A meta-analysis of prophylactic mesh placement during permanent colostomy on the prevention of parastomal hernia

doi:10.3877/cma.j.issn.1674-392X.2024.03.020

Abstract

Abstract:

Objective

To systematically evaluate the safety and efficacy of prophylactic mesh placement during permanent colostomy in preventing parastomal hernia (PSH).

Methods

A systematic search of English database (PubMed, Science Citation Index, Cochrane, EMBASE) and Chinese database (CNKI, Wanfang, VIP and CBM) was conducted for randomized controlled trials (RCTs) concerning prophylactic mesh placement during permanent colostomy for prevention of PSH, which published from the establishment of the database to July 2021. Two independent investigators evaluated the quality of the included literature and extracted data. Data were analyzed using Stata 13 and Revman 5.3 software.

Results

A total of 14 RCTs involving 1280 patients were included. There were 625 patients in the mesh group (who received prophylactic mesh placement) and 655 patients in the control group (who did not receive mesh placement). The results of meta-analysis revealed that prophylactic mesh group had lower incidence of PSH (RR=0.49, 95% CI 0.37-0.64, P<0.000 01) and lower incidence of PSH requiring repair (RR=0.25, 95% CI 0.13-0.51, P=0.0001) than those in the control group. There were no statistically difference between mesh group and control group for the incidence of stoma related infection (RR=0.90, 95% CI 0.38-2.13, P=0.81), stomal necrosis (RR=0.76, 95% CI 0.41-1.43, P=0.40), stomal retraction (RR=1.42, 95% CI 0.55-3.64, P=0.47), stoma skin and mucosa dehiscence (RR=1.21, 95% CI 0.64-2.30, P=0.56), stoma prolapse (RR=0.46, 95% CI 0.21-1.05, P=0.06) and stoma stenosis (RR=1.31, 95% CI 0.62-2.79, P=0.48).

Conclusion

Prophylactic mesh placement during permanent colostomy can prevent PSH after surgery, which is a safe and feasible method, but further high-quality and large sample studies are still required to verify the conclusion.

Key words: Parastomal hernia, Prophylaxis, Mesh, Randomized controlled trial, Meta analysis

Junjia Zhu, Qi Sun, Wenlong Xu, Tianyu Lu, Qiang Feng, Tao Chu, Chungen Xing, Chundong Gao, Yifeng Yu, Zhenguo Zhao. A meta-analysis of prophylactic mesh placement during permanent colostomy on the prevention of parastomal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(03): 336-342.

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URL: https://zhshfbwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-392X.2024.03.020

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Figures/Tables 6

References 31

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作者	年份	国家	样本量(例,M/C)	手术方式	补片位置	性别(男性∶女性,M/C)	年龄(岁,M/C)	BMI (kg/m²,M/C)	随访时间(月)	诊断方式
Jänes	2009	瑞典	27:27	开腹	Sublay	15:12/16:11	70/71	26/27	65.2	临床
Serra-Aracil	2009	西班牙	27:27	开腹	Sublay	19:5/16:8	67.5/67.2	25.6/27.3	29(中位)	临床及CT
Lo´pez-Cano	2012	西班牙	19:17	腹腔镜	IPOM	11:8/7:10	72.2/65.9	26.3/27.5	12	CT
Târcoveanu	2014	罗马尼亚	20:22	开腹	Sublay	-	-	-	20(中位)	临床及超声
Brandsma	2016	荷兰	72:78	开腹	Sublay	43:29/49:29	63.5/63	26.8/26.5	12.4	临床及CT
Lambrecht	2015	挪威	32:26	开腹	Sublay	22:10/21:5	64/63	-	40(中位)	临床及CT
López-Cano	2016	西班牙	24:28	腹腔镜	IPOM	21:3/16:8	70.5/67.3	25.3/26.9	26(中位)	CT
Odensten	2019	瑞典	114:118	开腹	Sublay	74:40/62:56	69.7/69.9	26.1/26.3	12	临床及CT
Makarainen-Uhlback	2020	芬兰	37:38	腹腔镜	IPOM	18:17/19:16	67.1/65.1	26.2/25.4	65(中位)	临床及CT
Marinez	2020	瑞典、丹麦	63:74	开腹及腹腔镜	Sublay	42:21/43:31	68/72	26.3/24.7	12	CT
Prudhomme	2020	法国	98:101	开腹及腹腔镜	Sublay	57:41/57:44	67.2/70.5	25.6/24.8	24	临床、CT及MRI
崔冀	2009	中国	30:30	开腹	IPOM	-	-	-	36	临床、CT及超声
袁炜嗣	2016	中国	41:41	腹腔镜	IPOM	26:15/20:21	65/65	22.4/23.6	12	临床及CT
饶敏	2019	中国	21:28	腹腔镜	Onlay	11:10/16:12	66.5/63.8	21.8/22.3	36	CT

作者	年份	国家	样本量(例,M/C)	手术方式	补片位置	性别(男性∶女性,M/C)	年龄(岁,M/C)	BMI (kg/m²,M/C)	随访时间(月)	诊断方式
Jänes	2009	瑞典	27:27	开腹	Sublay	15:12/16:11	70/71	26/27	65.2	临床
Serra-Aracil	2009	西班牙	27:27	开腹	Sublay	19:5/16:8	67.5/67.2	25.6/27.3	29(中位)	临床及CT
Lo´pez-Cano	2012	西班牙	19:17	腹腔镜	IPOM	11:8/7:10	72.2/65.9	26.3/27.5	12	CT
Târcoveanu	2014	罗马尼亚	20:22	开腹	Sublay	-	-	-	20(中位)	临床及超声
Brandsma	2016	荷兰	72:78	开腹	Sublay	43:29/49:29	63.5/63	26.8/26.5	12.4	临床及CT
Lambrecht	2015	挪威	32:26	开腹	Sublay	22:10/21:5	64/63	-	40(中位)	临床及CT
López-Cano	2016	西班牙	24:28	腹腔镜	IPOM	21:3/16:8	70.5/67.3	25.3/26.9	26(中位)	CT
Odensten	2019	瑞典	114:118	开腹	Sublay	74:40/62:56	69.7/69.9	26.1/26.3	12	临床及CT
Makarainen-Uhlback	2020	芬兰	37:38	腹腔镜	IPOM	18:17/19:16	67.1/65.1	26.2/25.4	65(中位)	临床及CT
Marinez	2020	瑞典、丹麦	63:74	开腹及腹腔镜	Sublay	42:21/43:31	68/72	26.3/24.7	12	CT
Prudhomme	2020	法国	98:101	开腹及腹腔镜	Sublay	57:41/57:44	67.2/70.5	25.6/24.8	24	临床、CT及MRI
崔冀	2009	中国	30:30	开腹	IPOM	-	-	-	36	临床、CT及超声
袁炜嗣	2016	中国	41:41	腹腔镜	IPOM	26:15/20:21	65/65	22.4/23.6	12	临床及CT
饶敏	2019	中国	21:28	腹腔镜	Onlay	11:10/16:12	66.5/63.8	21.8/22.3	36	CT

并发症	研究数目	研究例数	发生例数		RR(95% CI)	I²[%]	P值
并发症	研究数目	研究例数	补片组	对照组	RR(95% CI)	I²[%]	P值
造口相关感染	7	637	9	10	0.90(0.38~2.13)	0	0.81
造口坏死	8	748	14	19	0.76(0.41~1.43)	0	0.40
造口回缩	4	374	9	6	1.42(0.55~3.64)	0	0.47
造口皮肤黏膜分离	6	464	17	14	1.21(0.64~2.30)	0	0.56
造口脱垂	5	426	7	15	0.46(0.21~1.05)	0	0.06
造口狭窄	8	670	14	10	1.31(0.62~2.79)	0	0.48

并发症	研究数目	研究例数	发生例数		RR(95% CI)	I²[%]	P值
并发症	研究数目	研究例数	补片组	对照组	RR(95% CI)	I²[%]	P值
造口相关感染	7	637	9	10	0.90(0.38~2.13)	0	0.81
造口坏死	8	748	14	19	0.76(0.41~1.43)	0	0.40
造口回缩	4	374	9	6	1.42(0.55~3.64)	0	0.47
造口皮肤黏膜分离	6	464	17	14	1.21(0.64~2.30)	0	0.56
造口脱垂	5	426	7	15	0.46(0.21~1.05)	0	0.06
造口狭窄	8	670	14	10	1.31(0.62~2.79)	0	0.48

亚组分析	研究数目	研究例数	造口旁疝发生例数		RR(95% CI)	I²[%]	组间差异P值
亚组分析	研究数目	研究例数	补片组	对照组	RR(95% CI)	I²[%]	组间差异P值
补片位置
Sublay	8	773	90	156	0.53(0.35,0.78)	60	0.70
Onlay	1	39	4	13	0.36(0.14,0.91)	-
IPOM	5	298	33	83	0.45(0.33,0.62)	7
手术方式
开腹	7	581	52	110	0.35(0.17,0.69)	70	0.49
腹腔镜	5	277	37	88	0.45(0.34,0.60)	0	0.49

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