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Published on: September 11, 2021
Prophylactic mesh placement at index permanent end colostomy creation to prevent parastomal hernia-an updated
Shaheel M Sahebally1,2, Titus Z Lim3, Alisha A Azmir3
1Department of Colorectal Surgery, Gold Coast University Hospital, 1 Hospital Boulevard, Gold Coast, Queensland, 4215, Australia. sahebalm@tcd.ie.
Background:
Debate persists regarding the efficacy of prophylactic mesh insertion (PMI) at index permanent stoma creation to reduce the rate of parastomal hernia (PSH). This meta-analysis aimed to appraise all the latest evidence from newly published randomized controlled trials (RCTs) on PMI for PSH prevention.
Methods:
PubMed, EMBASE, and Cochrane databases were searched for relevant articles from inception until November 2020. All RCTs that reported on PMI at end colostomy creation with ≥ 12 months follow-up were included. The primary objective was the rate of clinical and radiological PSH while secondary objectives included number of PSH requiring repair and stoma (or mesh)-related complications. Random effects models were used to calculate pooled effect size estimates. Sensitivity analyses were also performed.
Results:
Eleven RCTs were included capturing 1097 patients. The mean (SD) age was 67.9 (±9.4) years. On random effects analysis, prophylactic mesh appeared to reduce the rate of both clinical (OR = 0.27, 95% CI = 0.12 to 0.61, p = 0.002) and radiological (OR = 0.39, 95% CI = 0.24 to 0.65, p = 0.0002) PSH. However, there was no difference in number of PSH requiring repair or stoma-related complications. On sensitivity analysis, when focusing on low-risk of bias studies, the benefit of prophylactic mesh in the retrorectus space was lost for both clinical (OR = 0.97, 95% CI = 0.62 to 1.51, p = 0.89) and radiological PSH (OR = 0.74, 95% CI = 0.46 to 1.18, p = 0.20).
Conclusion:
PMI may reduce the rate of subsequent PSH. However, further studies are required to confirm these findings and to establish the optimal mesh position and shape before definite recommendations can be made.
Insights
Prophylactic mesh insertion (PMI) may reduce parastomal hernia (PSH) rates after stoma creation. However, evidence from high-quality studies suggests this benefit may be lost, necessitating further research for definitive recommendations.
Area of Science:
- Colorectal surgery
- Surgical innovation
- Hernia repair
Background:
- Debate exists on the effectiveness of prophylactic mesh insertion (PMI) during permanent stoma creation for preventing parastomal hernias (PSH).
- Recent randomized controlled trials (RCTs) offer new data on this topic.
Purpose of the Study:
- To systematically review and meta-analyze the latest RCT evidence on PMI for PSH prevention.
- To assess the impact of PMI on clinical and radiological PSH rates, and complications.
Main Methods:
- Comprehensive search of PubMed, EMBASE, and Cochrane databases up to November 2020.
- Inclusion of RCTs with at least 12 months follow-up reporting on PMI at end colostomy.
- Random effects models used for pooled analysis; sensitivity analyses performed.
Main Results:
- Eleven RCTs involving 1097 patients were analyzed.
- Overall analysis indicated PMI reduced both clinical (OR=0.27) and radiological (OR=0.39) PSH rates.
- Sensitivity analysis of low-bias studies found no significant benefit of PMI for PSH prevention (clinical OR=0.97, radiological OR=0.74).
Conclusions:
- Prophylactic mesh insertion may decrease subsequent PSH rates.
- The benefit is uncertain when considering high-quality studies, particularly for retrorectus placement.
- Further research is needed to confirm efficacy and determine optimal mesh placement and characteristics.
