Abstract
Background
Parastomal hernias (PSH) are one of the most frequent complications of enterostomies with a non-negligible complication rate and a significant socioeconomic effect. Therefore, preventing PSH by placing a mesh at the time of primary surgery has been advocated. The aim of our study was to evaluate the safety and feasibility of the new stomaplasty ring [Koring™, (Koring GmbH, Basel, Switzerland)] and investigate the reason why surgeons are reluctant to take preventive measures.
Methods
A multicenter observational study was conducted on 30 patients between December 2013 and January 2015. In permanent end colostomies and end ileostomies, the Koring™ was implanted. The primary outcome was the 30-day morbidity (infection and other stoma-related complications). Secondary endpoints were the technical feasibility and the time needed to fix the ring. In addition, an online survey of 107 surgeons was performed.
Results
Twenty-seven patients received permanent end colostomies, and three received end ileostomies. No stoma-related complication was detected within the first 30 days post-operatively. The Koring™ ring was evaluated by the surgeons as easy and very easy to implant in more than half of the patients. Average additional operating time for ring implantation was 19 min.
Conclusions
Koring™ implantation at the time of creating the stoma is safe, easy and only adds minimally operating time. A long-term follow-up as well as a randomized controlled study is needed to evaluate the impact of the Koring™ on PSH prevention. The ease and rapidity with which Koring™ can be implanted may help surgeons to overcome their apprehension of using a preventative device.
Similar content being viewed by others
References
Brown H, Randle J (2005) Living with a stoma: a review of the literature. J Clin Nurs 14:74–81
Carne PW, Robertson GM, Frizelle FA (2003) Parastomal hernia. Br J Surg 90:784–793
Tam KW, Wei PL, Kuo LJ, Wu CH (2010) Systematic review of the use of a mesh to prevent parastomal hernia. World J Surg 34:2723–2729
Pearl RK (1989) Parastomal hernias. World J Surg 13:569–572
Hammond TM, Huang A, Prosser K, Frye JN, Williams NS (2008) Parastomal hernia prevention using a novel collagen implant: a randomised controlled phase 1 study. Hernia 12:475–481
Janes A, Cengiz Y, Israelsson LA (2004) Randomized clinical trial of the use of a prosthetic mesh to prevent parastomal hernia. Br J Surg 91:280–282
Serra-Aracil X, Bombardo-Junca J, Moreno-Matias J et al (2009) Randomized, controlled, prospective trial of the use of a mesh to prevent parastomal hernia. Ann Surg 249:583–587
Vijayasekar C, Marimuthu K, Jadhav V, Mathew G (2008) Parastomal hernia: Is prevention better than cure? Use of preperitoneal polypropylene mesh at the time of stoma formation. Tech Coloproctol 12:309–313
Bayer I, Kyzer S, Chaimoff C (1986) A new approach to primary strengthening of colostomy with Marlex mesh to prevent paracolostomy hernia. Surg Gynecol Obstet 163:579–580
Berger D (2008) Prevention of parastomal hernias by prophylactic use of a specially designed intraperitoneal onlay mesh (Dynamesh IPST). Hernia 12:243–246
Gogenur I, Mortensen J, Harvald T, Rosenberg J, Fischer A (2006) Prevention of parastomal hernia by placement of a polypropylene mesh at the primary operation. Dis Colon Rectum 49:1131–1135
Hotouras A, Murphy J, Thaha M, Chan CL (2013) The persistent challenge of parastomal herniation: a review of the literature and future developments. Colorectal Dis 15:e202–e214
Hoffmann H, Oertli D, Soysal S, Zingg U, Hahnloser D, Kirchhoff P (2015) A promising new device for the prevention of parastomal hernia. Surg Innov 22:283–284
Wijeyekoon SP, Gurusamy K, El-Gendy K, Chan CL (2010) Prevention of parastomal herniation with biologic/composite prosthetic mesh: a systematic review and meta-analysis of randomized controlled trials. J Am Coll Surg 211:637–645
Sugarbaker PH (1989) Prevention of hernia after enterostomy. Surg Gynecol Obstet 169:75–77
Kohler G, Hofmann A, Lechner M et al (2016) Prevention of parastomal hernias with 3D funnel meshes in intraperitoneal onlay position by placement during initial stoma formation. Hernia 20:151–159
Acknowledgments
We would like to thank all participating centers and surgeons, especially Urs Zingg, Limattal Hospital Zurich.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
The Koring is CE certified (EU1306403) and the KORING company is ISO 14385 certified.
Informed consent
Informed consent was obtained at each center.
Additional information
V. Guarnero and H. Hoffmann have contributed equally to this work.
Rights and permissions
About this article
Cite this article
Guarnero, V., Hoffmann, H., Hetzer, F. et al. A new stomaplasty ring (Koring™) to prevent parastomal hernia: an observational multicenter Swiss study. Tech Coloproctol 20, 293–297 (2016). https://doi.org/10.1007/s10151-016-1452-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-016-1452-4