***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 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 Objective : The aim of this study was to determine whether parastomal hernia ( PSH ) rate can be reduced by using synthetic mesh in the sublay position when constructing permanent end colostomy . The secondary aim was to investigate possible side-effects of the mesh . Background : Prevention of PSH is important as it often causes discomfort and leakage from stoma dressing . Different methods of prevention have been tried , including several mesh techniques . The incidence of PSH is high ; up to 78 % . Methods : R and omized controlled double-blinded multicenter trial . Patients undergoing open colorectal surgery , including creation of a permanent end colostomy , were r and omized into 2 groups , with and without mesh . A lightweight polypropylene mesh was placed around the colostomy in the sublay position . Follow up after 1 month and 1 year .  Computerized tomography  and clinical examination  were used to detect PSH at the 1-year follow up . Data were analyzed on an intention-to-treat basis . Results : After 1 year , 211 of 232 patients underwent clinical examination and 198 radiologic assessment s. Operation time was 36 minutes longer in the mesh arm . No difference in rate of PSH was revealed in the analyses of clinical ( P = 0.866 ) and radiologic ( P = 0.748 ) data . There was no significant difference in perioperative complications . Conclusions : The use of reinforcing mesh does not alter the rate of PSH . No difference in complication rate was seen between the 2 arms . Based on these results , the prophylactic use of mesh to prevent PSH can not be recommended Purpose Prevention of parastomal hernia represents an important aim when a permanent stoma is necessary . The objective of this work is to assess whether implantation of a prophylactic prosthetic mesh during laparoscopic abdominoperineal resection contributed to reduce the incidence of parastomal hernia . Methods Rectal cancer patients undergoing elective laparoscopic abdominoperineal resection with permanent colostomy were r and omized to placement of a large-pore lightweight mesh in the intraperitoneal/onlay position by the laparoscopic approach ( study group ) or to the  control group ( no mesh ) . Parastomal hernia was defined radiologically by a CT scan performed after 12 months of surgery . The usefulness of subcutaneous fat thickness measured by CT to discriminate patients at risk of parastomal hernia was assessed by ROC curve analysis . Results Thirty-six patients were r and omized , 19 to the mesh group and 17 to the control group .  Parastomal hernia was detected in 50 % of patients in the mesh group and in 93.8 % of patients in the control group ( P = 0.008 ) . The AUC for thickness of the subcutaneous abdominal was 0.819 ( P = 0.004 ) and the optimal threshold 23 mm . Subcutaneous fat thickness ≥23 mm was a significant predictor of parastomal hernia ( odds ratio 15.7 , P = 0.010 ) , whereas insertion of a mesh was a protective factor ( odds ratio 0.06 , P = 0.031 ) . Conclusions Use of prophylactic large-pore lightweight mesh in the intraperitoneal/onlay position by a purely laparoscopic approach reduced the incidence of parastomal hernia formation . Subcutaneous fat thickness ≥23 mm measured by CT was an independent predictor of parastomal hernia 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 stoma reinforcement with sublay placement of non-cross-linked porcine-derived acellular dermal matrix at the time of stoma construction . DESIGN : This is a r and omized , patient- and third-party assessor-blind , controlled trial . SETTING S : This study took place in colorectal/general surgery institutions . INTERVENTIONS : Patients were prospect ively r and omly assigned to undergo st and ard end-stoma construction with or without porcine-derived acellular dermal matrix reinforcement . PATIENTS : Patients undergoing construction of a permanent stoma were eligible . A total of 113 patients ( 59 men , 54 women ; mean age , 60 years ; mean BMI , 25.4 kg/m2 ) participated : 58 controls and 55 with reinforcement . MAIN OUTCOMES MEASURES : The incidence of parastomal hernia , safety , and stoma-related quality of life were assessed . RESULTS : Intraoperative complications and blood loss were similar between groups . Quality -of-life scores were similar through 24 months of follow-up . At 24 months of follow-up , the incidence of parastomal hernias was similar for both groups ( 12.2 % of the porcine-derived acellular dermal matrix group and 13.2 % of controls ) . LIMITATIONS : Study limitations include the inclusion of ileostomy and colostomy patients , open and laparoscopic techniques , and small numbers of patients at follow-up . CONCLUSIONS : Safety and quality -of-life data from this r and omized control trial show similar outcomes in both groups . Prosthetic reinforcement of stomas was safe , but it did not significantly reduce the incidence of parastomal hernia formation . Clinical Trial Registration : Identification no. NCT00771407 Background Parastomal hernia is a major clinical problem . In a r and omized , clinical trial , a prosthetic mesh in a sublay position at the index operation reduced the rate of parastomal hernia at 12-month follow-up , without any increase in the rate of complications . This study was design ed to evaluate the rate of complications after 5 years . Methods Between January 2001 and April 2003 , 54 patients who had a permanent ostomy were r and omized to a conventional stoma or to a stoma with the addition of a mesh in a sublay position . A large-pore , lightweight mesh with a reduced polypropylene content and a high proportion of absorbable material was used . Results After 5 years , 21 patients with a conventional stoma were alive and parastomal herniation was recorded in 17 patients , of whom repair had been dem and ed in 5 . In 15 patients operated on with the addition of a mesh herniation , that did not require repair , was present in 2 ( P < 0.001 ) . No fistulas or strictures developed . No mesh infection was noted and no mesh was removed during the study period . Conclusions At stoma formation , a prophylactic low-weight mesh in a sublay position is a safe procedure that reduces the rate of parastomal hernia Background Parastomal hernias can be prevented or repaired using synthetic mesh ; however , reported complications include infection , fibrosis and potential bowel erosion . The study aim was to assess the safety , feasibility and potential efficacy of using a prophylactic collagen implant . Methods Twenty patients undergoing defunctioning stomas were r and omised to a conventional procedure or reinforcement with the implant . Follow-up included regular symptom question naires , clinical examination , stoma site ultrasound , and serum inflammatory markers . Results Ten patients ( four males ; mean BMI 26.3 ) had a conventional stoma , and ten ( three males ; mean BMI 26.3 ) received the implant . At a median of 6.5 months follow-up , a parastomal hernia was clinical ly evident in three of ten patients without the implant , and in none of ten patients with the implant . There were no clinical complications , ultrasound evidence of chronic seromas or serological evidence of a systemic inflammatory response . Conclusions Xenogeneic collagen has been demonstrated to aid soft tissue reinforcement . In this study , in contrast to published data relating to the use of conventional synthetic mesh , there were no complications related to infection or the implant ’s proximity to the bowel . This trial demonstrates that the implant is safe , feasible to use and has the potential to prevent parastomal herniation Objective : The aim of this study was to investigate the incidence of parastomal hernias ( PSHs ) after end-colostomy formation using a  polypropylene mesh in a r and omized controlled trial versus conventional colostomy formation . Background : A PSH is the most frequent complication after stoma formation . Symptoms may range from mild abdominal pain to life-threatening obstruction and strangulation . The treatment of a PSH is notoriously difficult and recurrences up to 20 % have been reported despite the use of mesh . This has moved surgical focus toward prevention . Methods : Augmentation of the abdominal wall with a retro-muscular lightweight polypropylene mesh was compared with the traditional formation of a colostomy . In total , 150 patients ( 1:1 ratio ) were included . The incidence of a PSH , morbidity , mortality , quality of life , and cost-effectiveness was measured after 1 year of follow-up . Results : There was no difference between groups regarding demographics and predisposing factors for PSH . Three out of 67 patients ( 4.5 % ) in the mesh group and 16 out of 66 patients ( 24.2 % ) in the nonmesh group developed a PSH ( P = 0.0011 ) . No statistically significant difference was found in infections , concomitant hernias , SF-36 question naire , Von Korff pain score , and cost-effectiveness between both study groups . Conclusion : Prophylactic augmentation of the abdominal wall with a retromuscular lightweight polypropylene 
    Output:
    
Reductions persisted for synthetic and composite meshes .
Operative time was similar , with zero incidence of mesh infection/fistulation , and fewer peristomal complications .
Synthetic mesh demonstrated a favourable cost profile , with composite approximately cost neutral , and biological incurring net costs .
Conclusions Reinforcing elective stomas with mesh ( primarily synthetic ) reduces subsequent PSH rates , complications , repairs and saves money .