Prophylactic mesh to prevent parastomal hernia after end colostomy: a meta-analysis and trial sequential analysis

M. López-Cano*, H. T. Brandsma, K. Bury, B. Hansson, I. Kyle-Leinhase, J. G. Alamino, F. Muysoms

*Corresponding author for this work

Research output: Contribution to journalReview articleResearchpeer-review

28 Citations (Scopus)

Abstract

Purpose: Prevention of parastomal hernia (PSH) formation is crucial, given the high prevalence and difficulties in the surgical repair of PSH. To investigate the effect of a preventive mesh in PSH formation after an end colostomy, we aimed to meta-analyze all relevant randomized controlled trials (RCTs). Methods: We searched five databases. For each trial, we extracted risk ratios (RRs) of the effects of mesh or no mesh. The primary outcome was incidence of PSH with a minimum follow-up of 12 months with a clinical and/or computed tomography diagnosis. RRs were combined using the random-effect model (Mantel–Haenszel). To control the risk of type I error, we performed a trial sequential analysis (TSA). Results: Seven RCTs with low risk of bias (451 patients) were included. Meta-analysis for primary outcome showed a significant reduction of the incidence of PSH using a mesh (RR 0.43, 95% CI 0.26–0.71; P = 0.0009). Regarding TSA calculation for the primary outcome, the accrued information size (451) was 187.1% of the estimated required information size (RIS) (241). Wound infection showed no statistical differences between groups (RR 0.77, 95% CI 0.39–1.54; P = 0.46). PSH repair rate showed a significant reduction in the mesh group (RR 0.28 (95% CI 0.10–0.78; P = 0.01). Conclusions: PSH prevention with mesh when creating an end colostomy reduces the incidence of PSH, the risk for subsequent PSH repair and does not increase wound infections. TSA shows that the RIS is reached for the primary outcome. Additional RCTs in the previous context are not needed.

Original languageAmerican English
Pages (from-to)177-189
Number of pages13
JournalHernia
Volume21
Issue number2
DOIs
Publication statusPublished - 1 Apr 2017

Keywords

  • Hernia
  • Mesh
  • Parastomal
  • Prevention
  • Prophylaxis

Fingerprint Dive into the research topics of 'Prophylactic mesh to prevent parastomal hernia after end colostomy: a meta-analysis and trial sequential analysis'. Together they form a unique fingerprint.

Cite this