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Prophylactic mesh placement at index permanent end colostomy creation to prevent parastomal hernia—an updated meta-analysis

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Abstract

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.

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Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Gold Coast University Hospital, 1 Hospital Boulevard, Gold Coast, Queensland, 4215, Australia

    Shaheel M Sahebally, Titus Z Lim, Alisha A Azmir, Cu Tai Lu, Mark Doudle, Arun Naik, Gregory Nolan & Michael Von Papen

  2. Royal College of Surgeons in Ireland, Dublin, Ireland

    Shaheel M Sahebally

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  1. Shaheel M Sahebally
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  2. Titus Z Lim
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  3. Alisha A Azmir
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Contributions

Conceived and designed experiments: SMS.

Data gathering: SMS, TZL.

Performed the experiments: all authors.

Analyzed the data: all authors.

Wrote the manuscript: all authors.

Corresponding author

Correspondence to Shaheel M Sahebally.

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The authors declare no competing interests.

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Key points

Question

Is there a role for prophylactic mesh to prevent development of PSH when constructing a permanent end colostomy?

Findings

In this meta-analysis comprising 11 RCTs and 1097 patients, prophylactic mesh appeared to reduce the rate of both clinical and radiological PSH. However, the benefit was lost when low-risk of bias studies were evaluated.

Meaning

Prophylactic meshes may be effective at reducing subsequent PSH. However, more studies are needed to confirm or refute these findings.

Supplementary Information

Supplementary Figure 1.

Meta-analysis of the number of PSH requiring repair between mesh and no mesh groups (PNG 553 kb)

High resolution (TIFF 15843 kb)

Supplementary Figure 2.

Meta-analysis of the rate of stoma necrosis between mesh and no mesh groups (PNG 501 kb)

High resolution (TIFF 11504 kb)

Supplementary Figure 3.

Meta-analysis of the rate of stoma stenosis/stricture between mesh and no mesh groups (PNG 713 kb)

High resolution (TIFF 11187 kb)

Supplementary Figure 4.

Meta-analysis of the rate of stoma prolapse between mesh and no mesh groups (PNG 607 kb)

High resolution (TIFF 11187 kb)

Supplementary Figure 5.

Meta-analysis of the rate of stoma retraction between mesh and no mesh groups (PNG 506 kb)

High resolution (TIFF 9327 kb)

Supplementary Figure 6.

Meta-analysis of the rate of stoma dehiscence between mesh and no mesh groups (PNG 500 kb)

High resolution (TIFF 10615 kb)

Supplementary Figure 7.

Meta-analysis of the rate of peristomal infection between mesh and no mesh groups (PNG 416 kb)

High resolution (TIFF 9726 kb)

ESM 1

(DOC 62 kb)

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Sahebally, S.M., Lim, T.Z., Azmir, A.A. et al. Prophylactic mesh placement at index permanent end colostomy creation to prevent parastomal hernia—an updated meta-analysis. Int J Colorectal Dis 36, 2007–2016 (2021). https://doi.org/10.1007/s00384-021-03924-8

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