Prophylactic mesh placement to avoid incisional hernias after stoma reversal: a systematic review and meta-analysis

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Abstract

Purpose

To provide an overview of the available literature on prevention of incisional hernias after stoma reversal, with the use of prophylactic meshes.

Methods

A literature search of Pubmed, MEDLINE and EMBASE was performed. Search terms for stoma, enterostomy, mesh, prophylaxis and hernia were used. Search was updated to December 31th 2018. No time limitations were used, while English, Geman, Dutch and French were used as language restrictions. The primary outcome was the incidence of incisional hernia formation after stoma reversal. Secondary outcomes were mesh-related complications. Data on study design, sample size, patient characteristics, stoma and mesh characteristics, duration of follow-up and outcomes were extracted from the included articles.

Results

A number of 241 articles were identified and three studies with 536 patients were included. A prophylactic mesh was placed in 168 patients to prevent incisional hernias after stoma reversal. Follow-up ranged from 10 to 21 months. The risk of incisional hernia in case of prophylactic mesh placement was significantly lower in comparison to no mesh placement (OR 0.10, 95% CI 0.04–0.27, p < 0.001, I ² = 0%, CI 0–91.40%). No differences in surgical site infections were detected between the groups.

Conclusions

The use of a prophylactic mesh seems to reduce the risk on incisional hernias after stoma reversal and therefore mesh reinforcement should be considered after stoma reversal.

Electronic supplementary material

The online version of this article (10.1007/s10029-019-01996-8) contains supplementary material, which is available to authorized users.

Related collections

Most cited references 26

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Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer.

Linan Shi, Chunbo Tang, Kevin S W Tan … (2009)

A defunctioning stoma is frequently created to minimize the impact of any subsequent anastomotic leak after a low rectal anastomosis. This review evaluates the need for routine stoma formation. A meta-analysis was performed of randomized controlled trials (RCTs) and non-randomized studies with an interventional group evaluating the need for a defunctioning stoma after low anterior resection for rectal cancer. Primary outcomes analysed included clinical anastomotic leak rate, reoperation rate and mortality related to leak. Four RCTs and 21 non-randomized studies, with 11,429 patients in total, were analysed. Meta-analysis of the RCTs showed a lower clinical anastomotic leak rate (risk ratio (RR) 0.39 (95 per cent c.i. 0.23 to 0.66); P < 0.001) and a lower reoperation rate (RR 0.29 (0.16 to 0.53); P < 0.001) in the stoma group. Meta-analysis of the non-randomized studies showed a lower clinical anastomotic leak rate (RR 0.74 (0.67 to 0.83); P < 0.001), lower reoperation rate (RR 0.28 (0.23 to 0.35); P < 0.001) and lower mortality rate (RR 0.42 (0.28 to 0.61); P < 0.001) in the stoma group. A defunctioning stoma decreases clinical anastomotic leak rate and reoperation rate. It is recommended after low anterior resection for rectal cancer. 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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Parastomal hernia.

G. Robertson, Frank Frizelle, Ross Carne (2003)

Parastomal hernia following formation of an ileostomy or colostomy is common. This article reviews the incidence of hernia, the technical factors related to the construction of the stoma that may influence the incidence, and the success of the different methods of repair. A literature search using the Medline database was performed to locate English language articles on parastomal hernia. Further articles were obtained from the references cited in the literature initially reviewed. Parastomal hernia affects 1.8-28.3 per cent of end ileostomies, and 0-6.2 per cent of loop ileostomies. Following colostomy formation, the rates are 4.0-48.1 and 0-30.8 per cent respectively. Site of stoma formation (through or lateral to rectus abdominis), trephine size, fascial fixation and closure of lateral space are not proven to affect the incidence of hernia. The role of extraperitoneal stoma construction is uncertain. Mesh repair gives a lower rate of recurrence (0-33.3 per cent) than direct tissue repair (46-100 per cent) or stoma relocation (0-76.2 per cent). The incidence of parastomal hernia is between 0 and 48.1 per cent, depending on the type of stoma and length of follow-up. No technical factors related to the construction of the stoma have been shown to prevent herniation. If repair is required, a prosthetic mesh technique should be considered. Further randomized clinical trials (particularly of extraperitoneal stoma construction) are needed. Copyright 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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[Factors influencing the development of incisional hernia. A retrospective study of 2,983 laparotomy patients over a period of 10 years].

V. Schumpelick, J Höer, G Lawong … (2002)

Incisional hernia formation is one of the most frequent complications in visceral surgery requiring reoperation. Risk factors for incisional hernia formation and preventive strategies are not clearly defined. In a retrospective study including 2983 patients over a 10-year period, the influence of demographic data, pre-, intra- and postoperative risk factors for incisional hernia development were evaluated. From the subgroups medical history, medication, laboratory values, indication, surgical technique, course of operation, postoperative course and wound healing, altogether 43 parameters were analysed. Statistical evaluation was performed using the chi 2-test according to Pearson, and binary logistic regression analysis. The mean incisional hernia incidence in the study was 4.3%. In the mean follow-up period of 21.1 months, the incisional hernia incidence was calculated at 9.8% using the Kaplan-Meier estimate; for a 10-year period it reached 18.7%. The study revealed that 31.5% of all incisional hernias developed in the first 6 months after the operation, 54.4% after 12 months, 74.8% after 2 years and 88.9% after 5 years. Significant demographic factors influencing incisional hernia incidence were age (> 45 years) and male gender. The preoperative factors anaemia (Hb 25, the intraoperative factors recurrent incision and previous laparotomy, and the postoperative factors catecholamin-therapy and disturbed wound healing were of significant influence. The calculated incisional hernia incidence for a 10 year period of almost 20% and the manifestation of 50% of all hernias more than 12 months after the operation, underline the necessity to intensify surgical research in the field of laparotomy healing. In comparison to demographic and endogenous risk factors, the surgical technique has less influence on laparotomy healing. Measures to ameliorate tissue perfusin seem to exert a positive influence on incisional hernia incidence.

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Author and article information

Contributors

L. C. L. van den Hil:

ORCID: http://orcid.org/0000-0002-8030-6602

+31 43 3875492 , l.vandenhil@maastrichtuniversity.nl

Journal

Journal ID (nlm-ta): Hernia

Journal ID (iso-abbrev): Hernia

Title: Hernia

Publisher: Springer Paris (Paris )

ISSN (Print): 1265-4906

ISSN (Electronic): 1248-9204

Publication date (Electronic): 13 July 2019

Publication date PMC-release: 13 July 2019

Publication date (Print): 2019

Volume: 23

Issue: 4

Pages: 733-741

Affiliations

[1 ]ISNI 0000 0004 0480 1382, GRID grid.412966.e, Department of General Surgery, , Maastricht University Medical Centre, ; Maastricht, 6202 AZ The Netherlands

[2 ]ISNI 0000 0001 0481 6099, GRID grid.5012.6, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, ; Maastricht, 6200 MD The Netherlands

[3 ]ISNI 0000 0004 0480 1382, GRID grid.412966.e, Department of General Surgery, , Maastricht University Medical Centre, ; P.O. Box 616, 6200 MD Maastricht, The Netherlands

Author information

L. C. L. van den Hil http://orcid.org/0000-0002-8030-6602

Article

Publisher ID: 1996

DOI: 10.1007/s10029-019-01996-8

PMC ID: 6661031

PubMed ID: 31302788

SO-VID: e5bb35b2-7b14-4baf-bd02-46c0542c46ad

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.