title: Parastomal hernia as a consequence of colorectal cancer resections can prophylactically be controlled by mesh insertion at the time of primary surgery: a literature based systematic review of published trials.
abstract: OBJECTIVE
  The objective of this article was to systematically analyze the randomized, controlled trials (RCTs) evaluating the role of mesh in the prevention of parastomal hernia (PSH) at the time of primary colorectal resections.
  
  
  METHODS
  RCTs evaluating the role of mesh in the prevention of parastomal hernia (PSH) at the time of primary colorectal resections were analysed using RevMan®, and combined outcomes were expressed as odds ratio (OR) and standardized mean difference (SMD).
  
  
  RESULTS
  Three RCTs encompassing 128 patients were retrieved for the electronic databases. There were 64 patients in the mesh group and 64 patients in the no-mesh group. In the fixed effects model, the risk of developing postoperative complications (OR, 1.0; 95% CI, 0.36, 3.20; z=0.0; =1.0) was statistically similar after using mesh for PSH prevention at the time of primary colorectal resection and stoma construction in both groups. However, the risk of developing PSH (OR, 0.11; 95% CI, 0.05, 0.27; z=4.88; P<0.00001) was significantly lower after using mesh and mesh insertion to prevent PSH development statistically did not influence (SMD, -0.42; 95% CI, -0.96, 0.12; z=1.51; P=0.13) the duration of operation.
  
  
  CONCLUSIONS
  The incidence of PSH can be reduced by the insertion of mesh at stoma site at the time of primary stoma construction. A major multicentre RCT recruiting higher number of patients and longer follow up is required before recommending the routine use of mesh for PSH prevention.
authors.affiliation: Department of General and Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, West Sussex, UK. surgeon1wrh@hotmail.com
authors.forename: M S
authors.initials: MS
authors.lastname: Sajid
authors.forename: L
authors.initials: L
authors.lastname: Kalra
authors.forename: K
authors.initials: K
authors.lastname: Hutson
authors.forename: P
authors.initials: P
authors.lastname: Sains
mesh_terms: D002986:Clinical Trials as Topic; D015179:Colorectal Neoplasms / Q000601:surgery*; D006555:Hernia, Ventral / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control*; D013526:Surgical Mesh; D054047:Surgical Stomas