Use of prophylactic mesh to prevent parastomal hernia formation: a systematic review, meta-analysis and network meta-analysis

Purpose: To evaluate the effectiveness of prophylactic mesh placement in reducing the incidence of parastomal hernias following colostomy, ileostomy, and ileal conduit formation.

Methods: A systematic review identified relevant studies evaluating parastomal hernia incidence with prophylactic mesh use during stoma formation. Pairwise meta-analysis and network meta-analysis using Bayesian modeling were performed.

Results: 25 studies, consisting of 16 randomized control trials (RCT), 6 follow up studies, and 3 retrospective cohort studies, were included. Prophylactic mesh led to significantly fewer parastomal hernias beyond 6 months follow-up (OR 0.43, 95% CI 0.33-0.58). Hernias were reduced with mesh for both ileal conduits and colostomies. When analyzing hazard ratios (HRs), only 6 studies were included, and a statistically significant difference was observed among both randomized controlled trials (RCTs) (HR 0.75 [0.53, 0.92], p = 0.01) and non-RCTs (HR 0.57 [0.36, 0.92], p = 0.02). Network meta-analysis found the retromuscular approach with mesh had the lowest hernia rate. Regression was non-significant for variations between study types.

Conclusion: This meta-analysis demonstrated prophylactic mesh placement during ostomy creation significantly reduced parastomal hernia risk, more prominently beyond 6 months, consistently across randomized trials and observational studies for urologic and gastrointestinal ostomies. The retromuscular technique was most effective.