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.
Zotero 插件
