Martín-Arévalo J, López-Callejon V A, Moro-Valdezate D, Pérez-Santiago L, López-Mozos F, Carbonell Asins J A, Casado Rodrigo D, García-Botello S, Puente Monserrat J, Pla-Martí V
Colorectal Surgery Unit, Department of General and Digestive Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain.
Department of Colorectal Surgery, University Clinic Hospital of Valencia, University of Valencia, Av. Blasco Ibáñez, 17, 46010, Valencia, Spain.
Tech Coloproctol. 2025 Sep 25;29(1):169. doi: 10.1007/s10151-025-03211-6.
Parastomal hernia (PSH), a common ostomy complication, significantly impairs patient quality of life. Various prophylactic strategies, including surgical (mesh reinforcement) and non-surgical (abdominal wall strengthening exercises, AWSE) interventions, have been proposed, but their comparative effectiveness is unclear. This network meta-analysis primarily assessed PSH incidence.
Following PRISMA guidelines, we conducted a systematic review and network meta-analysis. Searches in PubMed, Embase and Web of Science identified randomised controlled trials (RCTs) and observational studies comparing prophylactic PSH prevention strategies. Data on PSH incidence were extracted. Network meta-analysis estimated odds ratios (ORs) and 95% confidence intervals (CIs). Effectiveness was determined by PSH incidence reduction, comparing all prophylactic interventions against a transrectal colostomy control group. Interventions were ranked using surface under the cumulative ranking curve probabilities.
The analysis included 73 studies (30 RCTs, 44 observational; 7473 patients). Funnel mesh was the most effective intervention (OR 0.09, 95% CI 0.05-0.17), followed by Stapled Mesh stomA Reinforcement Technique (SMART) (OR 0.16, 95% CI 0.05-0.48) and AWSE (OR 0.18, 95% CI 0.08-0.39). Subgroup analyses confirmed consistency in findings across study designs but highlighted variability in ileal conduits due to limited data. Heterogeneity was moderate (τ = 0.21, I = 36.1%).
Funnel mesh could be the most effective measure for high-risk patients, while extraperitoneal colostomy (ES) and AWSE may be a practical and scalable alternative. Further high-quality RCTs are needed to validate these findings and refine clinical guidelines for PSH prevention.
造口旁疝（PSH）是一种常见的造口并发症，严重损害患者生活质量。已提出多种预防策略，包括手术（网片加固）和非手术（腹壁强化锻炼，AWSE）干预措施，但它们的相对有效性尚不清楚。这项网状Meta分析主要评估了PSH的发生率。
遵循PRISMA指南，我们进行了一项系统评价和网状Meta分析。在PubMed、Embase和Web of Science中进行检索，以确定比较预防性PSH预防策略的随机对照试验（RCT）和观察性研究。提取了PSH发生率的数据。网状Meta分析估计了比值比（OR）和95%置信区间（CI）。通过比较所有预防性干预措施与经直肠结肠造口术对照组的PSH发生率降低情况来确定有效性。使用累积排名曲线概率下的面积对干预措施进行排名。
该分析纳入了73项研究（30项RCT，44项观察性研究；7473例患者）。漏斗形网片是最有效的干预措施（OR 0.09，95%CI 0.05-0.17），其次是吻合器网片造口强化技术（SMART）（OR 0.16，95%CI 0.05-0.48）和AWSE（OR 0.18，95%CI 0.08-0.39）。亚组分析证实了不同研究设计结果的一致性，但由于数据有限，突出了回肠造口术的变异性。异质性为中度（τ=0.21，I=36.1%）。
漏斗形网片可能是高危患者最有效的措施，而腹膜外结肠造口术（ES）和AWSE可能是一种实用且可扩展的替代方案。需要进一步的高质量RCT来验证这些发现，并完善PSH预防的临床指南。
