs 7, respectively), nonhernia intra-abdominal pathology (4 vs 10, respectively), stoma necrosis (1 vs 0, respectively), mesh-related complications (4 vs 1, respectively), patient-reported pain, abdominal wall–specific quality of life, stoma-specific quality of life, and decision regret at any time point. Conclusions and Relevance: In the setting of open parastomal hernia repair, a retromuscular Sugarbaker mesh placement technique was not superior to a keyhole configuration 2 years after repair. Further innovation is necessary to improve parastomal hernia repair outcomes. Trial Registration: ClinicalTrials.gov Identifier: NCT03972553
- Publication
JAMA Surgery, 2024, Vol 159, Issue 9, p982
- ISSN
2168-6254
- Publication type
Article
- DOI
10.1001/jamasurg.2024.1686