France: The use of a prosthetic mesh should not be recommended for the prevention of parastomal hernia (PSH), according to findings from a recent meta-analysis published in the journal Annals of Surgery.
The use of a mesh at the time of a stoma formation for parastomal hernia prevention is currently recommended by the European guidelines. However, the recommendations are based on the meta-analyses and RCTs published before 2017. Recently, two large RCT found no benefit in the mesh group. Michel Prudhomme, Department of Digestive Surgery, CHU Nimes, Univ Montpellier, Nimes, France, and colleagues investigated whether these latest results could change the conclusion of a meta-analysis.
For the purpose, the researchers conducted a comprehensive literature search and analyzed RCT investigating the use of a mesh for the prevention of PSH. It included all studies including end colostomies 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.
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The primary endpoint of this meta-analysis was the PSH rate at one year of follow-up with or without the use of a mesh.
Key findings of the study include:
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 one or two years between the mesh and non-mesh groups.
"Based on this meta-analysis including the latest RCT on the prevention of parastomal hernia, the use of a mesh shouldn't be recommended," concluded the authors.
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"Meta-Analysis and Systematic Review of the Use of a Prosthetic Mesh for Prevention of Parastomal Hernia," is published in the journal Annals of Surgery.
DOI: https://journals.lww.com/annalsofsurgery/Abstract/9000/Meta_Analysis_and_Systematic_Review_of_the_Use_of.93810.aspx