Background: Implantation of mesh at the time of stoma formation may reduce the rate of parastomal hernia. Until recently the evidence has been limited to only a few small randomised controlled trials. Aim: We present an updated systematic review and meta-analysis to assess the effect of mesh prophylaxis on rates of parastomal hernia. We examine ongoing and unpublished trials via online registries and propose recommendations for future research. Data Sources: MEDLINE, EMBASE and the Cochrane Library were searched up to March 2016 for published randomised controlled trials. Sixteen international trial registries were inspected for ongoing and unpublished trials. Study Selection Randomised controlled trials comparing mesh versus no mesh on the incidence of parastomal hernia after colostomy or ileostomy formation. Main Outcome Measures: The primary outcome measure was rate of parastomal hernia at least 12 months after stoma formation. Secondary outcomes included rates of stoma-related complications. Results: Of 3005 studies identified, 7 RCTs (432 patients) were eligible for inclusion in the final analysis. All were at high risk of bias. Mesh reduced the incidence of clinically detected parastomal hernia (10.8% versus 32.4%; P=0.001) (RR 0.34, CI 0.18 to 0.65, I2=39%) and the rate of radiological detected parastomal hernia (34.6% versus 55.3%; P=0.01) (RR 0.61, CI 0.42 to 0.89, I2=44%). No increase in the incidence of stoma-related complications was observed with the use of prophylactic mesh. Results from ongoing and unpublished RCTs are expected, but few will report on alternative mesh types or surgical techniques. Limitations: Heterogeneity of interventions, small patient populations and a high risk of bias seen in all studies implicate cautious interpretation of the results. Conclusion: Mesh prophylaxis at the time of stoma formation appears safe and effective in preventing parastomal hernia, however limitations of the primary evidence justify larger, more rigorous RCTs.
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机译:背景:造口形成时植入网孔可能会降低口腔旁疝的发生率。直到最近,证据还仅限于一些小型的随机对照试验。目的:我们提出了一个更新的系统评价和荟萃分析,以评估筛网预防措施对口旁疝的发生率的影响。我们通过在线注册中心检查正在进行的和未发表的试验,并为以后的研究提出建议。数据来源:检索截至2016年3月的MEDLINE,EMBASE和Cochrane库,以查找已发表的随机对照试验。对16个国际审判注册机构进行了检查,以进行正在进行的和未公开的审判。研究选择在结肠造口术或回肠造口术形成后,比较无孔网状与无孔网状的造口旁疝发生率的随机对照试验。主要结局指标:主要结局指标是造口后至少12个月的气管旁疝发生率。次要结果包括造口相关并发症的发生率。结果:在确定的3005项研究中,有7项RCT(432例患者)符合纳入最终分析的条件。所有人都有偏见的高风险。 Mesh降低了临床上检出的口旁疝的发生率(10.8%vs 32.4%; P = 0.001)(RR 0.34,CI 0.18 to 0.65,I2 = 39%)和放射学检出的口旁疝的发生率(34.6%vs 55.3%; P = 0.01)(RR 0.61,CI 0.42至0.89,I2 = 44%)。使用预防性网片未观察到造口相关并发症的发生率增加。预期正在进行中的和未发表的RCT的结果,但是很少有报道替代性网格类型或手术技术的报道。局限性:在所有研究中均发现干预措施的异质性,患者人数少以及偏见风险高,这意味着对结果的谨慎解释。结论:在造口时预防网状孔看起来是安全有效的,可以预防口旁疝,但是主要证据的局限性证明更大,更严格的RCT是合理的。
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