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Closure of stoma site with or without prophylactic mesh reinforcement: a systematic review and meta-analysis

International Journal of Colorectal Disease volume 35, pages 1477–1488 (2020)Cite this article

Abstract

Aims

To evaluate comparative outcomes of the closure of temporary stoma site with or without prophylactic mesh reinforcement

Methods

A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Studies comparing the reversal of stoma with and without prophylactic mesh reinforcement were included. Stoma site incisional hernia (SSIH), surgical site infection (SSI), operative time, seroma formation, haematoma formation, bowel obstruction, anastomosis leak, length of hospital stay (LOS) and secondary operation to repair the SSIH were the evaluated outcome parameters.

Results

Six comparative studies reporting a total of 1683 patients who underwent closure of stoma with (n = 669) or without (n = 1014) prophylactic mesh reinforcement were included. Use of mesh was associated with a significantly lower risk of SSIH (OR 0.22, P = 0.003) and need for surgical intervention to repair SSIH (OR 0.32, P = 0.04) compared with no use of mesh. However, it was associated with significantly longer operative time (MD 47.78, P = 0.02). There was no significant difference in SSI (OR 1.09, P = 0.59), bowel obstruction (OR 1.11, P = 0.74), seroma formation (OR 2.86, P = 0.19), anastomosis leak (OR 1.60, P = 0.15), haematoma formation (OR 1.25, P = 0.75) or LOS (MD − 0.45, P = 0.31) between two groups.

Conclusion

Prophylactic mesh reinforcement during the closure of temporary stoma may significantly reduce the risk of SSIH and surgical intervention to repair the hernia without increasing the risk of SSI or other morbidities. However, it may increase the procedure time. Future higher-quality randomised evidence is required.

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Authors and Affiliations

  1. Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK

    Ali Yasen Y. Mohamedahmed, Stephen Stonelake, Shafquat Zaman & Shahin Hajibandeh

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  1. Ali Yasen Y. Mohamedahmed
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  2. Stephen Stonelake
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  3. Shafquat Zaman
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  4. Shahin Hajibandeh
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Contributions

Conception and design: AYYM, SS, SH

Literature search and study selection: AYYM, SH

Data collection: AYYM, SZ

Analysis and interpretation: AYYM, SH

Writing the article: all authors

Critical revision of the article: all authors

Final approval of the article: all authors

Statistical analysis: AYYM

Corresponding author

Correspondence to Ali Yasen Y. Mohamedahmed.

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The authors declare that they have no conflict of interest.

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Table 5 Literature search strategy
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Mohamedahmed, A.Y.Y., Stonelake, S., Zaman, S. et al. Closure of stoma site with or without prophylactic mesh reinforcement: a systematic review and meta-analysis. Int J Colorectal Dis 35, 1477–1488 (2020). https://doi.org/10.1007/s00384-020-03681-0

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