Published in:
Open Access 01-07-2011 | Review Article
Repair of Parastomal Hernias with Biologic Grafts: A Systematic Review
Published in: Journal of Gastrointestinal Surgery | Issue 7/2011
Login to get accessAbstract
Background
Biologic grafts are increasingly used instead of synthetic mesh for parastomal hernia repair due to concerns of synthetic mesh-related complications. This systematic review was designed to evaluate the use of these collagen-based scaffolds for the repair of parastomal hernias.
Methods
Studies were retrieved after searching the electronic databases MEDLINE, EMBASE and Cochrane CENTRAL. The search terms ‘paracolostomy’, ‘paraileostomy’, ‘parastomal’, ‘colostomy’, ‘ileostomy’, ‘hernia’, ‘defect’, ‘closure’, ‘repair’ and ‘reconstruction’ were used. Selection of studies and assessment of methodological quality were performed with a modified MINORS index. All reports on repair of parastomal hernias using a collagen-based biologic scaffold to reinforce or bridge the defect were included. Outcomes were recurrence rate, mortality and morbidity.
Results
Four retrospective studies with a combined enrolment of 57 patients were included. Recurrence occurred in 15.7% (95% confidence interval [CI] 7.8–25.9) of patients and wound-related complications in 26.2% (95% CI 14.7–39.5). No mortality or graft infections were reported.
Conclusions
The use of reinforcing or bridging biologic grafts during parastomal hernia repair results in acceptable rates of recurrence and complications. However, given the similar rates of recurrence and complications achieved using synthetic mesh in this scenario, the evidence does not support use of biologic grafts.