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Meta-Analysis
. 2017 Jan;99(1):2-11.
doi: 10.1308/rcsann.2016.0186. Epub 2016 Jun 8.

Prophylactic mesh use during primary stoma formation to prevent parastomal hernia

J B Cornille  1 , S Pathak  1 , I R Daniels  1 , N J Smart  1
Affiliations
Meta-Analysis

Prophylactic mesh use during primary stoma formation to prevent parastomal hernia

J B Cornille et al. Ann R Coll Surg Engl. 2017 Jan.

Abstract

Introduction Parastomal hernia (PSH) is a common problem following stoma formation. The optimal technique for stoma formation is unknown although recent studies have focused on whether placement of prophylactic mesh at stoma formation can reduce PSH rates. The aim of this study was to systematically review use of prophylactic mesh versus no mesh with regard to occurrence of PSH and peristomal complications. Methods A systematic search was performed using PubMed, Embase™ and the Cochrane Library to identify randomised controlled trials that analysed placement of prophylactic mesh versus no mesh at time of initial surgery. Meta-analysis was performed using random effects methods. Results A total of 506 studies were identified by our search strategy. Of these, 8 studies were included, involving 430 patients (217 mesh vs 213 no mesh). Prophylactic mesh placement resulted in a significantly lower rate of PSH formation (42/217 [19.4%] vs 92/213 [43.2%]) with a combined risk ratio of 0.40 (95% confidence interval [CI]: 0.21-0.75, p=0.004). Placement of prophylactic mesh did not result in increased peristomal complications (15/218 [6.9%] vs 16/227 [7.0%]) with a combined risk ratio of 1.0 (95% CI: 0.49-2.01, p=0.990). Conclusions Prophylactic placement of mesh at primary stoma formation may reduce the incidence of PSH, without an increase in peristomal complications. However, the overall quality of the randomised controlled trials included in the meta-analysis was poor, and should prompt caution regarding the applicability of the findings of the individual studies and the meta-analysis to everyday practice.

Keywords: Mesh; Parastomal hernia; Prevention; Systematic review.

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Figures

Figure 1
Figure 1
Study flow diagram
Figure 2
Figure 2
Forest plot of the risk of parastomal herniation following stoma formation with prophylactic mesh placement versus no mesh
Figure 3
Figure 3
Forest plot of the risk of parastomal herniation following stoma formation with prophylactic synthetic mesh placement versus no mesh
Figure 4
Figure 4
Forest plot of the risk of parastomal herniation following stoma formation with prophylactic biological mesh placement versus no mesh
Figure 5
Figure 5
Forest plot of the risk of clinically diagnosed parastomal herniation following stoma formation with prophylactic mesh placement versus no mesh
Figure 6
Figure 6
Forest plot of the risk of computed tomography detected parastomal herniation following stoma formation with prophylactic mesh placement versus no mesh
Figure 7
Figure 7
Forest plot of the risk of peristomal complications (infection, necrosis, stenosis) following stoma formation with prophylactic mesh placement versus no mesh
See this image and copyright information in PMC

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