***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : The aim of this study was to assess the reduction in the incidence of parastomal hernia ( PH )  after placement of prophylactic synthetic mesh using a modified Sugarbaker technique when a permanent end-colostomy is needed . Summary of Background Data : Prevention of PH formation is crucial given the high prevalence of PH and difficulties in the surgical repair of PH . Methods : A r and omized , prospect i ve , double-blind , and controlled trial . Rectal cancer patients undergoing laparoscopic abdominoperineal resection with permanent colostomy were r and omized ( 1 : 1 ) to the mesh and nonmesh arms . In the mesh group , a large-pore lightweight composite mesh was placed in the intraperitoneal/onlay fashion using a modified Sugarbaker technique .  PH was detected by computed tomography ( CT ) after a minimum follow-up of 12 months . Analysis was per- protocol . Results : The mesh group included 24 patients and the control group 28 .  Preoperative data , surgical time , and postoperative morbidity were similar . The median follow-up was 26 months . After CT examination , 6 of 24 PHs ( 25 % ) were observed in the mesh group compared with 18 of 28 ( 64.3 % ) in the nonmesh group ( odds ratio 0.39 , 95 % confidence interval 0.18–0.82 ; P = 0.005 ) . The Kaplan-Meier curves showed significant differences in favor of the mesh group ( long-rank = 4.21 , P = 0.04 ) . The number needed to treat was 2.5 , which confirmed the effectiveness of the intervention . Conclusions : Placement of a prosthetic mesh by the laparoscopic approach following the modified Sugarbaker technique is safe and effective in the prevention of PH , reducing significantly the incidence of PH Purpose Parastomal hernia ( PSH ) is a common complication after colostomy formation . Recent studies indicate that mesh implantation during formation of a colostomy might prevent a PSH . To determine if placement of a retromuscular mesh at the colostomy site is a feasible , safe and effective procedure in preventing a parastomal hernia , we performed a multicentre r and omized controlled trial in 11 large teaching hospitals and three university centres in The Netherl and s. Methods Augmentation of the abdominal wall with a retromuscular light-weight polypropylene mesh ( Parietene Light ™ , Covidien ) around the trephine was compared with traditional colostomy formation .  Patients undergoing elective open formation of a permanent end-colostomy were eligible . 150 patients were r and omized between 2010 and 2012 . Primary endpoint of the PREVENT trial is the incidence of parastomal hernia . Secondary endpoints are morbidity , pain , quality of life , mortality and cost-effectiveness . This article focussed on the early results of the PREVENT trial and , therefore , operation time , postoperative morbidity , pain , and quality of life were measured . Results Outcomes represent results after 3 months of follow-up . A total of 150 patients were r and omized . Mean operation time of the mesh group ( N = 72 ) was significantly longer than in the control group ( N = 78 ) ( 182.6 vs. 156.8 min ; P = 0.018 ) . Four ( 2.7 % ) peristomal infections occurred of which one ( 1.4 % ) in the mesh group . No infection of the mesh occurred . Most of the other infections were infections of the perineal wound , equally distributed over both groups . No statistical differences were discovered in stoma or mesh-related complications , fistula or stricture formation , pain , or quality of life . Conclusions During open and elective formation of an end-colostomy , primary placement of a retromuscular light-weight polypropylene mesh for prevention of a parastomal hernia is a safe and feasible procedure . The PREVENT trial is registered at : http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=2018 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Parastomal hernias ( PH ) are frequent with a high morbidity . Three r and omised controlled trials have shown that prophylactic mesh stoma reinforcement significantly reduces their incidence . Implantation and fixation of mesh can be time-consuming , difficult to perform laparoscopically and does not deal with the excessive stretching of the trephine and the creation of an oversized defect . The Stapled Mesh stomAReinforcement Technique ( SMART ) obviates these technical problems . The aim of this study was to assess the safety and efficacy of a novel surgical technique called SMART in preventing parastomal herniation . MethodS MART uses a purpose design ed circular stapling gun ( Compact ™ , Frankenman International Limited ) of various diameters to create a precise trephine and simultaneously fixes a mesh sub-peritoneally and circumferentially to the trephine . Recruited patients were deemed to be high risk for parastomal herniation and r and omisation in a controlled trial was contraindicated . Incidence of parastomal related symptoms and recurrences were documented at clinic visits and radiological confirmation of recurrences , when available , was used for final analysis . A control group of patients who underwent stoma resiting without mesh reinforcement for parastomal herniation was used for comparative purpose s. Results 22 patients ( 16 F:6 M , mean age 49 ± 16 years , BMI 33.0 ± 7.0 ) underwent SMART ( 18 open , 4 laparoscopic ) . There were no intra-operative or early stoma complications . During a median FU of 21 months ( range 12–24 ) , four patients ( 19 % ) were diagnosed with recurrent parastomal herniation , one of which required re-operation . The parastomal herniation rate ( 73 % ) in the control group ( 6 F:5 M ) was significantly higher ( p = 0.003 ) although patients had similar age ( 59 ± 15 years , p = 0.1 ) and body-mass index ( 29.0 ± 3.0 , p = 0.1 ) . ConclusionS MART is a new and simple technique of precisely creating a reinforced stoma trephine at both open and laparoscopic surgery . It obviates the technical disadvantages of traditional stoma formation . This pilot study , in a selected group of patients at high risk for parastomal herniation , indicates that the procedure is clinical ly safe but r and omised controlled trials are required to determine its efficacy in reducing parastomal herniation in all patients undergoing elective stoma formation Background Hernias around ostomies are a very common complication , exceeding 50 % . Only a few studies deal with the prophylactic use of mesh to prevent parastomal hernia revealing promising results . Patients and methods Twenty-two patients undergoing elective rectal surgery with a permanent colostomy — one with an ileostomy and two needing surgical correction of a preexisting colostomy — were enrolled in a prospect i ve study . A specially design ed mesh made of polyvinylidene fluoride with a central whole and a funnel arising ( Dynamesh IPST ® ) was prophylactically implanted using an intraperitoneal onlay technique . The patients were followed for a median of 11 ( range 2–19 ) months by clinical examination every 3 months . Results No infection or any other adverse effect was observed , and no parastomal hernia or stoma protrusion could be detected clinical ly . Twelve patients had a routine computed tomography after 6 months , which also excluded any hernia formation . Conclusion The prophylactic use of Dynamesh IPST ® is a safe and effective procedure preventing stoma complications such as hernia formation or prolapse , at least in the short run Abstract Objective . There are no data on the frequency of  parastomal hernia ( PSH )  after ileal conduit with a prophylactic mesh . The primary objective of this study was to determine the prevalence of PSH . Secondary objectives were to elaborate whether age , gender , body mass index ( BMI ) , previous laparotomy or diabetes influenced the outcome ; and to find any mesh-related complications . Material s and methods . In a single centre during 2003 - 2012 , a large-pore , lightweight mesh was placed in a sublay position in 114 consecutive patients with ileal conduits . Preoperative and postoperative patient data were retrospectively collected and cross-sectional follow-up was conducted . During the predefined clinical examination a PSH was defined as any protrusion in the vicinity of the ostomy with the patient straining in both an erect and a supine position . Results .Fifty-eight patients ( 24 women and 34 men , mean age 69 years ) had follow-up examinations after a mean of 35 months ( median 32 months ) . Bladder cancer was the most common cause for surgery . Eight patients ( 14 % ) had a PSH . Age , gender , BMI , previous laparotomy and diabetes did not affect the outcome . No mesh-related complications occurred among the 114 patients with a prophylactic mesh . Conclusions . The prevalence of PSH after ileal conduit with a prophylactic mesh corresponded to that of colostomies with a prophylactic mesh . A prophylactic mesh did not seem to be associated with complications . The degree to which a prophylactic mesh may reduce the rate of PSH after an ileal conduit should be established in r and omized trials Introduction Parastomal hernias occur frequently after placement of a permanent colostomy . Preliminary reports have shown a beneficial effect of placing a mesh at the primary operation to prevent the formation of a parastomal hernia . We studied the safety and prophylactic effect of placing a newly design ed polypropylene mesh in an onlay position at the primary operation . Methods This was a prospect i ve study that included 25 patients scheduled for elective colorectal surgery . Risk factors for development of parastomal hernia were recorded before surgery . A prepared lasercut polypropylene mesh with six “ arms ” was placed in an onlay position . Immediate and long-term complications were evaluated by an experienced stoma nurse and a surgeon .  Abdominal ultrasound  was performed at 6 and 12 months follow-up . Parastomal hernia was defined as both clinical and ultrasonographic signs of protrusion in the vicinity of the stoma . Results The median follow-up time was 12 ( range , 2–26 ) months . One patient died eight days after surgery . Of the 24 patients included , none had infections or immediate complications after surgery . Two patients had minor complications necessitating a local revision of one of the mesh arms . No other long-term complication was found . Two patients had signs of parastomal hernia at 6 and 12 months follow-up , respectively . Conclusions Placement of a polypropylene mesh in an onlay position at the primary operation is a safe procedure and probably results in a low risk of parastomal hernia occurrence Parastomal  hernia ( PSH ) is the most common complication of an end‐colostomy and about one‐quarter of patients need operative repair , which is often unsuccessful . A r and omized trial was carried out to compare the results of using mesh or no mesh at the time of formation of a colostomy with the clinical identification of PSH as the primary outcome Background : The prevalence of terminal parastomal hernia ( PH ) after colostomy placement  may be as high as 50 % . The effect of the PH may range from discomfort to life-threatening complications . Surgical procedures for repairing PH are difficult to perform and present a high-failure rate . Objective : To reduce the incidence of PH by implanting a lightweight mesh in the sublay position . Material and Methods : R and omized , controlled , prospect i ve study . Patients were scheduled for permanent end colostomy surgery to treat cancer of the lower third of the rectum , performed by the same colorectal surgery team . An Ultrapro lightweight mesh was inserted in the sublay position in the study group . Using simple r and omization , the sample size required was estimated to be 27 per group . Patients were followed-up clinical ly and radiologically with abdominal computed tomography by an independent clinician and a radiologist who were all blind to the aims of the study , 1 month and every 6 months after surgery . Results : The groups were homogeneous in terms of their clinical and demographic characteristics . Surgical time and postoperative morbidity were similar in the 2 groups . Mortality was 0 . No mesh intolerance was reported . In the clinical follow-up ( median : 29 months , range : 13–49 ) , 11/27 ( 40.7 % ) hernias were recorded in the control group compared with 4/27 ( 14.8 % ) in the study group ( P = 0.03 ) . Abdominal computed tomography identified 14/27 ( 44.4 % ) hernias in the control group compared with 6/27 ( 22.2 % ) in the study group ( P = 0.08 ) . Conclusions : Parastomal placement of a mesh reduces the appearance of PH . The technique is safe , well-tolerated , and does not increase morbidity rates BACKGROUND : A large proportion of patients with a colostomy or an ileostomy develop parastomal hernias . The placement of a reinforcing material at the stoma site may reduce parastomal hernia incidence . OBJECTIVE : We aim ed to assess the safety and efficacy of 
    Output:
    
There were no differences in rates of parastomal infection , stomal stenosis or necrosis .
Mesh type and position , and study quality did not have an independent effect on this relationship .
CONCLUSION Mesh placed prophylactically at the time of stoma creation reduced the rate of parastomal hernia , without an increase in mesh-related complications