Fascial incision shapes and paracolostomy hernia: cruciate vs. reinforced longitudinal (the “Hepworth hitch”): longcross randomized controlled trial (GECO2 STUDY)

Purpose: Primary objective was to compare the rates of parastomal hernia (PH) at 2 years after the creation of a terminal colostomy using two types of fascial incision: cross-shaped and reinforced longitudinal. Secondary objectives included the evaluation of postoperative complications, readmissions, reoperations for PH, and patients’ quality of life. Methods: This was a multicenter superiority clinical trial conducted at 5 hospitals involving patients with rectal cancer and definitive colostomy. Patients were randomized into two groups: cross incision (n = 42) or reinforced longitudinal incision (n = 52), for the exteriorization of the colon in terminal colostomy. PH at 2 years was determined by physical examination, computed tomography (CT), and symptoms. Baseline data on risk factors for PH, postoperative complications, readmissions, reoperations for symptomatic PH, and quality of life were recorded. Results: A total of 95 patients were included: cross (n = 42) and reinforced longitudinal (n = 52). Demographic characteristics, risk factors for PH, and surgical factors were similar between the two groups. No significant differences were found in the clinical PH rate between the cruciate versus longitudinal incision groups (48.60% vs. 45.20%; p = 0.770), radiological PH (54.30% vs. 53.70%; p = 0.956), or symptomatic PH (14.30% vs. 19%; p = 0.579). The comprehensive complication index (CCI), readmissions, and reoperation rates for symptomatic PH (8.6% vs. 7.1%; p = 0.816) were similar in both groups. No significant differences were observed in the three health aspects evaluated using the EORTC QLQ-C30 scale. Conclusion: The reinforcement of a longitudinal fascial incision as an isolated surgical technique does not reduce the incidence of PH after a 2-year follow-up.