Abstract
BackgroundParastomal hernia is a very common complication after colostomy, especially end-colostomy. It is unclear whether prophylactic placement of mesh at the time of stoma formation could prevent parastomal hernia formation after surgery for rectal cancer. A systematic review and meta-analysis were conducted to evaluate the efficacy of prophylactic mesh in end-colostomy construction.MethodsPubMed, Embase, and the Cochrane Library were searched, covering records entered from their inception to September 2015. Randomized controlled trials (RCTs) comparing stoma with mesh to stoma without mesh after surgery for rectal cancer were included. The primary outcome was the incidence of parastomal hernia. Pooled risk ratios (RR) with 95 % confidence intervals (CI) were obtained using random effects models.ResultsSix RCTs containing 309 patients were included. Parastomal hernia occurred in 24.4 % (38 of 156) of patients with mesh and 50.3 % (77 of 153) of patients without mesh. Meta-analysis showed a lower incidence of parastomal hernia (RR, 0.42; 95 % CI 0.22–0.82) and reoperation related to parastomal hernia (RR, 0.23; 95 % CI 0.06–0.89) in patients with mesh. Stoma-related morbidity was similar between mesh group and non-mesh group (RR, 0.65; 95 % CI 0.33–1.30).ConclusionsProphylactic placement of a mesh at the time of a stoma formation seems to be associated with a significant reduction in the incidence of parastomal hernia and reoperation related to parastomal hernia after surgery for rectal cancer, but not the rate of stoma-related morbidity. However, the results should be interpreted with caution because of the heterogeneity among the studies.
Highlights
ResultsSix Randomized controlled trials (RCTs) containing 309 patients were included
Colorectal cancer is the third most common malignancy worldwide, but its mortality is considerably lower than that of other cancers [1]
Meta-analysis showed a lower incidence of parastomal hernia (RR, 0.42; 95 % confidence intervals (CI) 0.22–0.82) and reoperation related to parastomal hernia (RR, 0.23; 95 % CI 0.06–0.89) in patients with mesh
Summary
Six studies comprising 309 patients were included in the meta-analysis. Study sample size ranged from 36 to 70 patients Among these six Significant heterogeneity was observed across all trials in the primary outcome (P = 0.004, I2 = 71 %). The results showed the mesh group to have a lower incidence of parastomal hernia than the non-mesh group (RR, 0.34; 95 % CI 0.18–0.64). No significant heterogeneity was observed among the remaining studies (P = 0.11, I2 = 47 %). The pooled results from these studies showed the mesh group to be associated with a lower risk of reoperation related to parastomal hernia (RR, 0.23; 95 % CI 0.06–0.89, Fig. 5), with no heterogeneity among the studies (P = 0.96, I2 = 0 %).
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