The utilization of an absorbable mesh after ostomy reversal does not decrease incisional hernia rates

Siddiqui, Usman; Gontarz, Brendan; Lewis, R. T.; Wakefield, Dorothy; Scott, Robert G.

doi:10.1016/j.amjsurg.2023.04.013

Cited by 1 publication

(3 citation statements)

References 22 publications

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“…A synthetic mesh was used in most studies [4,15,17,19,20] while a biological mesh was used only in the identified RCT [4]. There have been only three small studies to date that used biosynthetic mesh types [14,16,18].…”

Section: Discussionmentioning

confidence: 99%

“…Any disagreement was settled through discussion or referred to a third review author (MB). Of the 46 potentially relevant studies identified by the search strategies, 11 were deemed suitable for inclusion [4,6,[13][14][15][16][17][18][19][20][21]. Figure 1 shows the PRISMA flowchart for the selection process, including reasons for exclusion.…”

Section: Re Sultsmentioning

confidence: 99%

“…Similarly, the results of the RCT showed a RR of 0•78 (95% CI 0.54-1.13; p = 0.19). [4,6,[13][14][15][16][17][18][19][20][21].…”

Section: Reoperationmentioning

confidence: 99%

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

Dewantoro,

Manson,

Brazzelli

et al. 2024

Colorectal Disease

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AimTemporary stoma formation remains a common part of modern‐day colorectal surgical operations. At the time of reversal, a second procedure is required when the bowel is anastomosed and the musculature is closed. The rate of incisional hernia at these sites is 30%–35% with conventional suture closure. Mesh placement at this site is therefore an attractive option to reduce hernia risk, particularly as new mesh types, such as biosynthetic meshes, are available. The aim of this work was to conduct a systematic review and meta‐analysis assessing the use of mesh for prophylaxis of incisional hernia at stoma closure and to explore the outcome measures used by each of the included studies to establish whether they are genuinely patient‐centred.MethodThis is a systematic review and meta‐analysis assessing the published literature regarding the use of mesh at stoma site closure operations. Comprehensive literature searches of major electronic databases were performed by an information specialist. Screening of search results was undertaken using standard systematic review principles. Data from selected studies were input into an Excel file. Meta‐analysis of the results of included studies was conducted using RevMan software (v.5.4). Randomized controlled trial (RCT) and non‐RCT data were analysed separately.ResultsEleven studies with a total of 2008 patients were selected for inclusion, with various mesh types used. Of the included studies, one was a RCT, seven were nonrandomized comparative studies and three were case series. The meta‐analysis of nonrandomized studies shows that the rate of incisional hernia was lower in the mesh reinforcement group compared with the suture closure group (OR 0.21, 95% CI 0.12–0.37) while rates of infection and haematoma/seroma were similar between groups (OR 0.7, 95% CI 0.41–1.21 and OR 1.05, 95% CI 0.63–1.80, respectively). The results of the RCT were in line with those of the nonrandomized studies.ConclusionCurrent evidence indicates that mesh is safe and reduces incisional hernia. However, this is not commonly adopted into current clinical practice and the literature has minimal patient‐reported outcome measures. Future work should explore the reasons for such slow adoption as well as the preferences of patients in terms of outcome measures that matter most to them.

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