Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, 33179, FL, United States.
Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.
Hernia. 2024 Oct;28(5):1577-1589. doi: 10.1007/s10029-024-03137-2. Epub 2024 Aug 23.
This umbrella review aimed to summarize the findings and conclusions of published systematic reviews on the prophylactic role of mesh against parastomal hernias in colorectal surgery.
PRISMA-compliant umbrella overview of systematic reviews on the role of mesh in prevention of parastomal hernias was conducted. PubMed and Scopus were searched through November 2023. Main outcomes were efficacy and safety of mesh. Efficacy was assessed by the rates of clinically and radiologically detected hernias and the need for surgical repair, while safety was assessed by the rates of overall complications.
19 systematic reviews were assessed; 7 included only patients with end colostomy and 12 included patients with either ileostomy or colostomy. The use of mesh significantly reduced the risk of clinically detected parastomal hernias in all reviews except one. Seven reviews reported a significantly lower risk of radiologically detected parastomal hernias with the use of mesh. The pooled hazards ratio of clinically detected and radiologically detected parastomal hernias was 0.33 (95%CI: 0.26-0.41) and 0.55 (95%CI: 0.45-0.68), respectively. Six reviews reported a significant reduction in the need for surgical repair when a mesh was used whereas six reviews found a similar need for hernia repair. The pooled hazards ratio for surgical hernia repair was 0.46 (95%CI: 0.35-0.62). Eight reviews reported similar complications in the two groups. The pooled hazard ratio of complications was 0.81 (95%CI: 0.66-1).
The use of surgical mesh is likely effective and safe in the prevention of parastomal hernias without an increased risk of overall complications.
本伞状综述旨在总结已发表的关于在结直肠手术中使用网片预防造口旁疝的系统评价的研究结果和结论。
对预防造口旁疝中使用网片的作用进行了符合 PRISMA 原则的伞状系统评价综述。检索了 PubMed 和 Scopus 数据库，检索时间截至 2023 年 11 月。主要结局是网片的疗效和安全性。疗效评估指标为临床和影像学检测到的疝的发生率和需要手术修复的情况，而安全性评估指标为总并发症的发生率。
评估了 19 篇系统评价；其中 7 篇仅纳入了行末端造口术的患者，12 篇纳入了行回肠造口术或结肠造口术的患者。除 1 篇外，所有综述均表明使用网片可显著降低临床检测到的造口旁疝的风险。7 篇综述报告使用网片可显著降低影像学检测到的造口旁疝的风险。临床和影像学检测到的造口旁疝的汇总风险比分别为 0.33（95%CI：0.26-0.41）和 0.55（95%CI：0.45-0.68）。6 篇综述报告使用网片可显著降低手术修复的需求，而 6 篇综述发现两组的疝修复需求相似。手术治疗疝的汇总风险比为 0.46（95%CI：0.35-0.62）。8 篇综述报告两组的并发症相似。并发症的汇总风险比为 0.81（95%CI：0.66-1）。
在预防造口旁疝方面，使用外科网片可能是有效且安全的，且不会增加总体并发症的风险。
