Systematic Review of the Use of a Mesh to Prevent Parastomal Hernia

Parastomal hernia is a major complication after stoma placement. Surgical procedures for repairing parastomal hernia are difficult and their failure rate is high. The use of a mesh implanted at the primary operation has shown promising results. Therefore, we performed a systematic review of the literature to evaluate the results of the placement of mesh at the time of stoma formation with the aim of preventing parastomal hernia. The Medline, Embase, and Cochrane Library databases were searched using the keywords "parastomal or paracolostomy hernia." Data regarding the incidence of hernia, the operative parameters, including mesh placement and types, and complications, including infection, stoma necrosis, and stenosis, were used and analyzed to evaluate the use of prophylactic mesh at the time of stoma formation. Three randomized controlled trials, three prospective observational series, and one retrospective study were selected and summarized. During the follow-up period (observation time of 1-83 months), parastomal hernia was present in 32/58 patients (55%) who did not have mesh placement and in 14/179 patients (7.82%) in whom mesh was used. Meta-analysis of three randomized controlled trials showed that prophylactic use of the mesh significantly diminished the incidence of parastomal hernia (p < 0.0001). Postoperative morbidity levels were similar whether the mesh was placed or not. Prophylactic use of mesh at the time of stoma formation is a safe procedure and reduces the risk of parastomal hernia. For more detailed evaluation, additional large, double-blinded, randomized controlled trials with long-term follow-up are necessary.