Open AccessEfficacy of Prophylactic Mesh in End‐Colostomy Construction: A Systematic Review and Meta‐analysis of Randomized Controlled Trials
Author(s) -
Wang Shuanhu,
Wang Wenbin,
Zhu Bing,
Song Guolei,
Jiang Congqiao
Publication year - 2016
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-016-3576-0
Subject(s) - medicine , stoma (medicine) , colostomy , randomized controlled trial , surgery , abdominal surgery , meta analysis , relative risk , hernia , incidence (geometry) , general surgery , confidence interval , physics , optics
Background Parastomal 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. Methods PubMed, 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. Results Six 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). Conclusions Prophylactic 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.