Prophylactic mesh use during primary stoma formation to prevent parastomal hernia.

2.50
Hdl Handle:
http://hdl.handle.net/11287/612529
Title:
Prophylactic mesh use during primary stoma formation to prevent parastomal hernia.
Authors:
Cornille, J B; Pathak, Samir; Daniels, Ian R. ( 0000-0002-9114-0812 ) ; Smart, Neil J. ( 0000-0002-3043-8324 )
Abstract:
INTRODUCTION Parastomal hernia (PSH) is a common problem following stoma formation. The optimal technique for stoma formation is unknown although recent studies have focused on whether placement of prophylactic mesh at stoma formation can reduce PSH rates. The aim of this study was to systematically review use of prophylactic mesh versus no mesh with regard to occurrence of PSH and peristomal complications. METHODS A systematic search was performed using PubMed, Embase™ and the Cochrane Library to identify randomised controlled trials that analysed placement of prophylactic mesh versus no mesh at time of initial surgery. Meta-analysis was performed using random effects methods. RESULTS A total of 506 studies were identified by our search strategy. Of these, 8 studies were included, involving 430 patients (217 mesh vs 213 no mesh). Prophylactic mesh placement resulted in a significantly lower rate of PSH formation (42/217 [19.4%] vs 92/213 [43.2%]) with a combined risk ratio of 0.40 (95% confidence interval [CI]: 0.21-0.75, p=0.004). Placement of prophylactic mesh did not result in increased peristomal complications (15/218 [6.9%] vs 16/227 [7.0%]) with a combined risk ratio of 1.0 (95% CI: 0.49-2.01, p=0.990). CONCLUSIONS Prophylactic placement of mesh at primary stoma formation may reduce the incidence of PSH, without an increase in peristomal complications. However, the overall quality of the randomised controlled trials included in the meta-analysis was poor, and should prompt caution regarding the applicability of the findings of the individual studies and the meta-analysis to everyday practice.
Citation:
Prophylactic mesh use during primary stoma formation to prevent parastomal hernia. 2017 Jan;99(1):2-11. Epub 2016 Jun 8
Publisher:
Royal College of Surgeons
Journal:
Annals of the Royal College of Surgeons of England
Issue Date:
8-Jun-2016
URI:
http://hdl.handle.net/11287/612529
DOI:
10.1308/rcsann.2016.0186
PubMed ID:
27269439
Additional Links:
http://publishing.rcseng.ac.uk/doi/full/10.1308/rcsann.2016.0186
Note:
This article is currently freely available via the publisher's website. Click on 'Additional Link' above to access the full-text via the publisher's site.
Type:
Journal Article; Meta-Analysis
Language:
en
ISSN:
1478-7083
Appears in Collections:
Colorectal Surgery; HeSRU publications; 2016 RD&E publications

Full metadata record

DC FieldValue Language
dc.contributor.authorCornille, J Ben
dc.contributor.authorPathak, Samiren
dc.contributor.authorDaniels, Ian R.en
dc.contributor.authorSmart, Neil J.en
dc.date.accessioned2016-06-10T14:58:31Z-
dc.date.available2016-06-10T14:58:31Z-
dc.date.issued2016-06-08-
dc.identifier.citationProphylactic mesh use during primary stoma formation to prevent parastomal hernia. 2017 Jan;99(1):2-11. Epub 2016 Jun 8en
dc.identifier.issn1478-7083-
dc.identifier.pmid27269439-
dc.identifier.doi10.1308/rcsann.2016.0186-
dc.identifier.urihttp://hdl.handle.net/11287/612529-
dc.description.abstractINTRODUCTION Parastomal hernia (PSH) is a common problem following stoma formation. The optimal technique for stoma formation is unknown although recent studies have focused on whether placement of prophylactic mesh at stoma formation can reduce PSH rates. The aim of this study was to systematically review use of prophylactic mesh versus no mesh with regard to occurrence of PSH and peristomal complications. METHODS A systematic search was performed using PubMed, Embase™ and the Cochrane Library to identify randomised controlled trials that analysed placement of prophylactic mesh versus no mesh at time of initial surgery. Meta-analysis was performed using random effects methods. RESULTS A total of 506 studies were identified by our search strategy. Of these, 8 studies were included, involving 430 patients (217 mesh vs 213 no mesh). Prophylactic mesh placement resulted in a significantly lower rate of PSH formation (42/217 [19.4%] vs 92/213 [43.2%]) with a combined risk ratio of 0.40 (95% confidence interval [CI]: 0.21-0.75, p=0.004). Placement of prophylactic mesh did not result in increased peristomal complications (15/218 [6.9%] vs 16/227 [7.0%]) with a combined risk ratio of 1.0 (95% CI: 0.49-2.01, p=0.990). CONCLUSIONS Prophylactic placement of mesh at primary stoma formation may reduce the incidence of PSH, without an increase in peristomal complications. However, the overall quality of the randomised controlled trials included in the meta-analysis was poor, and should prompt caution regarding the applicability of the findings of the individual studies and the meta-analysis to everyday practice.en
dc.languageENG-
dc.language.isoenen
dc.publisherRoyal College of Surgeonsen
dc.relation.urlhttp://publishing.rcseng.ac.uk/doi/full/10.1308/rcsann.2016.0186en
dc.rightsArchived with thanks to Annals of the Royal College of Surgeons of Englanden
dc.subjectWessex Classification Subject Headings::Gastroenterologyen
dc.titleProphylactic mesh use during primary stoma formation to prevent parastomal hernia.en
dc.typeJournal Articleen
dc.typeMeta-Analysisen
dc.identifier.journalAnnals of the Royal College of Surgeons of Englanden
dc.description.noteThis article is currently freely available via the publisher's website. Click on 'Additional Link' above to access the full-text via the publisher's site.en
dc.type.versionIn press (epub ahead of print)en

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