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Meta-Analysis
. 2017 Feb 9;12(2):e0171548.
doi: 10.1371/journal.pone.0171548. eCollection 2017.

Prophylactic mesh placement for the PREvention of paraSTOmal hernias: The PRESTO systematic review and meta-analysis

Frank Pianka  1   2 , Pascal Probst  1   2 , Anne-Valerie Keller  2 , Daniel Saure  3 , Kathrin Grummich  2 , Markus W Büchler  1 , Markus K Diener  1   2
Affiliations
Meta-Analysis

Prophylactic mesh placement for the PREvention of paraSTOmal hernias: The PRESTO systematic review and meta-analysis

Frank Pianka et al. PLoS One. .

Abstract

Background: Parastomal hernia (PH) is the most common complication after ostomy formation. Prophylactic mesh placement may be effective in reducing the rate of PH at the stoma site. The aims of this systematic review were to summarize the evidence with regard to the safety and effectiveness in comparison with the standard procedure without mesh placement and to identify important risk constellations.

Method: A systematic literature search was performed in PubMed, EMBASE and the Cochrane library with no language or date restrictions. Randomized (RCTs) and non-randomized controlled trials (nRCTs) were included. The main outcomes of interest were PH (primary outcome) rate and stoma-related complications (secondary outcomes) such as stenosis or fistula. Statistical analysis included meta-analyses of pooled data and subgroup analyses.

Results: Eleven trials (eight RCTs; three nRCTs) with a total of 755 patients were included. PH rate varied from 0% to 59% in the intervention and from 20% to 94% in the control group. RCTs showed a significant reduction of PH rate in the mesh group (OR 0.24; 95% CI 0.10 to 0.58, p = 0.034), whereas included nRCTs did not. No significant differences were observed in postoperative complication rates. Subgroup analyses showed superiority of non-absorbable meshes and sublay mesh positioning in open surgery.

Conclusion: Prophylactic mesh placement is safe and reduces PH rate. A recommendation for prophylactic non-absorbable meshes in a sublay position can be made for patients undergoing open colorectal operations with end-ostomies. Further research endeavors should focus on patient-oriented outcomes, not only PH rate, with respect to tailored treatment in specific patient populations.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flowchart.
Fig 2
Fig 2. Risk of bias summary.
Review authors' assessments of each risk of bias item for each included trial, presented as low (-), high (+) or unclear (?).
Fig 3
Fig 3. Forest plots for the primary outcome (parastomal hernia).
Pooled data from eight RCTs and three nRCTs, with odds ratios (OR) and corresponding 95% confidence intervals (CI).
See this image and copyright information in PMC

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