title: Repair of parastomal hernias with biologic grafts: a systematic review.
abstract: BACKGROUND
  Biologic grafts are increasingly used instead of synthetic mesh for parastomal hernia repair due to concerns of synthetic mesh-related complications. This systematic review was designed to evaluate the use of these collagen-based scaffolds for the repair of parastomal hernias.
  
  
  METHODS
  Studies were retrieved after searching the electronic databases MEDLINE, EMBASE and Cochrane CENTRAL. The search terms 'paracolostomy', 'paraileostomy', 'parastomal', 'colostomy', 'ileostomy', 'hernia', 'defect', 'closure', 'repair' and 'reconstruction' were used. Selection of studies and assessment of methodological quality were performed with a modified MINORS index. All reports on repair of parastomal hernias using a collagen-based biologic scaffold to reinforce or bridge the defect were included. Outcomes were recurrence rate, mortality and morbidity.
  
  
  RESULTS
  Four retrospective studies with a combined enrolment of 57 patients were included. Recurrence occurred in 15.7% (95% confidence interval [CI] 7.8-25.9) of patients and wound-related complications in 26.2% (95% CI 14.7-39.5). No mortality or graft infections were reported.
  
  
  CONCLUSIONS
  The use of reinforcing or bridging biologic grafts during parastomal hernia repair results in acceptable rates of recurrence and complications. However, given the similar rates of recurrence and complications achieved using synthetic mesh in this scenario, the evidence does not support use of biologic grafts.
authors.affiliation: Department of Surgery, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. n.slater@chir.umcn.nl
authors.forename: Nicholas Jonathan
authors.initials: NJ
authors.lastname: Slater
authors.forename: Bibi M E
authors.initials: BM
authors.lastname: Hansson
authors.forename: Otmar R
authors.initials: OR
authors.lastname: Buyne
authors.forename: Thijs
authors.initials: T
authors.lastname: Hendriks
authors.forename: Robert P
authors.initials: RP
authors.lastname: Bleichrodt
mesh_terms: D046449:Hernia, Abdominal / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D019651:Plastic Surgery Procedures / Q000379:methods*; D054047:Surgical Stomas / Q000009:adverse effects*; D054457:Tissue Scaffolds; D014183:Transplantation, Heterologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome