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Hernia
Published in: Hernia 3/2021

Open Access 01-06-2021 | Seroma | Review

Prevention of incisional hernia at the site of stoma closure with different reinforcing mesh types: a systematic review and meta-analysis

Authors: Roberto Peltrini, Nicola Imperatore, Gaia Altieri, Simone Castiglioni, Maria Michela Di Nuzzo, Luciano Grimaldi, Michele D’Ambra, Ruggero Lionetti, Umberto Bracale, Francesco Corcione

Published in: Hernia | Issue 3/2021

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Abstract

Purpose

To evaluate safety and efficacy of a mesh reinforcement following stoma reversal to prevent stoma site incisional hernia (SSIH) and differences across the prostheses used.

Methods

A systematic search of PubMed/MEDLINE, EMBASE, SCOPUS and Cochrane databases was conducted to identify comparative studies until September 2020. A meta-analysis of postoperative outcomes and a network meta-analysis for a multiple comparison of the prostheses with each other were performed.

Results

Seven studies were included in the analysis (78.4% ileostomy and 21.6% colostomy) with a total of 1716 patients with (n = 684) or without (n = 1032) mesh. Mesh placement was associated with lower risk of SSIH (7.8%vs18.1%, OR0.266,95% CI 0.123–0.577, p < 0.001) than no mesh procedures but also with a longer operative time (SMD 0.941, 95% CI 0.462–1.421, p < 0.001). There was no statistically significant difference in terms of Surgical Site infection (11.5% vs 11.1%, OR 1.074, 95% CI 0.78–1.48, p = 0.66), seroma formation (4.4% vs 7.1%, OR 1.052, 95% CI 0.64–1.73, p = 0.84), anastomotic leakage (3.7% vs 2.7%, OR 1.598, 95% CI 0.846–3.019, p = 0.149) and length of stay (SMD − 0.579,95% CI − 1.261 to 0.102, p = 0.096) between mesh and no mesh groups. Use of prosthesis was associated with a significant lower need for a reoperation than no mesh group (8.1% vs 12.1%, OR 0.332, 95% CI 0.119–0.930, p = 0.036). Incidence of seroma is lower with biologic than polypropylene meshes but they showed a trend towards poor results compared with polypropylene or biosynthetic meshes.

Conclusion

Despite longer operative time, mesh prophylactic reinforcement at the site of stoma seems a safe and effective procedure with lower incidence of SSIH, need for reoperation and comparable short-term outcomes than standard closure technique. A significant superiority of a specific mesh type was not identified.
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Metadata
Title
Prevention of incisional hernia at the site of stoma closure with different reinforcing mesh types: a systematic review and meta-analysis
Authors
Roberto Peltrini
Nicola Imperatore
Gaia Altieri
Simone Castiglioni
Maria Michela Di Nuzzo
Luciano Grimaldi
Michele D’Ambra
Ruggero Lionetti
Umberto Bracale
Francesco Corcione
Publication date
01-06-2021
Publisher
Springer Paris
Published in
Hernia / Issue 3/2021
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-021-02393-w

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