title: Meta-analysis of prophylactic mesh to prevent parastomal hernia.
abstract: BACKGROUND
  Rates of parastomal hernia following stoma formation remain high. Previous systematic reviews suggested that prophylactic mesh reduces the rate of parastomal hernia; however, a larger trial has recently called this into question. The aim was to determine whether mesh placed at the time of primary stoma creation prevents parastomal hernia.
  
  
  METHODS
  The Cochrane Central Register of Controlled Trials, MEDLINE, Embase and CINAHL were searched using medical subject headings for parastomal hernia, mesh and prevention. Reference lists of identified studies, clinicaltrials.gov and the WHO International Clinical Trials Registry were also searched. All randomized clinical trials were included. Two authors extracted data from each study independently using a purpose-designed sheet. Risk of bias was assessed by a tool based on that developed by Cochrane.
  
  
  RESULTS
  Ten randomized trials were identified among 150 studies screened. In total 649 patients were included in the analysis (324 received mesh). Overall the rates of parastomal hernia were 53 of 324 (16·4 per cent) in the mesh group and 119 of 325 (36·6 per cent) in the non-mesh group (odds ratio 0·24, 95 per cent c.i. 0·12 to 0·50; P < 0·001). Mesh reduced the rate of parastomal hernia repair by 65 (95 per cent c.i. 28 to 85) per cent (P = 0·02). There were no differences in rates of parastomal infection, stomal stenosis or necrosis. Mesh type and position, and study quality did not have an independent effect on this relationship.
  
  
  CONCLUSIONS
  Mesh placed prophylactically at the time of stoma creation reduced the rate of parastomal hernia, without an increase in mesh-related complications.
authors.affiliation: Departments of Surgery, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: A J
authors.initials: AJ
authors.lastname: Cross
authors.affiliation: Departments of Surgery, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: P L
authors.initials: PL
authors.lastname: Buchwald
authors.affiliation: Departments of Surgery, Christchurch Hospital, Christchurch, New Zealand.|Departments of Surgery, University of Otago, Christchurch, New Zealand.
authors.forename: F A
authors.initials: FA
authors.lastname: Frizelle
authors.affiliation: Departments of Surgery, Christchurch Hospital, Christchurch, New Zealand.|Departments of Surgery, University of Otago, Christchurch, New Zealand.
authors.forename: T W
authors.initials: TW
authors.lastname: Eglinton
mesh_terms: D059685:Herniorrhaphy / Q000706:statistics & numerical data; D006801:Humans; D000069290:Incisional Hernia / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D015233:Models, Statistical; D010030:Ostomy / Q000295:instrumentation / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013526:Surgical Mesh; D054047:Surgical Stomas; D016896:Treatment Outcome