Repair of Parastomal Hernias with Biologic Grafts: A Systematic Review

Abstract

BackgroundBiologic grafts are increasingly used instead of synthetic mesh for parastomal hernia repair due to concerns of synthetic mesh-related complications. This systematic review was designed to evaluate the use of these collagen-based scaffolds for the repair of parastomal hernias.MethodsStudies were retrieved after searching the electronic databases MEDLINE, EMBASE and Cochrane CENTRAL. The search terms ‘paracolostomy’, ‘paraileostomy’, ‘parastomal’, ‘colostomy’, ‘ileostomy’, ‘hernia’, ‘defect’, ‘closure’, ‘repair’ and ‘reconstruction’ were used. Selection of studies and assessment of methodological quality were performed with a modified MINORS index. All reports on repair of parastomal hernias using a collagen-based biologic scaffold to reinforce or bridge the defect were included. Outcomes were recurrence rate, mortality and morbidity.ResultsFour retrospective studies with a combined enrolment of 57 patients were included. Recurrence occurred in 15.7% (95% confidence interval [CI] 7.8–25.9) of patients and wound-related complications in 26.2% (95% CI 14.7–39.5). No mortality or graft infections were reported.ConclusionsThe use of reinforcing or bridging biologic grafts during parastomal hernia repair results in acceptable rates of recurrence and complications. However, given the similar rates of recurrence and complications achieved using synthetic mesh in this scenario, the evidence does not support use of biologic grafts.

Parastomal Hernia

“…This technique has been associated with an overall morbidity rate of 12.7%, a wound infection rate of 1.9%, a mesh infection rate of approximately 2%, and a PSH recurrence rate of 14.8-17.2%. The sublay and intraperitoneal onlay mesh (IPOM) techniques may be theoretically more efective in preventing recurrent PSH formation because the mesh is located on the high-pressure side of the abdominal wall, and this pressure supports the mesh ixed to the fascia [7,35,36]. Perhaps because of this, the sublay and IPOM techniques appear to have lower recurrence rates (6.9-7.9 and 7.2-9.2%, respectively) than that of the onlay technique; however, this diference is not statistically signiicant ( Table 4).…”

“…The only drawback of using ePTFE meshes is the high infection risk when it is used in a contaminated ield [2,6,39,40]. Therefore, biological prostheses have gained popularity in PSH repair because of their resistance to mesh infection in potentially contaminated areas [3,14,36]. However, it cannot be concluded that biologic meshes are preferred over synthetic prostheses for reducing the rates of short-or long-term complications [36].…”

“…Therefore, biological prostheses have gained popularity in PSH repair because of their resistance to mesh infection in potentially contaminated areas [3,14,36]. However, it cannot be concluded that biologic meshes are preferred over synthetic prostheses for reducing the rates of short-or long-term complications [36]. Biological grafts are also very expensive and associated with higher rates of seroma formation than those of synthetic meshes [40].…”

“…Biological grafts are also very expensive and associated with higher rates of seroma formation than those of synthetic meshes [40]. In addition, a recent systematic review showed that biological grafts have recurrence rates comparable to those of synthetic meshes [2,36].…”

Actualización de las hernias paraestomales: diagnóstico, tratamiento y prevención

“…Su interés es su resistencia a la infección en un campo quirúrgico contaminado 9 . En una revisión sistemática reciente 48 se ha descrito una tasa de recurrencia del 15.7 % y una tasa de complicaciones de herida del 26.2 %, sin ninguna infección de malla. No obstante, su principal problema es su coste, de 5 a 10 veces más caras que una malla sintética similar 39 .…”