Email updates

Keep up to date with the latest news and content from Trials and BioMed Central.

Open Access Study protocol

PREVENTion of a parastomal hernia with a prosthetic mesh in patients undergoing permanent end-colostomy; the PREVENT-trial: study protocol for a multicenter randomized controlled trial

Henk-Thijs Brandsma1*, Birgitta ME Hansson1, Hilde V-Haaren-de Haan1, Theo J Aufenacker2, Camiel Rosman1 and Rob P Bleichrodt1

Author Affiliations

1 Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

2 Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands

For all author emails, please log on.

Trials 2012, 13:226  doi:10.1186/1745-6215-13-226

Published: 27 November 2012

Abstract

Background

Parastomal hernia is a common complication of a colostomy. Ultimately, one-third of patients with a parastomal hernia will need surgical correction due to frequent leakage or life-threatening bowel obstruction or strangulation. However, treatment remains a challenge resulting in high recurrence rates. Two single center trials demonstrated that the frequency of parastomal hernias decreases by prophylactic placement of a mesh around the stoma at the time of formation. Unfortunately, both studies were small-sized, single-center studies and with these small numbers less common complications could be missed which were the reasons to initiate a prospective randomized multicenter trial to determine if a retromuscular, preperitoneal mesh at the stoma site prevents parastomal hernia and does not cause unacceptable complications.

Methods

One hundred and fifty patients undergoing open procedure, elective formation of a permanent end-colostomy will be randomized into two groups. In the intervention group an end-colostomy is created with placement of a preperitioneal, retromuscular lightweight monofilament polypropylene mesh, and compared to a group with a traditional stoma without mesh. Patients will be recruited from 14 teaching hospitals in the Netherlands during a 2-year period. Primary endpoint is the incidence of parastomal hernia. Secondary endpoints are stoma complications, cost-effectiveness, and quality of life. Follow-up will be performed at 3 weeks, 3 months and at 1, 2, and 5 years. To find a difference of 20% with a power of 90%, a total number of 134 patients must be included. All results will be reported according to the CONSORT 2010 statement.

Discussion

The PREVENT-trial is a multicenter randomized controlled trial powered to determine whether prophylactic placement of a polypropylene mesh decreases the incidence of a parastomal hernia versus the traditional stoma formation without a mesh.

Trial registration

The PREVENT-trial is registered at: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2018 webcite

Keywords:
Parastomal hernia; Prophylactic; Prevention; Mesh; Colostomy