Association of Mesenteric Molding Suturing on Parastomal Hernia Incidence: Retrospective Study.

Abstract

<h4>Introduction</h4>Parastomal hernia (PSH) is a common complication following colostomy, with reported incidence rates of 30-50%. Prophylactic mesh reinforcement is effective but associated with long-term risks such as infection and erosion, particularly concerning in elective settings. Mesenteric molding suturing (MMS) is an emerging mesh-free technique that stabilizes the stoma by shaping the mesentery through suturing, potentially reducing PSH risk without implant-related complications. We aimed to assess the association of MMS with PSH incidence compared with conventional end-colostomy.<h4>Methods</h4>This single-center, retrospective cohort study included patients who underwent elective end-colostomy between January 2016 and December 2022. Exclusion criteria were emergency surgery, prior major abdominal surgery, concomitant malignancies, preoperative abdominal wall hernia, severe cardiopulmonary disease, or incomplete follow-up. The primary endpoint was PSH incidence within 2 y, confirmed by clinical examination and/or computed tomography.<h4>Results</h4>The PSH rate was significantly lower in the MMS group (19.8%, 125/630) than in the control group (27.6%, 199/720) (P < 0.001). Multivariable Cox regression showed MMS was associated with reduced PSH risk (hazard ratio = 0.68, 95% confidence interval: 0.21-0.97, P = 0.02). Kaplan-Meier analysis demonstrated significantly lower cumulative PSH incidence in the MMS group over 3 y (log-rank P = 0.0017). MMS was associated with slightly longer operative time but not with increased blood loss, postoperative hospital stay, 30-d readmission, or stoma-related complications.<h4>Conclusions</h4>In elective, nonemergent colostomy, MMS was associated with reduced PSH incidence without being associated with increased surgical complexity, representing a safe and cost-effective alternative worthy of further validation in prospective studies.