Prophylactic mesh use during primary stoma formation to prevent parastomal hernia

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.

Eficacia de la malla biosintética de poli-4-hidroxibutirato (PHASIXTM) en la infección del sitio quirúrgico por Pseudomona aeruginosa tras reparación de la hernia ventral compleja

“…En la bibliografía publicada, los resultados de las diferentes técnicas y mallas utilizadas como profilaxis de la HP son muy heterogéneos 47,61,62 . En la mayoría de los estudios se observa una disminución de la incidencia de HP al usar una malla profiláctica 12,27,[63][64][65][66][67][68] , en algunos solo se evidencia una disminución de la incidencia detectada clínicamente, pero no por tac 69 , y en otros no se objetiva ni reducción clínica ni radiológica 28,70 (tabla 3).…”

Prevention and treatment of parastomal hernia: a position statement on behalf of the Association of Coloproctology of Great Britain and Ireland

“…Twelve systematic reviews and meta-analyses have now been published regarding the use of prophylactic mesh during primary stoma creation [28][29][30][31][32][33][34][35][36][37][38][39]. All reviews have demonstrated a statistically significant risk reduction of PSH with the use of prophylactic mesh.…”

Parastomal Hernia

“…In view of these encouraging preliminary results, an increasing number of clinical studies have documented the safety and efectiveness of prophylactic placement of mesh. Very recently, four meta-analyses ( Table 5) have shown that prophylactic mesh application at the time of stoma creation is a promising method and may reduce the incidence of PSH, without an increased risk of mesh-related peristomal complications [33,[41][42][43]. These results have been evident when obtained using either clinical (6.5-10.8 vs. 28.8-32.4%) or radiological (34 vs. 55%) outcome measures [33,43].…”

“…In one of these studies, Cornille et al [41] reported that the use of synthetic meshes as prophylaxis resulted in a signiicantly lower PSH occurrence (23.4 vs. 54.7%, p = 0.008) than that for biological meshes (10.2 vs. 15.9%, p = 0.510), when the diferent types of mesh were separately compared with controls (no mesh). In another study, Lee et al [44] demonstrated a costefectiveness analysis and reported that prophylactic mesh insertion might be cost-efective unless the incidence of mesh infection and the cost of the mesh were high.…”