Update Systematic Review, Meta-Analysis and GRADE Assessment of the Evidence on Parastomal Hernia Prevention—A EHS, ESCP and EAES Collaborative Project

Objective: To perform a systematic review and meta-analysis on the effectiveness of prophylactic mesh for the prevention of parastomal hernia in end colostomy, with the ultimate objective to summarize the evidence for an interdisciplinary, European rapid guideline.Methods: We updated a previous syst...

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Main Authors: Alexander A. Tzanis, Cesare Stabilini, Filip E. Muysoms, Lisa Rossi, Ourania Koutsiouroumpa, Dimitris Mavridis, Michel Adamina, Umberto Bracale, Henk-Thijs Brandsma, Stéphanie O. Breukink, Manuel López Cano, Samantha Cole, Suzanne Doré, Kristian Kiim Jensen, Marianne Krogsgaard, Neil J. Smart, Christoffer Odensten, Chantal Tielemans, Stavros A. Antoniou
Format: Article
Language:English
Published: Frontiers Media S.A. 2023-08-01
Series:Journal of Abdominal Wall Surgery
Subjects:
Online Access:https://www.frontierspartnerships.org/articles/10.3389/jaws.2023.11550/full
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author Alexander A. Tzanis
Cesare Stabilini
Filip E. Muysoms
Lisa Rossi
Ourania Koutsiouroumpa
Dimitris Mavridis
Michel Adamina
Umberto Bracale
Henk-Thijs Brandsma
Stéphanie O. Breukink
Manuel López Cano
Samantha Cole
Suzanne Doré
Kristian Kiim Jensen
Marianne Krogsgaard
Neil J. Smart
Christoffer Odensten
Chantal Tielemans
Stavros A. Antoniou
author_facet Alexander A. Tzanis
Cesare Stabilini
Filip E. Muysoms
Lisa Rossi
Ourania Koutsiouroumpa
Dimitris Mavridis
Michel Adamina
Umberto Bracale
Henk-Thijs Brandsma
Stéphanie O. Breukink
Manuel López Cano
Samantha Cole
Suzanne Doré
Kristian Kiim Jensen
Marianne Krogsgaard
Neil J. Smart
Christoffer Odensten
Chantal Tielemans
Stavros A. Antoniou
author_sort Alexander A. Tzanis
collection DOAJ
description Objective: To perform a systematic review and meta-analysis on the effectiveness of prophylactic mesh for the prevention of parastomal hernia in end colostomy, with the ultimate objective to summarize the evidence for an interdisciplinary, European rapid guideline.Methods: We updated a previous systematic review with de novo evidence search of PubMed from inception up to June 2022. Primary outcome was quality of life (QoL). Secondary outcomes were clinical diagnosis of parastomal hernia, surgery for parastomal hernia, and 30 day or in-hospital complications Clavien-Dindo ≥3. We utilised the revised Cochrane Tool for randomised trials (RoB 2 tool) for risk of bias assessment in the included studies. Minimally important differences were set a priori through voting of the panel members. We appraised the evidence using GRADE and we developed GRADE evidence tables.Results: We included 12 randomized trials. Meta-analysis suggested no difference in QoL between prophylactic mesh and no mesh for primary stoma construction (SMD = 0.03, 95% CI [−0.14 to 0.2], I2 = 0%, low certainty of evidence). With regard to parastomal hernia, the use of prophylactic synthetic mesh resulted in a significant risk reduction of the incidence of the event, according to data from all available randomized trials, irrespective of the follow-up period (OR = 0.33, 95% CI [0.18–0.62], I2 = 74%, moderate certainty of evidence). Sensitivity analyses according to follow-up period were in line with the primary analysis. Little to no difference in surgery for parastomal hernia was encountered after pooled analysis of 10 randomised trials (OR = 0.52, 95% CI [0.25–1.09], I2 = 14%). Finally, no significant difference was found in Clavien-Dindo grade 3 and 4 adverse events after surgery with or without the use of a prophylactic mesh (OR = 0.77, 95% CI [0.45–1.30], I2 = 0%, low certainty of evidence).Conclusion: Prophylactic synthetic mesh placement at the time of permanent end colostomy construction is likely associated with a reduced risk for parastomal hernia and may confer similar risk of peri-operative major morbidity compared to no mesh placement. There may be no difference in quality of life and surgical repair of parastomal hernia with the use of either approach.
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spelling doaj.art-647dcc0f84ea4f0c84e3ce4591c7145f2023-08-29T04:11:04ZengFrontiers Media S.A.Journal of Abdominal Wall Surgery2813-20922023-08-01210.3389/jaws.2023.1155011550Update Systematic Review, Meta-Analysis and GRADE Assessment of the Evidence on Parastomal Hernia Prevention—A EHS, ESCP and EAES Collaborative ProjectAlexander A. Tzanis0Cesare Stabilini1Filip E. Muysoms2Lisa Rossi3Ourania Koutsiouroumpa4Dimitris Mavridis5Michel Adamina6Umberto Bracale7Henk-Thijs Brandsma8Stéphanie O. Breukink9Manuel López Cano10Samantha Cole11Suzanne Doré12Kristian Kiim Jensen13Marianne Krogsgaard14Neil J. Smart15Christoffer Odensten16Chantal Tielemans17Stavros A. Antoniou18Metaxa Memorial Cancer Hospital, Piraeus, GreeceDepartment of Surgery, University of Genoa, Genoa, ItalyDepartment of Surgery, Maria Middelares Hospital, Ghent, BelgiumDepartment of Surgery, IRCCS Policlinico San Martino, University of Genoa, Genoa, ItalyDepartment of Primary Education, School of Education, University of Ioannina, Ioannina, GreeceDepartment of Primary Education, School of Education, University of Ioannina, Ioannina, GreeceDepartment of Surgery, Cantonal Hospital Winterthur, Zurich, SwitzerlandDepartment of Public Health, University of Naples Federico II, Naples, ItalyDepartment of Surgery, Antonius Ziekenhuis, Sneek, NetherlandsMaastricht University Medical Centre, Maastricht, Netherlands0Abdominal Wall Surgery Unit, Val d’ Hebrón University Hospital, Universidad Autónoma de Barcelona, Barcelona, Spain1Patient Representative, Nottingham, United Kingdom2Patient Representative, Rayne, United Kingdom3Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, Denmark4Department of Surgery, Zealand University Hospital, Koege, Denmark5Department of General Surgery, Royal Devon and Exeter Hospital, Exeter, United Kingdom6Department of Surgical and Perioperative Sciences, Surgery, Umeå University Educational Unit at Sunderby Hospital, Sunderby, Sweden7University Hospital Ghent, Ghent, Belgium8Department of Surgery, Papageorgiou General Hospital, Thessaloniki, GreeceObjective: To perform a systematic review and meta-analysis on the effectiveness of prophylactic mesh for the prevention of parastomal hernia in end colostomy, with the ultimate objective to summarize the evidence for an interdisciplinary, European rapid guideline.Methods: We updated a previous systematic review with de novo evidence search of PubMed from inception up to June 2022. Primary outcome was quality of life (QoL). Secondary outcomes were clinical diagnosis of parastomal hernia, surgery for parastomal hernia, and 30 day or in-hospital complications Clavien-Dindo ≥3. We utilised the revised Cochrane Tool for randomised trials (RoB 2 tool) for risk of bias assessment in the included studies. Minimally important differences were set a priori through voting of the panel members. We appraised the evidence using GRADE and we developed GRADE evidence tables.Results: We included 12 randomized trials. Meta-analysis suggested no difference in QoL between prophylactic mesh and no mesh for primary stoma construction (SMD = 0.03, 95% CI [−0.14 to 0.2], I2 = 0%, low certainty of evidence). With regard to parastomal hernia, the use of prophylactic synthetic mesh resulted in a significant risk reduction of the incidence of the event, according to data from all available randomized trials, irrespective of the follow-up period (OR = 0.33, 95% CI [0.18–0.62], I2 = 74%, moderate certainty of evidence). Sensitivity analyses according to follow-up period were in line with the primary analysis. Little to no difference in surgery for parastomal hernia was encountered after pooled analysis of 10 randomised trials (OR = 0.52, 95% CI [0.25–1.09], I2 = 14%). Finally, no significant difference was found in Clavien-Dindo grade 3 and 4 adverse events after surgery with or without the use of a prophylactic mesh (OR = 0.77, 95% CI [0.45–1.30], I2 = 0%, low certainty of evidence).Conclusion: Prophylactic synthetic mesh placement at the time of permanent end colostomy construction is likely associated with a reduced risk for parastomal hernia and may confer similar risk of peri-operative major morbidity compared to no mesh placement. There may be no difference in quality of life and surgical repair of parastomal hernia with the use of either approach.https://www.frontierspartnerships.org/articles/10.3389/jaws.2023.11550/fullstomaostomycolostomymeshprevention
spellingShingle Alexander A. Tzanis
Cesare Stabilini
Filip E. Muysoms
Lisa Rossi
Ourania Koutsiouroumpa
Dimitris Mavridis
Michel Adamina
Umberto Bracale
Henk-Thijs Brandsma
Stéphanie O. Breukink
Manuel López Cano
Samantha Cole
Suzanne Doré
Kristian Kiim Jensen
Marianne Krogsgaard
Neil J. Smart
Christoffer Odensten
Chantal Tielemans
Stavros A. Antoniou
Update Systematic Review, Meta-Analysis and GRADE Assessment of the Evidence on Parastomal Hernia Prevention—A EHS, ESCP and EAES Collaborative Project
Journal of Abdominal Wall Surgery
stoma
ostomy
colostomy
mesh
prevention
title Update Systematic Review, Meta-Analysis and GRADE Assessment of the Evidence on Parastomal Hernia Prevention—A EHS, ESCP and EAES Collaborative Project
title_full Update Systematic Review, Meta-Analysis and GRADE Assessment of the Evidence on Parastomal Hernia Prevention—A EHS, ESCP and EAES Collaborative Project
title_fullStr Update Systematic Review, Meta-Analysis and GRADE Assessment of the Evidence on Parastomal Hernia Prevention—A EHS, ESCP and EAES Collaborative Project
title_full_unstemmed Update Systematic Review, Meta-Analysis and GRADE Assessment of the Evidence on Parastomal Hernia Prevention—A EHS, ESCP and EAES Collaborative Project
title_short Update Systematic Review, Meta-Analysis and GRADE Assessment of the Evidence on Parastomal Hernia Prevention—A EHS, ESCP and EAES Collaborative Project
title_sort update systematic review meta analysis and grade assessment of the evidence on parastomal hernia prevention a ehs escp and eaes collaborative project
topic stoma
ostomy
colostomy
mesh
prevention
url https://www.frontierspartnerships.org/articles/10.3389/jaws.2023.11550/full
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