Comparing the effectiveness of prophylactic strategies for parastomal hernia prevention: a network meta-analysis.

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Techniques in Coloproctology Pub Date : 2025-09-25 DOI:10.1007/s10151-025-03211-6

J Martín-Arévalo, V A López-Callejon, D Moro-Valdezate, L Pérez-Santiago, F López-Mozos, J A Carbonell Asins, D Casado Rodrigo, S García-Botello, J Puente Monserrat, V Pla-Martí

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引用次数: 0

Abstract

Background: Parastomal hernia (PSH), a common ostomy complication, significantly impairs patient quality of life. Various prophylactic strategies, including surgical (mesh reinforcement) and non-surgical (abdominal wall strengthening exercises, AWSE) interventions, have been proposed, but their comparative effectiveness is unclear. This network meta-analysis primarily assessed PSH incidence.

Methods: Following PRISMA guidelines, we conducted a systematic review and network meta-analysis. Searches in PubMed, Embase and Web of Science identified randomised controlled trials (RCTs) and observational studies comparing prophylactic PSH prevention strategies. Data on PSH incidence were extracted. Network meta-analysis estimated odds ratios (ORs) and 95% confidence intervals (CIs). Effectiveness was determined by PSH incidence reduction, comparing all prophylactic interventions against a transrectal colostomy control group. Interventions were ranked using surface under the cumulative ranking curve probabilities.

Results: The analysis included 73 studies (30 RCTs, 44 observational; 7473 patients). Funnel mesh was the most effective intervention (OR 0.09, 95% CI 0.05-0.17), followed by Stapled Mesh stomA Reinforcement Technique (SMART) (OR 0.16, 95% CI 0.05-0.48) and AWSE (OR 0.18, 95% CI 0.08-0.39). Subgroup analyses confirmed consistency in findings across study designs but highlighted variability in ileal conduits due to limited data. Heterogeneity was moderate (τ² = 0.21, I² = 36.1%).

Conclusions: Funnel mesh could be the most effective measure for high-risk patients, while extraperitoneal colostomy (ES) and AWSE may be a practical and scalable alternative. Further high-quality RCTs are needed to validate these findings and refine clinical guidelines for PSH prevention.

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比较造口旁疝预防策略的有效性：网络荟萃分析。

背景：造口旁疝（PSH）是一种常见的造口并发症，严重影响患者的生活质量。各种预防策略，包括手术（补片加固）和非手术（腹壁强化练习，AWSE）干预，已被提出，但其比较效果尚不清楚。该网络荟萃分析主要评估PSH发病率。方法：遵循PRISMA指南，我们进行了系统评价和网络荟萃分析。在PubMed、Embase和Web of Science中搜索发现了比较预防性PSH预防策略的随机对照试验（rct）和观察性研究。提取PSH发病率数据。网络荟萃分析估计了优势比（ORs）和95%置信区间（ci）。通过PSH发生率的降低来确定有效性，将所有预防性干预措施与经直肠结肠造口对照组进行比较。在累积排序曲线概率下，采用曲面对干预措施进行排序。结果：本分析纳入73项研究（30项随机对照试验，44项观察性研究，7473例患者）。漏斗补片是最有效的干预措施（OR 0.09, 95% CI 0.05-0.17），其次是缝合补片补气孔技术（SMART）（OR 0.16, 95% CI 0.05-0.48）和AWSE （OR 0.18, 95% CI 0.08-0.39）。亚组分析证实了研究设计结果的一致性，但由于数据有限，强调了回肠导管的变异性。异质性为中等（τ2 = 0.21, I2 = 36.1%）。结论：漏斗网可能是高危患者最有效的措施，而腹腔外结肠造口术（ES）和AWSE可能是一种实用且可扩展的替代方法。需要进一步的高质量随机对照试验来验证这些发现并完善PSH预防的临床指南。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.