Synthetic vs biologic mesh for the repair and prevention of parastomal hernia

Table 3 Study characteristics and outcomes of synthetic mesh and biologic mesh repair of parastomal hernia n (%)

Ref.	No. patients (completed follow-up)		Type of stoma	Material; technique	Recurrence of parastomal hernia1		Wound infection		Mesh infection	Other3		Mortality	Follow-up (mo)
	Mesh	No mesh			Mesh	No mesh	Mesh	No mesh	Mesh	Mesh	No mesh
Hansson et al[8]	61	-	C: 55 I: 4 U: 2	L: 55; IPOM: SB; ePTFE	4 (7)	-	1 (2)	-	1 (2)	21 (34)	-	12 (2)	26
Fei et al[34]	11	-	C: 6 I: 5	O: 11 Sublay: K; PP	1 (9)	-	0	-	NS	3 (27)	-	0	24
Mizrahi et al[2]	29 (28)	-	C: 18 I: 10 U: 1	L: 29 IPOM: K; ePTFE	13 (46)	-	NS	-	1 (4)	3 (11)	-	12 (4)	28
Wara et al[5]	72	-	C: 48 I: 24	L: 72 IPOM: K; PP+ePTFE	2 (3)	-	1 (1)	-	3 (4)	20 (28)	-	22 (3)	36
Pastor et al[26]	12	13	C: 10 I: 15	L: 12 O: 13 IPOM: K 3 SB: 7, lateral slit: 1 e-PTFE	4 (33)	7 (54)	2 (17)	2 (15)	0	1 (8)	0	0	14
Lüning et al[65]	15	-	C: 12 I: 3	O: 16 Onlay PP 7; PE 6; VICRYL 1; CRE-PPM 2	3 (20)	-	0	-	1 (7)	1 (7)	-	NS	33
Hansson et al[31]	55	-	C: 47 I: 5 U: 3	L 55 IPOM; K ePTFE	20 (36)	-	0	-	2 (4)	29 (53)	-	0	36 (median)
Berger et al[35]	47	-	NS	L: 46 O: 1 Sandwich PVDF-PP	1 (2)	-	1 (2)	-	NS	3 (6)	-	0	20 (median)
Muysoms et al[27]	24	-	C:20 I: 4	L: 24 IPOM K:11 non-slit SB 13 Parietex 11; DUALMESH 10; Composix 3	10 (42)	-	NS	-	NS	2 (8)	-	52 (21)	K: 31 SB: 14
Guzmán-Valdivia et al[32]	25	-	C:25	O: 25; Sublay PP	2 (8)	-	2 (8)	-	0	2 (8)	-	0	12
Craft et al[66]	21	-	C: 5 I: 7 U: 9	L: 21; IPOM K: 5 SB: 16 DUALMESH	1 (5)	-	1 (5)	-	2 (10)	8 (38)	-	0	14
Berger et al[7]	66	-	C:58 I:7 U:1	L: 66; IPOM SB: 41 Sandwich: 25 DUALMESH (until 4-2004) and Polyvinylidene	8 (12)	-	1 (2)	-	2 (3)	5 (8)	-	0	24 (median)
Mancini et al[29]	25	-	C: 15 I: 5 U: 6	L: 25; IPOM SB DUALMESH	1 (4)	-	1 (4)	-	1 (4)	3 (12)	-	12 (4)	19 (median)
van Sprundel et al[37]	16	-	C: 8 I: 5 U: 4	O: 16; IPOM K DUALMESH	1 (6)	-	0	-	0	5 (31)	-	0	29 (median)
de Ruiter et al[33]	46	-	C: 46	O: 46 Onlay CRE-PPM	7 (15)	-	0	-	3 (7)	2 (4)	-	0	51
Longman et al[67]	10	-	C: 7 I: 3	O: 10 Sublay K PP	0	-	0	-	0	1 (10)	-	0	30 (median)
LeBlanc et al[28]	12	-	C: 8 I: 2 U: 2	L: 12 IPOM SB 7, K 5 e-PTFE	1 (8)	-	0	-	0	2 (17)	-	12 (8)	20
Stelzner et al[36]	20 (19)	-	C: 20	O: 20 IPOM SB e-PTFE	3 (16)	-	1 (5)	-	0	3 (16)	-	0	42
Steele et al[30]	58	-	C: 31 I: 27	O: 58 Onlay “Stove pipe hat” PP	15 (26)	-	2 (3)	-	0	9 (16)	-	0	51
Hofstetter et al[38]	13	-	C: 13	O: 13 IPOM K e-PTFE	0	-	0	-	0	0	-	0	NS
Asif et al[17]	33		C: 12 I: 21	L: 33 SB:14 K:19 DUALMESH	11 (33)4	-	4 (12)		0	9 (27)		0	SB: 7 K: 36
Weighted pooled % (95%CI)					15.1% (9.7-21.6)		2.8% (1.6-4.4)		3,1% (1.8-4.6) FE	17,8% (12.0-24.4)		1.9 (0.9-3.2)
Smart et al[4]	27	-	C: 20 I:7	O: 20 Onlay: K; Permacol	15 (55)	-	1 (4)	-	0	0	-	12 (4)	17
Taner et al[25]	13	-	NS	O: 13 Overlay + Underlay (sandwich) AlloDerm	2 (15)	-	1 (8)	-	0	4 (31%)	-	0	10
Aycock et al[18]	11	-	C:2 I:9	O: 11 Inlay 8; Onlay 3; AlloDerm	3 (27)	-	2 (18)	-	NS	1 (9)	-	0	9
Araujo et al[24]	13	-	C: 13	O: 13 Onlay; Peri-Guard	1 (8)	-	0	-	NS	NS	-	0	50
Ellis[19]	20	-	C: 17 I: 3	O: 20 IPOM; SB; Surgisis	2 (10)	-	0	-	0	4 (20)	-	0	18
Weighted pooled % (95%CI)					24% (8.6-44.1)		5.6% (1.4-12.1)		0% (0-5.4) FE	13.4% (1.9-32.7)		2.6% (0.3-6.9) FE

Synthetic mesh repair:

¹With regard to lost after follow-up;

²Unrelated to mesh;

³Seroma 41 (48, 74, 121, 149, 171, 178, 201, 257); Cardiopulmonary 11 (48, 121, 171, 203, 487); Urinary tract infection 1 (243); Cutaneous/ fascial dehiscence 1 (252); Stoma complication 8 (121, 243, 245, 285); Ileus 13 (48, 87, 171, 212, 272); Post-operative bleeding 5 (48, 121, 171); Haematoma 6 (74, 171); Bowel stenosis 19 (121, 161, 178, 203, 207, 243, 272, 285, 487); Fistula formation 2 (285); Renal failure 4 (179, 203); Peritonitis 3 (121, 171); Other 18 (87, 171, 203, 207, 212, 243, 257, 272, 487);

⁴All keyhole. Biologic mesh repair: ¹With regard to lost after follow-up; ²Unrelated to mesh; ³Complications other: Seroma 6 (165, 429), Incisional separation 2 (165), Epidural infection 1 (242). FE: Fixed-effect model. L: Laparoscopic; O: Open; C: Colostomy; I: Ileostomy; SB: Sugarbaker; K: Keyhole PP: Polypropylene mesh; IPOM: Intraperitoneal mesh; PCM: Parietex composite mesh; ePTFE: Expanded polytetrafluoroethylene; CRE-PPM: Central ring enforced polypropylene mesh; PP + ePTFE: Polypropylene-based mesh covered with ePTFE.