Experimental intervention
stoma
STERILE, CAVITY

The re-establishment of intestinal continuity will be achieved by either stapled or by hand-sewn anastomosis, according to the surgeon’s preference, and the bowel will be positioned back into the peritoneal cavity.Changing of surgical gloves must be performed before mesh implantation. Either after surgical stoma closure or, latest, before mesh placement.A retromuscular space is created by blunt dissection overlapping the suture line in cranio-caudal direction by 4–6cm. In the medial-to-lateral direction, the dissection is limited by the linea alba and linea semilunaris in case the stoma is placed within the rectus sheath. In case the stoma is outside the rectus sheath or below the linea arcuata (no posterior rectus sheath), a retromuscular space should be formed by dissection overlapping the future fascial suture line by 4–6cm in all directions.The posterior rectus sheath (if the stoma is within the rectus sheath) will be closed with a continuous polydioxanone suture (PDS Plus, USP 2-0) with tissue bites of 5 mm and intersuture spacing of 5 mm applied exclusively to the fascia omitting subcutaneous fat and muscle tissue (small-stitch technique, SST). In case the stoma is outside the rectus sheath or below the linea arcuata (no posterior rectus sheath), the posterior abdominal wall should be closed with a continuous polydioxanone suture (PDS Plus, USP 2-0) with tissue bites of 5 mm and intersuture spacing of 5 mm applied exclusively to the fascia omitting subcutaneous fat and muscle tissue (small-stitch technique, SST).The retromuscular space should be irrigated with 500 ml of sterile fluid (lavage) before mesh placement. The type of solution is at the discretion of the surgeon, e.g. saline solution (NaCl 0.9%), Ringer’s or any antiseptic solutions like polyhexanide (PHX), Lavanox or others can be used for this purpose as long as its application is approved for this purpose.A non-absorbable, macro-pore (pore size ≥ 1000μm [The mesh should be fixed to the posterior fascia tension-free with single knots if deemed necessary by the operating surgeon. The suture material is at the discretion of the operating surgeon.The rectus muscle should The anterior rectus sheath will be closed in the same manner as the posterior sheath with a continuous polydioxanone suture (PDS Plus, USP 2-0) with tissue bites of 5 mm and intersuture spacing of 5 mm applied exclusively to the fascia omitting subcutaneous fat and muscle tissue (small-stitch technique, SST).Subcutaneous drains can be placed at the discretion of the operating surgeon.The skin will be closed according to the surgeon’s preference (suture, staples, pursestring).Further perioperative and postoperative treatment will be equal for both groups according to the respective local standard of care.