{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T02:51:57Z","timestamp":1790391117694,"version":"4.1.0"},"reference-count":19,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2024,11,1]]},"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>Prophylactic placement of a mesh has been suggested to prevent parastomal hernia. Evidence to support this practice is contradictory.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine whether funnel-shaped permanent synthetic parastomal mesh is effective and safe in parastomal hernia prevention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>The Chimney Trial was a randomized single-blinded multicenter trial conducted in 4 hospitals in Finland and 1 in Sweden from February 2019 and September 2021. Of 439 patients with rectal adenocarcinoma undergoing either laparoscopic or robotic-assisted abdominoperineal resection or the Hartmann procedure, 143 were enrolled in the trial, 135 received their allocated intervention, and 121 were analyzed at 12-month follow-up. Data were analyzed from December 2023 to May 2024.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>In the intervention group, a permanent colostomy was created with a funnel-shaped intraperitoneal mesh and compared to a control group with a stoma without the mesh.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome and Measure<\/jats:title><jats:p>The primary end point was the incidence of computed tomography (CT)\u2013confirmed parastomal hernia 12 months after surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 68 patients (mean [SD] age, 68.7 [11.6] years; 36 [53% male and 32 [47%] female) who received the intended allocation in the mesh group and 67 (mean [SD] age, 66.4 [11.7] years; 48 [72%] male and 19 [28%] female) who received the intended allocation in the control group. CT scans were available for 58 patients in the mesh group and 59 patients in the control group at the 12-month follow-up. CT scans confirmed parastomal hernia in 6 of 58 patients (10%) in the mesh group compared to 22 of 59 patients (37%) in the control group (difference, 27%; 95% CI, 12-41; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). Clinical parastomal hernia as a secondary outcome was recorded in 1 of 60 patients (2%) in the mesh group compared to 27 of 61 (43%) in the control group (difference, 41%; 95% CI, 29-55; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). The number of patients with Clavien-Dindo class II ileus was 23 (35%) in the mesh group compared to 11 (17%) in the control group (difference, 18%; 95% CI, 3-32; <jats:italic>P<\/jats:italic>\u2009=\u2009.006). Only slight differences between the groups were detected in other stoma-related complications, readmissions, operative time, surgical site infections, reoperations, and quality of life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this study, funnel-shaped parastomal mesh prevented a significant number of parastomal hernias without predisposing patients to mesh- or stoma-related complications during 12-month follow-up. The results of this study suggest the funnel-shaped mesh is a feasible option to prevent parastomal hernia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT03799939?tab=history\">NCT03799939<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2024.3260","type":"journal-article","created":{"date-parts":[[2024,8,28]],"date-time":"2024-08-28T15:35:29Z","timestamp":1724859329000},"page":"1244","source":"Crossref","is-referenced-by-count":21,"title":["Parastomal Hernia Prevention Using Funnel-Shaped Intra-Abdominal Mesh Compared to No Mesh"],"prefix":"10.1001","volume":"159","author":[{"given":"Elisa","family":"M\u00e4k\u00e4r\u00e4inen","sequence":"first","affiliation":[{"name":"Oulu University Hospital, Medical Research Center Oulu, Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heikki","family":"Wiik","sequence":"additional","affiliation":[{"name":"Oulu University Hospital, Medical Research Center Oulu, Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maziar","family":"Nikberg","sequence":"additional","affiliation":[{"name":"Department of Surgery V\u00e4stmanland\u2019s Hospital V\u00e4ster\u00e5s and Centre for Clinical Research Region V\u00e4stmanland, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyrki","family":"K\u00f6ssi","sequence":"additional","affiliation":[{"name":"P\u00e4ij\u00e4t-H\u00e4me Central Hospital, Lahti, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Carpelan-Holmstr\u00f6m","sequence":"additional","affiliation":[{"name":"Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarja","family":"Pinta","sequence":"additional","affiliation":[{"name":"Sein\u00e4joki Central Hospital, Sein\u00e4joki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsi","family":"Lehto","sequence":"additional","affiliation":[{"name":"Tampere University Hospital, Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marko","family":"Nikki","sequence":"additional","affiliation":[{"name":"Oulu University Hospital, Medical Research Center Oulu, Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyri","family":"J\u00e4rvinen","sequence":"additional","affiliation":[{"name":"Oulu University Hospital, Medical Research Center Oulu, Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasi","family":"Ohtonen","sequence":"additional","affiliation":[{"name":"Oulu University Hospital, Medical Research Center Oulu, Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tero","family":"Rautio","sequence":"additional","affiliation":[{"name":"Oulu University Hospital, Medical Research Center Oulu, Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"soi240061r1","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1007\/s10029-017-1697-5","article-title":"European Hernia Society guidelines on prevention and treatment of parastomal hernias.","volume":"22","author":"Antoniou","year":"2018","journal-title":"Hernia"},{"issue":"3","key":"soi240061r2","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1097\/SLA.0000000000002542","article-title":"Use of prophylactic mesh when creating a colostomy does not prevent parastomal hernia: a randomized controlled trial\u2014STOMAMESH.","volume":"269","author":"Odensten","year":"2019","journal-title":"Ann 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