Rectus abdominis muscle atrophy, prophylactic mesh, and stoma placement: retrospective findings from a prospective multicenter trial

PURPOSE: The primary aim of this study was to investigate whether rectus abdominis muscle atrophy is associated with a lower risk of developing parastomal hernia. Secondary objectives were to assess whether the use of prophylactic mesh is a risk factor for rectus abdominis muscle atrophy and whether the position of the stoma within the rectus abdominis muscle affects the risk of parastomal hernia.

METHODS: This retrospective study analysed patients from a prospective, randomised, multicentre trial in which rectal cancer patients were randomised to stoma creation with or without prophylactic mesh. Computed tomography at 12 months was evaluated to identify parastomal hernia, rectus abdominis muscle atrophy and position of stoma in the rectus abdominis muscle.

RESULTS: Out of 149 patients, rectus abdominis muscle atrophy was observed in 9% and parastomal hernia in 42% of patients. There was no association between rectus abdominis muscle atrophy and parastomal hernia (p = 0.80; RR 1.07; CI 0.62-1.86), nor between prophylactic mesh and rectus abdominis muscle atrophy (p = 0.19; RR 2.00; CI 0.7-5.73). Stoma placement within the rectus abdominis muscle also showed no association with parastomal hernia development (p = 0.69; RR 0.97; CI 0.81-1.15).

CONCLUSION: This study found no statistically significant association between rectus abdominis muscle atrophy and parastomal hernia. The use of prophylactic mesh was not a risk factor for rectus abdominis muscle atrophy, and stoma placement within the rectus abdominis muscle was not associated with parastomal hernia. The previously reported association between prophylactic mesh, rectus abdominis muscle atrophy, and parastomal hernia was not confirmed in this cohort.