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Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
Systematic Review and Meta-analysis of Prophylactic Mesh During Primary Stoma Formation to Prevent Parastomal Hernia
Stephen J Chapman1, Benjamin Wood, Thomas M Drake
11 Section of Translational Anaesthesia and Surgery, Leeds Institute of Biological and Clinical Sciences, University of Leeds, Leeds, United Kingdom 2 Academic Unit of Surgical Oncology, Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, United Kingdom.
Background:
Implantation of mesh at the time of stoma formation may reduce the rate of parastomal hernia. Until recently, the evidence has been limited to only a few small randomized controlled trials.
Objective:
We present an updated systematic review and meta-analysis to assess the effect of mesh prophylaxis on rates of parastomal hernia. We examine ongoing and unpublished trials via online registries and propose recommendations for future research.
Data Sources:
MEDLINE, EMBASE, and the Cochrane Library were searched up to March 2016 for published randomized controlled trials. Sixteen international trial registries were inspected for ongoing and unpublished trials.
Study Selection:
Randomized controlled trials comparing mesh versus no mesh on the incidence of parastomal hernia after colostomy or ileostomy formation were selected.
Main Outcome Measures:
The primary outcome measure was rate of parastomal hernia at least 12 months after stoma formation. Secondary outcomes included rates of stoma-related complications.
Results:
Of 3005 studies identified, 7 randomized controlled trials (432 patients) were eligible for inclusion in the final analysis. All were at high risk of bias. Mesh reduced the incidence of clinically detected parastomal hernia (10.8% vs 32.4%; p = 0.001) (risk ratio, 0.34; 95% CI, 0.18-0.65; I = 39%) and the rate of radiologically detected parastomal hernia (34.6% vs 55.3%; p = 0.01) (risk ratio, 0.61; 95% CI, 0.42-0.89; I = 44%). No increase in the incidence of stoma-related complications was observed with the use of prophylactic mesh. Results from ongoing and unpublished randomized controlled trials are expected, but few will report on alternative mesh types or surgical techniques.
Limitations:
Heterogeneity of interventions, small patient populations, and a high risk of bias seen in all studies implicate cautious interpretation of the results.
Conclusion:
Mesh prophylaxis at the time of stoma formation appears safe and effective in preventing parastomal hernia; however, limitations of the primary evidence justify larger, more rigorous randomized controlled trials.
Insights
Mesh prophylaxis significantly reduces parastomal hernia rates after stoma formation. This meta-analysis indicates mesh is safe and effective, though larger trials are needed due to study limitations.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Clinical Trials
Background:
- Parastomal hernias are a common complication following stoma formation.
- Mesh implantation during stoma creation is a potential preventative strategy.
- Previous evidence was limited to small, randomized controlled trials.
Purpose of the Study:
- To conduct an updated systematic review and meta-analysis on mesh prophylaxis for parastomal hernia prevention.
- To assess the safety and efficacy of mesh in reducing parastomal hernia incidence.
- To identify ongoing trials and propose future research directions.
Main Methods:
- Systematic search of MEDLINE, EMBASE, and Cochrane Library up to March 2016.
- Inclusion of randomized controlled trials comparing mesh versus no mesh.
- Primary outcome: parastomal hernia rate at 12 months post-stoma formation.
Main Results:
- Seven randomized controlled trials (432 patients) were included, all with high risk of bias.
- Mesh significantly reduced clinically detected parastomal hernia (10.8% vs 32.4%).
- Mesh also reduced radiologically detected parastomal hernia (34.6% vs 55.3%) without increasing complications.
Conclusions:
- Mesh prophylaxis appears safe and effective in preventing parastomal hernias.
- Heterogeneity, small sample sizes, and bias necessitate cautious interpretation.
- Larger, more rigorous randomized controlled trials are justified to confirm findings.
