Comparative retrospective study between using mesh or not in ileostomy closure as a preventive method for incisional hernia

Background and aims
Stomal-site incisional hernia is a complication following ileostomy closure, with rates of about 40%. Because there were no previous studies undertaken to find a definite solution for it. Different preventive methods were studied to decrease the incidence of post-ileostomy closure incisional hernia. One of these methods was the usage of prophylactic mesh-reinforcement mode of absorbable poliglecaprone monofilament fiber and nonabsorbable polypropylene monofilament fiber during ileostomy closure and to study its role in prevention of stomal-site incisional hernia without increasing the incidence of wound complications.
Aim
Evaluating the importance of prophylactic mesh reinforcement during closure of ileostomy to prevent stomal-site incisional hernia.
Patients and methods
This was a retrospective study, which included 40 Egyptian patients presenting for ileostomy closure. Half of them without mesh and the other half applied mesh at ileostomy site during closure. Patients of the two groups underwent ileostomy closure between February 2018 and March 2020 and then they had been assessed in the following 2 years for the occurrence of postoperative incisional hernias.
Results
Regarding the incidence of incisional hernia, 10 (25%) out of 40 patients in the current study developed incisional hernias. In group B (without mesh reinforcement), eight (40.0%) patients developed incisional hernias, while in group A (with mesh reinforcement), two (10.0%) patients developed incisional hernias. Although there was a trend for developing incisional hernia in patients without mesh reinforcement and the study shows significant results of incisional hernia reduction with mesh reinforcement during the first 6 months after closure (=0.035), prophylactic mesh repair significantly reduces that incidence in the total follow-up period of 2 years (=0.028).
Conclusion
The study shows a significant decrease of incisional hernia with mesh reinforcement during the first 6 months after closure. However, in the total follow-up period of 2 years, prophylactic mesh repair significantly reduces post-ileostomy closure incidence of incisional hernia, without significantly increasing the incidence of wound infection.