Prophylactic Mesh Does Not Prevent Parastomal Hernia at Long-Term: Meta-Analysis and Trial Sequential Analysis

Abstract Introduction Previous randomized clinical trials (RCT) and systematic reviews evaluating parastomal hernia (PH) after a prophylactic mesh placement during end colostomy formation have reported contradictory results. This review attempted to determine the efficacy of this strategy in long-term follow-up according to the latest available data. Methods Medline, EMBASE, Cochrane Library, Web of Science and Google Scholar were searched. RCTs were included if they compared mesh with no mesh during initial end colostomy creation in adults to prevent PH with a follow-up longer than 2 years. To evaluate PH incidence, PH repair rate and mortality a meta-analysis was performed. Subgroup analysis included surgical approach and mesh position. A trial sequential analysis (TSA) was performed. Results Eight RCTs involving 537 patients were included. The incidence of PH at long term was not reduced when a prophylactic mesh was placed (RR = 0.68 95% CI:0.46–1.02; I2 = 81%, P = 0.06). The PH repair rate was low but no difference was found between the groups (RR = 0.90 95% CI: 0.51–1.56; I2=0%; P = 0.70). No difference was detected between groups when mortality was assessed (RR = 1.03 95% CI: 0.77–1.39; I2 = 21%; P = 0.83). Subgroup analyses did not show differences according to the surgical approach or mesh position used. With regard to TSA, an optimal information size was not achieved. Conclusion Prophylactic mesh placement during end colostomy formation does not prevent PH in the long term. The PH repair rate and mortality rate did not vary between groups. Heterogeneity among the included RCTs might restrict the accuracy of the results.