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

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.