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133. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

26.04. - 29.04.2016, Berlin

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Prophylactic mesh placement for the prevention of parastomal hernias – the PRESTO systematic review and meta-analysis

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  • Frank Pianka - Universitätsklinikum Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Anne-Valerie Keller - Studienzentrum der Deutschen Gesellschaft für Chirurgie (SDGC), Heidelberg, Deutschland
  • Kathrin Grummich - Studienzentrum der Deutschen Gesellschaft für Chirurgie (SDGC), Heidelberg, Deutschland
  • Saure Daniel - Institut für Medizinische Biometrie und Informatik (IMBI), Heidelberg, Deutschland
  • Pietro Contin - Universitätsklinikum Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Pascal Probst - Universitätsklinikum Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Markus Wolfgang Büchler - Universitätsklinikum Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Markus K. Diener - Universitätsklinikum Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland

Deutsche Gesellschaft für Chirurgie. 133. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 26.-29.04.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. Doc16dgch042

doi: 10.3205/16dgch042, urn:nbn:de:0183-16dgch0422

Published: April 21, 2016

© 2016 Pianka et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Background: Parastomal hernia (PH) is the most common complication after ostomy formation. Past trials have suggested the use of a prophylactic mesh at the stoma site to reduce the rate of PH. The aim of this systematic review was to summarize the evidence for this method in comparison to the standard procedure without mesh placement.

Materials and methods: A systematic literature search was performed in Pubmed, EMBASE and the Cochrane library without language or date restrictions. Randomized controlled (RCTs) as well as clinical controlled trials (CCTs) were included. Main outcome of interest was PH rate. Statistical analysis included meta-analyses of pooled data; results were described with weighted odds ratios and corresponding 95% confidence intervals.

Results: 396 articles were screened, seven studies (5 RCTs; 2 CCTS) with a total of 288 patients were included. RCTs showed a significant reduction of PH in mesh vs no mesh cases, with a pooled OR of 0.17 [0.09; 0.34]. The included CCTs showed no significant difference in PH rate. Furthermore, no significant results were observed in subgroup analyses and postoperative complications rates.

Conclusion: The use of a prophylactic mesh significantly prevents the development of PH in comparison to a mesh-free operation. However, the overall quality of the reviewed trials was low and a large-scale multi-center RCT including an assessment of clinical relevance of hernia occurrences has to be performed.

Figure 1 [Fig. 1]