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Background <p>Parastomal hernia is a common and time-dependent complication after permanent colostomy following laparoscopic abdominoperineal resection (APR) for rectal cancer. Although prophylactic mesh placement using the Sugarbaker technique has shown favorable short-term results, long-term real-world evidence remains limited.</p> Methods <p>This was an ambispective observational cohort study consisting of a retrospective historical cohort (2018–2021) and a prospectively followed cohort (2021–2025) after the introduction of prophylactic mesh. This study included patients undergoing elective laparoscopic APR with permanent end colostomy between 2018 and 2025. Laparoscopic APR was performed according to a standardized institutional step-by-step protocol that remained unchanged throughout the study period. Patients were categorized into a prophylactic mesh group using the Sugarbaker technique and a non-mesh group, based on study period and patient preference. The primary outcome was the cumulative incidence of parastomal hernia assessed radiologically during follow-up. Time-to-event data were analyzed using the Kaplan–Meier method and compared using the log-rank test.</p> Results <p>A total of 84 patients were included, comprising 40 patients in the mesh group and 44 in the non-mesh group. Baseline demographic and clinical characteristics were comparable between groups. During a follow-up period of up to 4 years, the cumulative incidence of parastomal hernia was consistently lower in the mesh group at all time points. Kaplan–Meier analysis demonstrated a significantly lower incidence of parastomal hernia in the Sugarbaker group compared with the non-mesh group (log-rank <i>p</i> = 0.00018). The absolute risk reduction at 4 years was 47.0%, corresponding to a number needed to treat (NNT) of approximately 2.1. No mesh-related complications were observed during follow-up.</p> Conclusion <p>Prophylactic mesh placement using the Sugarbaker technique during laparoscopic APR was associated with a sustained reduction in PSH risk over 4 years, without evidence of increased perioperative or mesh-related morbidity. These findings suggest that prophylactic mesh may be beneficial in selected patients.</p>

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Effectiveness of prophylactic Sugarbaker mesh during laparoscopic abdominoperineal resection: a cohort study with 4-year follow-up

  • 期刊论文

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  • 发表日期：

    2026年7月14日

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  • Vinh Ngoc Truong Pham,
  • Triet Minh Le,
  • Huy Duc Tran,
  • Viet Van Ung,
  • Thinh Huu Nguyen

摘要

Background

Parastomal hernia is a common and time-dependent complication after permanent colostomy following laparoscopic abdominoperineal resection (APR) for rectal cancer. Although prophylactic mesh placement using the Sugarbaker technique has shown favorable short-term results, long-term real-world evidence remains limited.

Methods

This was an ambispective observational cohort study consisting of a retrospective historical cohort (2018–2021) and a prospectively followed cohort (2021–2025) after the introduction of prophylactic mesh. This study included patients undergoing elective laparoscopic APR with permanent end colostomy between 2018 and 2025. Laparoscopic APR was performed according to a standardized institutional step-by-step protocol that remained unchanged throughout the study period. Patients were categorized into a prophylactic mesh group using the Sugarbaker technique and a non-mesh group, based on study period and patient preference. The primary outcome was the cumulative incidence of parastomal hernia assessed radiologically during follow-up. Time-to-event data were analyzed using the Kaplan–Meier method and compared using the log-rank test.

Results

A total of 84 patients were included, comprising 40 patients in the mesh group and 44 in the non-mesh group. Baseline demographic and clinical characteristics were comparable between groups. During a follow-up period of up to 4 years, the cumulative incidence of parastomal hernia was consistently lower in the mesh group at all time points. Kaplan–Meier analysis demonstrated a significantly lower incidence of parastomal hernia in the Sugarbaker group compared with the non-mesh group (log-rank p = 0.00018). The absolute risk reduction at 4 years was 47.0%, corresponding to a number needed to treat (NNT) of approximately 2.1. No mesh-related complications were observed during follow-up.

Conclusion

Prophylactic mesh placement using the Sugarbaker technique during laparoscopic APR was associated with a sustained reduction in PSH risk over 4 years, without evidence of increased perioperative or mesh-related morbidity. These findings suggest that prophylactic mesh may be beneficial in selected patients.