Prosthetic mesh placement for the prevention of parastomal herniation

Abstract

Study characteristicsFollowing our data search in January 2018, we included 10 trials with a total of 844 participants, which we assessed using the standard Cochrane Review protocol. The trials compared the incidence of hernia development around a stoma between a group having a mesh placement at the time of stoma formation and a control group having a conventional stoma formation without mesh placement. Key resultsWe found that mesh placement around the stoma at the time of stoma formation reduces the incidence of future hernia formation. The participants having a mesh fitted had a similar level of complications as those not having a mesh. Quality of evidenceWe found low-quality evidence favouring the insertion of a mesh into people having a stoma.Prosthetic mesh placement for the prevention of parastomal herniation (Review)

Prevention of parastomal hernia after abdominoperineal excision with a prophylactic three‐dimensional funnel mesh

“…In our study, as in previous reports, we did not register a significant increase in short‐term postoperative morbidity/mortality, hospital stay or reintervention rate with the placement of PSM . Patients with PSM presented a trend towards more local complications of the ostomy, but the difference did not reach statistical significance.…”

“…Interest in hernia surgery is increasing worldwide, with focus not only on treatment but also on prevention (by laparoscopy or an open approach) . Previous data from randomized clinical trials and meta‐analyses confirm the safety, efficacy and cost‐effectiveness of PSH prevention with a permanent synthetic mesh when creating an end‐colostomy . A recently published multicentre randomized trial (the STOMAMESH trial) analysed the placement of a prophylactic synthetic mesh for prevention of PSH .…”

“…High‐quality clinical evidence shows that the placement of a prophylactic PSM when performing a PEC (open or laparoscopic) reduces the incidence of PSH and the risk of subsequent repairs without increasing infectious complications . However, a recent multicentre randomized trial found that the use of a prophylactic PSM did not improve the rate of PSH after permanent colostomy .…”

Stoma Complications

“…Intrastromal Ultrasonography is a relatively new imaging modality which can confirm parastomal hernia [22]. In order to prevent from a parastomal hernia which is nearly inevitable especially for end colostomies, prophylactic mesh usage during primary operation can be a safe and effective option [23][24][25]. The main controversy exists on the type of the mesh (biologic vs. composite) and the technique for mesh implementation (intraperitoneal, preperitoneal, retromuscular etc.)…”

Parastomal Hernia – Cinderella no more

“…In terms of guidelines available to help direct surgeons, it is notable that the European Hernia Society guidelines (2017) ‘strongly recommend’ the use of a prophylactic synthetic non‐absorbable mesh when constructing an end colostomy . The issue was also covered by ACPGBI in their position statement (2018) although the language was a little more taciturn: “ Prophylactic synthetic non‐absorbable mesh may be used when constructing an elective permanent end colostomy for cancer only to reduce the risk of PSH development (Quality of evidence: moderate; Strength of recommendation: weak) ” Furthermore, both Cochrane and NICE have recently reported that they regard the evidence on efficacy to be limited in both quantity and quality .…”