Introduction Parastomal herniation (PSH) is a common and debilitating problem following stoma formation, with up to 30% of patients requiring further surgical intervention. The optimal surgical technique for stoma formation is yet to be defined though recent randomised trials have focussed on whether prophylactic mesh placement at the time of stoma creation can reduce the rate of PSH. The aim of this study was to systematically review use of prophylactic mesh versus no mesh with regard to a) occurrence of PSH and b) peristomal complications.
Method A literature search was performed using PubMed, Embase and the Cochrane Library databases to identify Randomised Control Trials (RCTs) that analysed placement of prophylactic mesh versus no mesh at time of initial surgery to prevent PSH. The primary outcomes of interest were PSH occurrence and peristomal complications.
Results A total of 409 studies were identified by our search strategy. Six studies were included, involving 319 patients (158 mesh vs161 no mesh). Prophylactic mesh placement resulted in a significantly lower rate of PSH formation 15.2% (23/151) versus40.6% (63/155), with a combined risk ratio was 0.39 (95% CI, 0.20 to 0.77, P = 0.007). Placement of prophylactic mesh did not result in increased peristomal complications (7% (11/157) versus 2% (9/160) with a combined risk ratio of 1.23(95% CI, 0.53 to 2.85, P = 0.63).
Conclusion Prophylactic placement of mesh at primary stoma formation appears to reduce the incidence of PSH, without an increase in peristomal complications.
Disclosure of interest None Declared.