Prophylactic funnel mesh for preventing parastomal hernia in patients with permanent end stoma: a systematic review and meta-analysis.

Abstract

Purpose: The high incidence of parastomal hernia (PSH) has led surgeons to study strategies to minimize PSH, including prophylactic mesh placement during permanent stoma creation. There are several studies on prophylactic mesh for preventing PSH with conflicting results and there is limited information on using 3D funnel meshes and their effectiveness in preventing PSH.

Methods: A search was performed on PubMed, Scopus, Cochrane Central Register of Clinical Trials, and Web of Science for studies published up to September 2024. Odds ratios (ORs) and mean differences (MD) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed with I² statistics. Statistical analysis was performed using R Software version 4.4.1 (R Foundation for Statistical Computing).

Results: One randomized controlled trial and six observational studies were included, totaling 585 patients who underwent colorectal surgeries requiring a permanent stoma. Of these, 278 patients (47.5%) received prophylactic funnel meshes, and 307 (52.5%) underwent conventional stoma procedures. Compared to conventional procedures without mesh, the funnel mesh group showed significantly lower rates of PSH (9% vs. 54%; OR 0.07, 95% CI 0.03-0.17, p < 0.001). However, no significant differences were observed in time to PSH development, stoma prolapse, Clavien-Dindo grade 3b complications, stricture, ileus, leak, wound infection, small bowel obstruction, 30-day mortality, operative time, or hospital stay.

Conclusion: In patients undergoing colorectal surgery with a permanent end stoma, prophylactic funnel mesh was associated with lower rates of PSH, but findings remain exploratory and limited by current evidence.