Prevention of incisional hernia at the site of stoma closure with different reinforcing mesh types: a systematic review and meta-analysis

Abstract

Purpose To evaluate safety and efficacy of a mesh reinforcement following stoma reversal to prevent stoma site incisional hernia (SSIH) and differences across the prostheses used. Methods A systematic search of PubMed/MEDLINE, EMBASE, SCOPUS and Cochrane databases was conducted to identify comparative studies until September 2020. A meta-analysis of postoperative outcomes and a network meta-analysis for a multiple comparison of the prostheses with each other were performed. Results Seven studies were included in the analysis (78.4% ileostomy and 21.6% colostomy) with a total of 1716 patients with (n = 684) or without (n = 1032) mesh. Mesh placement was associated with lower risk of SSIH (7.8%vs18.1%, OR0.266,95% CI 0.123–0.577, p < 0.001) than no mesh procedures but also with a longer operative time (SMD 0.941, 95% CI 0.462–1.421, p < 0.001). There was no statistically significant difference in terms of Surgical Site infection (11.5% vs 11.1%, OR 1.074, 95% CI 0.78–1.48, p = 0.66), seroma formation (4.4% vs 7.1%, OR 1.052, 95% CI 0.64–1.73, p = 0.84), anastomotic leakage (3.7% vs 2.7%, OR 1.598, 95% CI 0.846–3.019, p = 0.149) and length of stay (SMD − 0.579,95% CI − 1.261 to 0.102, p = 0.096) between mesh and no mesh groups. Use of prosthesis was associated with a significant lower need for a reoperation than no mesh group (8.1% vs 12.1%, OR 0.332, 95% CI 0.119–0.930, p = 0.036). Incidence of seroma is lower with biologic than polypropylene meshes but they showed a trend towards poor results compared with polypropylene or biosynthetic meshes. Conclusion Despite longer operative time, mesh prophylactic reinforcement at the site of stoma seems a safe and effective procedure with lower incidence of SSIH, need for reoperation and comparable short-term outcomes than standard closure technique. A significant superiority of a specific mesh type was not identified.

Synthetic mesh versus biological mesh to prevent incisional hernia after loop-ileostomy closure: a randomized feasibility trial

“…No surgical site occurrence was reported within the mean follow up time of 20 months [ 12 ]. In a recent systematic review, the use of prophylactic mesh was considered safe in terms of SSI, seroma and anastomotic leakage [ 13 ]. Additionally, mesh decreased the hernia rate compared to non-mesh closure.…”

Incidence, risk factors, and predictive modeling of stoma site incisional hernia after enterostomy closure: a multicenter retrospective cohort study

“…Severe SSIH even requires multiple surgeries, which greatly increases the patient’s economic burden and mental suffering. Currently, the incidence of SSIH varies among different studies, which may be closely related to follow-up time and disease type [ 11 , 12 ]. Tilney et al [ 13 ] reported that the probability of recurrent incisional hernia after ileostomy was 3.7%, and the probability of recurrent incisional hernia after colostomy was 14.6%.…”

Reversal of stoma with biosynthetic mesh fascial reinforcement: a systematic review and meta‐analysis

“…Biological meshes, typically made of porcine collagen which degrades over time, are available and have been examined in the context of this operation [8][9][10]. However, these are expensive and take-up of these products for this operation has been slow within colorectal practice.…”