AB090. SOH26AB_0146. Does the placement of a prophylactic mesh reduce the rate of parastomal hernia in end colostomy formation in patients?—a systematic review

Background: Parastomal hernia (PSH) is one of the most common late complications following end colostomy formation. Prophylactic mesh reinforcement has been proposed as a technique to reduce PSH incidence, with early trials suggesting benefit. However, conflicting outcomes from more recent studies have highlighted the need for an updated synthesis of high-quality evidence to guide clinical practice.

Methods: A systematic review of randomised controlled trials (RCTs) was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, Cochrane, and Scopus databases were searched for RCTs comparing prophylactic mesh placement versus no mesh at the time of end colostomy formation following colorectal resection for benign or malignant disease. Eligible studies reported PSH incidence and peri-stomal or mesh-related complications. Data were extracted on patient demographics, operative details, detection methods, postoperative complications, re-operation rates, and quality-of-life outcomes.

Results: Thirteen RCTs met inclusion criteria, comprising 1,307 patients (610 with prophylactic mesh and 697 without). The mean patient age was 63.9 years, and the most frequently performed procedure was abdomino-perineal resection for rectal malignancy. Earlier trials demonstrated a reduction in PSH formation with mesh reinforcement, whereas more recent, methodologically robust trials showed no significant difference in either clinically or radiologically detected PSH. Importantly, prophylactic mesh placement did not result in a statistically significant increase in peri-stomal complications, mesh-related morbidity, or re-operation rates across studies.

Conclusions: Prophylactic mesh placement at the time of colostomy formation may be safe and potentially effective, but contemporary evidence shows no consistent reduction in PSH incidence. Given substantial heterogeneity among trials, further well-designed studies using modern surgical techniques are required before routine adoption can be recommended.

Keywords: Colorectal; colostomy; mesh; prophylactic; review