| ObjectiveParastomal hernia is the most common long-term complication after abdominal ostomy.Due to its high incidence and ease of recurrence,it poses significant challenges for clinical treatment and patient prognosis.Some studies have shown that the prophylactic placement of mesh during the initial enterostomy can effectively prevent the occurrence of parastomal hernia.However,researchers have also put forward opposing viewpoints in recent years.In this study,meta-analysis was used to evaluate the clinical efficacy of prophylactic mesh placement during enterostomy in preventing parastomal hernia and postoperative stoma complications.Material and methodsComputer searches were conducted on eight domestic and international databases,including Web of science,Pub Med,Embase,Cochrane Library,CNKI,CBM,Wan Fang and VIP database.From database creation to March 2022,RCTs on the impact of prophylactic mesh placement on PSH during the first enterostomy were looked up.Two reviewers independently screened,extracted data and evaluated quality according to the established inclusion and exclusion criteria.Sensitivity analysis was performed by eliminating the included literature one by one,the Cochrane Risk of Bias tool was used to assess the included literature’s potential for bias,and the funnel plot,egger’s test,and sensitivity analysis were used to assess the potential for publication bias,and the relevant data were analyzed using Rev Man 5.3and Stata15 software.Results1.The results of quantitative meta-analysisAfter screening and exclusion,a total of 17 RCT studies were finally included,including 14 English literature and 3 Chinese literature.A total of 1307 patients were included in this study,including 657 patients in the patch group(preventive patch placement group)and 650 patients in the control group(traditional ostomy surgery).The follow-up time ranged from 12 to 67 months.Within the maximum follow-up period,the results of Meta-analysis showed that the incidence of PSH in the mesh group was 24.0%(158/657)lower than that in the control group(42.9%(279/650),and the difference was statistically significant(RR=0.55,95%CI 0.40-0.76,I~2=64%,P<0.01).There was no significant difference in the incidence of stoma prolapse(RR=0.69,95%CI 0.46-1.04,I2=0%,P=0.08)between the two groups(9.5%vs 13.0%);the mesh group(8/303)had no significant difference in the incidence of stoma infection compared to the control group(9/301)(RR=0.87,95%CI 0.35-2.17,I2=0%,P=0.77);the incidence of stoma necrosis was not significantly different between the mesh group(16/320)and the control group(19/309)(RR=0.83,95%CI 0.45-1.54,I2=0,P=0.56);the mesh group(17/272)and the control group(9/259)had no significant difference in the incidence of stoma stenosis(RR=1.61,95%CI 0.78-3.34,I2=0%,P=0.20);meanwhile,prophylactic mesh had no significant effect on the occurrence of secondary stoma surgery(8.3%vs10.6%)(RR=0.78,95%CI 0.52-1.16,I2=0%,P=0.22)and there was no significant difference in the incidence rate significance.In the subgroup analysis,the number of centers,operation method,mesh location,mesh type and follow-up time were not the main sources of heterogeneity.2.The results of sensitivity analysisThe included literatures were eliminated one by one,and the meta-analysis results showed that there was no significant reduction or reversal of results;different effect models were used for each study,and the results did not change significantly.Both analyses found the results to be stable and highly reliable.3.The results of publication biasThe publication bias funnel plot for parastomal hernia and stoma prolapse revealed image asymmetry,P>|t|0.05 in Egger’s test indicating that the study had a publication bias.In the future,it is still necessary to continue research and update relevant evidence-based medical evidence to reduce or eliminate the current publication bias.Further analysis of the two outcomes using the clipping method showed stable results.ConclusionProphylactic placement of mesh during enterostomy surgery can effectively reduce the occurrence of parastomal hernia without increasing the risk of stoma prolapse,stoma infection,stoma necrosis,stoma stenosis and secondary stoma surgery,has potential clinical promotion value.However,large sample RCTs with long-term follow-up are still needed to verify the results and reduce or even eliminate the current publication bias. |
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