Systematic Reviews
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Dec 26, 2017; 5(6): 150-166
Published online Dec 26, 2017. doi: 10.13105/wjma.v5.i6.150
Synthetic vs biologic mesh for the repair and prevention of parastomal hernia
Loes Knaapen, Otmar Buyne, Harry van Goor, Nicholas J Slater
Loes Knaapen, Otmar Buyne, Harry van Goor, Department of Surgery, Radboud University Medical Centre, Nijmegen 6500 HB, The Netherlands
Nicholas J Slater, Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Nijmegen 6500 HB, The Netherlands
Author contributions: Knaapen L and Slater NJ equally contributed to the conception and design of the study, literature review and analysis; all authors equally contributed to drafting, critical revision, editing, and final approval of the manuscript.
Conflict-of-interest statement: All authors declare no competing interests or funding.
Data sharing statement: Statistical code and dataset are available from the corresponding author at loes.knaapen@radboudumc.nl.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Loes Knaapen, Department of Surgery, Radboud University Medical Centre, P.O. Box 9101, Nijmegen 6500 HB, The Netherlands. loes.knaapen@radboudumc.nl
Telephone: +31-24-3611111
Received: May 21, 2017
Peer-review started: May 22, 2017
First decision: July 6, 2017
Revised: July 29, 2017
Accepted: September 12, 2017
Article in press: September 12, 2017
Published online: December 26, 2017
Abstract
AIM

To outline current evidence regarding prevention and treatment of parastomal hernia and to compare use of synthetic and biologic mesh.

METHODS

Relevant databases were searched for studies reporting hernia recurrence, wound and mesh infection, other complications, surgical techniques and mortality. Weighted pooled proportions (95%CI) were calculated using StatsDirect. Heterogeneity concerning outcome measures was determined using Cochran’s Q test and was quantified using I2. Random and fixed effects models were used. Meta-analysis was performed with Review Manager software with the statistical significance set at P ≤ 0.05.

RESULTS

Forty-four studies were included: 5 reporting biologic mesh repairs; 21, synthetic mesh repairs; and 18, prophylactic mesh repairs. Most of the studies were retrospective cohorts of low to moderate quality. The hernia recurrence rate was higher after undergoing biologic compared to synthetic mesh repair (24.0% vs 15.1%, P = 0.01). No significant difference was found concerning wound and mesh infection (5.6% vs 2.8%; 0% vs 3.1%). Open and laparoscopic techniques were comparable regarding recurrences and infections. Prophylactic mesh placement reduced the occurrence of a parastomal hernia (OR = 0.20, P < 0.0006) without increasing wound infection [7.8% vs 8.2% (OR = 1.04, P = 0.91)] and without differences between the mesh types.

CONCLUSION

There is no superiority of biologic over synthetic mesh for parastomal hernia repair. Prophylactic mesh placement during the initial surgery significantly reduces parastomal hernia occurrence regardless of the mesh type.

Keywords: Parastomal hernia, Synthetic mesh repair, Biologic mesh repair, Prophylactic mesh repair

Core tip: This review and meta-analysis outlines all current evidence regarding prevention and treatment of parastomal hernia and compares the use of synthetic and biologic mesh. There is no superiority of biologic over synthetic mesh for parastomal hernia repair concerning parastomal hernia recurrence, wound infection and mesh infection. Prophylactic mesh placement during the initial surgery significantly reduces parastomal hernia occurrence regardless of the mesh type.