A Randomized Controlled Study on Patients Who Underwent Ileostomy Closure with Mesh Reinforcement and its Value in Prevention of Closure Site Incisional Hernia

Abstract Background: Stomal site incisional hernia is often an underestimated complication following ileostomy closure, with rates about 40%. This was because there were no sufficient previous studies undergone to find a definite solution for it. Therefore, various preventive methods was studied to reduce the incidence of post-ileostomy closure incisional hernia. One of these methods was the usage of prophylactic mesh rein-forcement (using a mesh manufactured from approximately equal parts of absorbable poliglecaprone monofilament fiber and non-absorbable polypropylene monofilament fiber) during ileostomy closure and study its role in prevention of stomal site incisional hernia without increasing the incidence of wound complications. Aim of Study: Evaluation of the role of prophylactic mesh reinforcement during closure of ileostomy in prevention of stomal site incisional hernia. Patients and Methods: This was a retrospective study, included 30 Egyptian patients presenting for ileostomy closure. Half of them were control and the other half applied mesh at ileostomy site during closure. Patients of the two groups underwent ileostomy closure between February 2016 and March 2018 and then they had been assessed in the following two years for the occurrence of post-operative incisional hernias. Results: Regarding the incidence of incisional hernia, 9 out of 30 patients (30%) in the current study developed incisional hernias. In group B (without mesh reinforcement) 7 patients (46.7%) developed incisional hernias, while in group A (with mesh reinforcement) 2 patients (13.3%) devel-oped incisional hernias. Although there was trend for devel-oping incisional hernia in patients without mesh reinforcement and the study shows significant result of incisional hernia reduction with mesh reinforcement during the first six months after closure (p=0.0421), prophylactic mesh repair did not significantly reduce that incidence in the total follow-up period of the two years (p=0.1086). Conclusion: We have concluded that the study shows significant result of incisional hernia reduction with mesh reinforcement during the first six months after closure. However, in the total follow-up period of the two years prophylactic mesh repair did not significantly reduce post-ileostomy closure incidence of incisional hernia, without significantly increasing the incidence of wound infection.