LAUSR

In this month’s issue of Colorectal Disease, CorreaMarinez et al. report on the secondary end points of the StomaConst randomized controlled trial [1]. This trial randomised and analysed the parastomal hernia (PSH) and complication rates of 201 patients undergoing an end colostomy. These patients were randomised to have a sublay mesh or a cruciate or circular incision to the sheath to form their colostomy. The paper by Correa Marinez et al. highlights a significant issue impacting on the quality of life of many patients undergoing both emergency and elective colorectal resection [1]. Based on historic data, it has been suggested that up to 30% of rectal cancers are managed with either a Hartmann’s procedure or abdominoperineal resection [2]. David and colleagues demonstrated that less than a third of patients having a Hartmann’s procedure underwent reversal of their stoma [3]. CorreaMarinez and colleagues show that, with an intense followup strategy, a staggering 63% of patients experience a stoma related complication. Indeed, this trial suggested that between 38% and 51% of patients develop a parastomal hernia [4]. The use of mesh to prevent PSH had initial excellent results [5] and was included in the 2017 European Hernia Society guidelines. The present study, unfortunately, builds on a recent metaanalysis [6] that has not demonstrated the superiority of a single technique, including sublay mesh, in preventing stoma related complications and, as previously reported, PSH [4]. Irrespective of the technique used to perform an end colostomy, it is important that it is performed in a careful and meticulous manner. Stoma formation should hold a greater place in training curricula given the considerable potential complications and the impact on patients’ quality of life. In those incidences where the formation of an end colostomy is necessary and justified, we must find ways to reduce the incidence of PSH and stomarelated complication. Studies such as the CIPHER cohort study [7] will go some way towards understanding the breadth of techniques that are currently employed and generate hypotheses as to the drivers of lower herniation and complication rates. I would urge the surgical community to support such initiatives and the studies that will be generated from this work.