Prophylactic full-thickness suturing of the rectus abdominis muscle reduces parastomal hernia after enterostomy: a 5-year retrospective cohort study.
- 1Department of Colorectal and Anal Surgery, Shengzhou People's Hospital (Shengzhou Branch of the First Affiliated Hospital of Zhejiang University School of Medicine, Shengzhou Hospital of Shaoxing University), Shaoxing, China.
- 2Ningbo University, Ningbo, China.
Abstract
Background
Parastomal hernia (PSH) is one of the most common long-term complications after enterostomy. Prophylactic mesh can reduce PSH risk but is limited by mesh-related adverse events and high costs. This study aimed to evaluate the efficacy and safety of prophylactic full-thickness rectus abdominis suturing for PSH prevention without implant materials.Methods
This single-center retrospective cohort study enrolled 244 patients undergoing enterostomy from January 2020 to December 2024. Patients were allocated alternately by calendar-month: 94 patients received full-thickness rectus-suture reinforcement (reinforcement group), and 150 underwent conventional stoma creation (conventional group). The primary endpoint was CT-confirmed PSH incidence within 2-year follow-up. Secondary endpoints included hernia-sac diameter, time-to-PSH-onset and stoma-related complications. Univariable and multivariable logistic regression, Firth penalized regression, 1:1 propensity-score-matching (PSM), Kaplan-Meier survival analysis and interrupted time-series (ITS) segmented regression were performed.Results
The reinforcement group showed significantly lower 2-year PSH incidence (9.6% vs. 27.3%, P < 0.001). Suture reinforcement was an independent protective factor against PSH (adjusted OR = 0.29, 95% CI: 0.13-0.65, P = 0.002), and Firth-penalized logistic regression confirmed the stability of this finding (OR = 0.31, 95% CI: 0.14-0.68, P = 0.003). After PSM, the inter-group difference remained significant (14.9% vs. 31.9%, P = 0.006), and multivariable regression in the matched cohort still identified suture reinforcement as an independent protective factor (adjusted OR = 0.35, 95% CI: 0.17-0.72, P = 0.004). Patients in the reinforcement group had smaller hernia-sac diameter (2.9 cm vs. 7.3 cm, P < 0.001) and delayed PSH onset (12.2 months vs. 6.7 months, P = 0.001). ITS analysis supported the robustness of observational findings. Early postoperative complication rates were comparable between groups.Conclusions
Prophylactic full-thickness rectus-abdominis suturing is associated with reduced PSH incidence, delayed hernia onset and milder hernia severity. This implant-free, low-cost technique is safe and simple. Prospective randomized trials are needed to further validate its clinical value.
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BibTeX
@article{zhang2026prophylactic,
title = {{Prophylactic full-thickness suturing of the rectus abdominis muscle reduces parastomal hernia after enterostomy: a 5-year retrospective cohort study.}},
author = {Guoqiang Zhang and Bowen Zheng},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1978158},
url = {https://europepmc.org/article/MED/42908567},
note = {CC BY},
}
RIS
TY - JOUR
TI - Prophylactic full-thickness suturing of the rectus abdominis muscle reduces parastomal hernia after enterostomy: a 5-year retrospective cohort study.
AU - Guoqiang Zhang
AU - Bowen Zheng
PY - 2026
DA - 2026/10/07
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1978158
UR - https://europepmc.org/article/MED/42908567
AB - Background Parastomal hernia (PSH) is one of the most common long-term complications after enterostomy. Prophylactic mesh can reduce PSH risk but is limited by mesh-related adverse events and high costs. This study aimed to evaluate the efficacy and safety of prophylactic full-thickness rectus abdominis suturing for PSH prevention without implant materials.Methods This single-center retrospective cohort study enrolled 244 patients undergoing enterostomy from January 2020 to December 2024. Patients were allocated alternately by calendar-month: 94 patients received full-thickness rectus-suture reinforcement (reinforcement group), and 150 underwent conventional stoma creation (conventional group). The primary endpoint was CT-confirmed PSH incidence within 2-year follow-up. Secondary endpoints included hernia-sac diameter, time-to-PSH-onset and stoma-related complications. Univariable and multivariable logistic regression, Firth penalized regression, 1:1 propensity-score-matching (PSM), Kaplan-Meier survival analysis and interrupted time-series (ITS) segmented regression were performed.Results The reinforcement group showed significantly lower 2-year PSH incidence (9.6% vs. 27.3%, P < 0.001). Suture reinforcement was an independent protective factor against PSH (adjusted OR = 0.29, 95% CI: 0.13-0.65, P = 0.002), and Firth-penalized logistic regression confirmed the stability of this finding (OR = 0.31, 95% CI: 0.14-0.68, P = 0.003). After PSM, the inter-group difference remained significant (14.9% vs. 31.9%, P = 0.006), and multivariable regression in the matched cohort still identified suture reinforcement as an independent protective factor (adjusted OR = 0.35, 95% CI: 0.17-0.72, P = 0.004). Patients in the reinforcement group had smaller hernia-sac diameter (2.9 cm vs. 7.3 cm, P < 0.001) and delayed PSH onset (12.2 months vs. 6.7 months, P = 0.001). ITS analysis supported the robustness of observational findings. Early postoperative complication rates were comparable between groups.Conclusions Prophylactic full-thickness rectus-abdominis suturing is associated with reduced PSH incidence, delayed hernia onset and milder hernia severity. This implant-free, low-cost technique is safe and simple. Prospective randomized trials are needed to further validate its clinical value.
SN - 2296-858X
ER -