AUTHOR=Tzanis Alexander A. , Stabilini Cesare , Muysoms Filip E. , Rossi Lisa , Koutsiouroumpa Ourania , Mavridis Dimitris , Adamina Michel , Bracale Umberto , Brandsma Henk-Thijs , Breukink Stéphanie O. , López Cano Manuel , Cole Samantha , Doré Suzanne , Jensen Kristian Kiim , Krogsgaard Marianne , Smart Neil J. , Odensten Christoffer , Tielemans Chantal , Antoniou Stavros A. 

TITLE=Update Systematic Review, Meta-Analysis and GRADE Assessment of the Evidence on Parastomal Hernia Prevention—A EHS, ESCP and EAES Collaborative Project

JOURNAL=Journal of Abdominal Wall Surgery

VOLUME=Volume 2 - 2023

YEAR=2023

URL=https://www.frontierspartnerships.org/journals/journal-of-abdominal-wall-surgery/articles/10.3389/jaws.2023.11550

DOI=10.3389/jaws.2023.11550

ISSN=2813-2092

ABSTRACT=Objective: To perform a systematic review and meta-analysis on the effectiveness of prophylactic mesh for the prevention of parastomal hernia in end colostomy, with the ultimate objective to inform an interdisciplinary, European rapid guideline. Methods: We updated a previous systematic review with evidence search of PubMed. Primary outcome was quality of life (QoL). Secondary outcomes were clinical diagnosis of parastomal hernia, surgery for parastomal hernia, and 30-day or in-hospital complications Clavien‐Dindo ≥3. We utilised The revised Cochrane tool for randomised trials (RoB 2 tool) for risk of bias assessment in the included studies. Minimally important differences were set a priori through voting of the panel members. We appraised the evidence using GRADE and we developed GRADE evidence tables. Results: We included 12 randomized trials. Meta-analysis suggested no difference in QoL between prophylactic mesh and no mesh for primary stoma construction (SMD = 0.03, 95% CI [-0.14 – 0.2], I2 = 0%, low certainty of evidence). With regard to parastomal hernia, the use of prophylactic synthetic mesh resulted in a significant risk reduction of the incidence of the event, according to data from all available randomized trials, irrespective of the follow-up period (OR = 0.33, 95% CI [0.18 – 0.62], I2 = 74%, moderate certainty of evidence). Sensitivity analyses according to follow-up period were in line with the primary analysis. Little to no difference in surgery for parastomal hernia was encountered after pooled analysis of 10 randomised trials (OR = 0.52, 95% CI [0.25 – 1.09], I2 = 14%). Finally, no significant difference was found in Clavien-Dindo grade 3 and 4 adverse events after surgery with or without the use of a prophylactic mesh (OR = 0.77, 95% CI [0.45 – 1.30], I2 = 0%, low certainty of evidence). Conclusions: Prophylactic synthetic mesh placement at the time of permanent end colostomy construction is likely associated with a reduced risk for parastomal hernia and may confer similar risk of peri-operative major morbidity compared to no mesh placement. There may be no difference in quality of life and surgical repair of parastomal hernia with the use of either approach.