Prudhomme M, Fabbro-Peray P, Rullier E, Occean BV, Bertrand MM. Meta-analysis and Systematic Review of the Use of a Prosthetic Mesh for Prevention of Parastomal Hernia.
Ann Surg 2021;
274:20-28. [PMID:
33378298 DOI:
10.1097/sla.0000000000004704]
[Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE
The primary endpoint of this meta-analysis was the PSH rate at 1 year of follow-up with or without the use of a mesh.
SUMMARY OF BACKGROUND DATA
European guidelines currently recommend the use of a mesh at the time of a stoma formation for the prevention of PSH. These recommendations are based on the RCT and meta-analyses published before 2017. More recently 2 large RCT found no benefit in the mesh group. We investigated whether these latest results could change the conclusion of a meta-analysis.
METHODS
We conducted a comprehensive literature search and analyzed RCT investigating the use of a mesh to prevent PSH formation. All studies including end colostomies were included in the qualitative analysis no matter the surgical technique or the type of mesh. All studies with a limited risk of bias and presenting with usable data were used in the quantitative analysis.
RESULTS
There is a large heterogeneity among the studies, in terms of position of the mesh, surgical technique, and diagnostic method for the PSH.No statistically significant difference was found on the PSH rate at 1 or 2 years between the mesh and non-mesh groups.
CONCLUSIONS
Based on this meta-analysis including the latest RCT on the prevention of PSH, the use of a mesh should not be recommended.
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