{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:50:10Z","timestamp":1791352210936,"version":"4.3.1"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Parastomal hernia (PSH) is one of the most common long-term complications after enterostomy. Prophylactic mesh can reduce PSH risk but is limited by mesh-related adverse events and high costs. This study aimed to evaluate the efficacy and safety of prophylactic full-thickness rectus abdominis suturing for PSH prevention without implant materials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective cohort study enrolled 244 patients undergoing enterostomy from January 2020 to December 2024. Patients were allocated alternately by calendar-month: 94 patients received full-thickness rectus-suture reinforcement (reinforcement group), and 150 underwent conventional stoma creation (conventional group). The primary endpoint was CT-confirmed PSH incidence within 2-year follow-up. Secondary endpoints included hernia-sac diameter, time-to-PSH-onset and stoma-related complications. Univariable and multivariable logistic regression, Firth penalized regression, 1:1 propensity-score-matching (PSM), Kaplan\u2013Meier survival analysis and interrupted time-series (ITS) segmented regression were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The reinforcement group showed significantly lower 2-year PSH incidence (9.6% vs. 27.3%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Suture reinforcement was an independent protective factor against PSH (adjusted OR\u2009=\u20090.29, 95% CI: 0.13\u20130.65,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002), and Firth-penalized logistic regression confirmed the stability of this finding (OR\u2009=\u20090.31, 95% CI: 0.14\u20130.68,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.003). After PSM, the inter-group difference remained significant (14.9% vs. 31.9%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.006), and multivariable regression in the matched cohort still identified suture reinforcement as an independent protective factor (adjusted OR\u2009=\u20090.35, 95% CI: 0.17\u20130.72,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.004). Patients in the reinforcement group had smaller hernia-sac diameter (2.9\u2005cm vs. 7.3\u2005cm,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and delayed PSH onset (12.2 months vs. 6.7 months,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.001). ITS analysis supported the robustness of observational findings. Early postoperative complication rates were comparable between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Prophylactic full-thickness rectus-abdominis suturing is associated with reduced PSH incidence, delayed hernia onset and milder hernia severity. This implant-free, low-cost technique is safe and simple. Prospective randomized trials are needed to further validate its clinical value.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1978158","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:53:38Z","timestamp":1791348818000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prophylactic full-thickness suturing of the rectus abdominis muscle reduces parastomal hernia after enterostomy: a 5-year retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Guoqiang","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Colorectal and Anal Surgery, Shengzhou People's Hospital (Shengzhou Branch of the First Affiliated Hospital of Zhejiang University School of Medicine, Shengzhou Hospital of Shaoxing University)","place":["Shaoxing, 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