Update Systematic Review, Meta-Analysis and GRADE Assessment of the Evidence on Parastomal Hernia Prevention-A EHS, ESCP and EAES Collaborative Project.

IF 1.3 4区 工程技术 Q3 MECHANICS
Nihon Reoroji Gakkaishi Pub Date : 2023-08-29 eCollection Date: 2023-01-01 DOI:10.3389/jaws.2023.11550
Alexander A Tzanis, Cesare Stabilini, Filip E Muysoms, Lisa Rossi, Ourania Koutsiouroumpa, Dimitris Mavridis, Michel Adamina, Umberto Bracale, Henk-Thijs Brandsma, Stéphanie O Breukink, Manuel López Cano, Samantha Cole, Suzanne Doré, Kristian Kiim Jensen, Marianne Krogsgaard, Neil J Smart, Christoffer Odensten, Chantal Tielemans, Stavros A Antoniou
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引用次数: 0

Abstract

Objective: To perform a systematic review and meta-analysis on the effectiveness of prophylactic mesh for the prevention of parastomal hernia in end colostomy, with the ultimate objective to summarize the evidence for an interdisciplinary, European rapid guideline. Methods: We updated a previous systematic review with de novo evidence search of PubMed from inception up to June 2022. Primary outcome was quality of life (QoL). Secondary outcomes were clinical diagnosis of parastomal hernia, surgery for parastomal hernia, and 30 day or in-hospital complications Clavien-Dindo ≥3. We utilised the revised Cochrane Tool for randomised trials (RoB 2 tool) for risk of bias assessment in the included studies. Minimally important differences were set a priori through voting of the panel members. We appraised the evidence using GRADE and we developed GRADE evidence tables. Results: We included 12 randomized trials. Meta-analysis suggested no difference in QoL between prophylactic mesh and no mesh for primary stoma construction (SMD = 0.03, 95% CI [-0.14 to 0.2], I2 = 0%, low certainty of evidence). With regard to parastomal hernia, the use of prophylactic synthetic mesh resulted in a significant risk reduction of the incidence of the event, according to data from all available randomized trials, irrespective of the follow-up period (OR = 0.33, 95% CI [0.18-0.62], I2 = 74%, moderate certainty of evidence). Sensitivity analyses according to follow-up period were in line with the primary analysis. Little to no difference in surgery for parastomal hernia was encountered after pooled analysis of 10 randomised trials (OR = 0.52, 95% CI [0.25-1.09], I2 = 14%). Finally, no significant difference was found in Clavien-Dindo grade 3 and 4 adverse events after surgery with or without the use of a prophylactic mesh (OR = 0.77, 95% CI [0.45-1.30], I2 = 0%, low certainty of evidence). Conclusion: Prophylactic synthetic mesh placement at the time of permanent end colostomy construction is likely associated with a reduced risk for parastomal hernia and may confer similar risk of peri-operative major morbidity compared to no mesh placement. There may be no difference in quality of life and surgical repair of parastomal hernia with the use of either approach.

更新系统综述、元分析和 GRADE 证据评估--EHS、ESCP 和 EAES 合作项目。
目的就预防性网片对预防结肠造口术后腹股沟旁疝的有效性进行系统回顾和荟萃分析,最终目的是总结证据,制定跨学科的欧洲快速指南。方法:我们更新了之前的系统性综述,在 PubMed 上重新进行了证据搜索,搜索时间从开始到 2022 年 6 月。主要结果是生活质量(QoL)。次要结果为腹股沟旁疝的临床诊断、腹股沟旁疝手术以及 30 天或住院并发症 Clavien-Dindo ≥3。我们使用修订版 Cochrane 随机试验工具(RoB 2 工具)对纳入研究进行偏倚风险评估。通过专家组成员的投票,预先设定了最小重要差异。我们使用 GRADE 对证据进行评估,并制定了 GRADE 证据表。结果我们纳入了 12 项随机试验。Meta 分析表明,在初次造口术中使用预防性网片和不使用网片在 QoL 方面没有差异(SMD = 0.03,95% CI [-0.14 至 0.2],I2 = 0%,证据确定性低)。关于造口旁疝,根据所有可用随机试验的数据,无论随访时间长短,使用预防性合成网片都能显著降低该事件的发生风险(OR = 0.33,95% CI [0.18-0.62],I2 = 74%,中度证据确定性)。根据随访期进行的敏感性分析与主要分析结果一致。对10项随机试验进行汇总分析后发现,腹股沟旁疝手术几乎没有差异(OR = 0.52,95% CI [0.25-1.09],I2 = 14%)。最后,在使用或不使用预防性网片的手术后,Clavien-Dindo 3 级和 4 级不良事件没有发现明显差异(OR = 0.77,95% CI [0.45-1.30],I2 = 0%,证据确定性低)。结论与不放置网片相比,在进行永久性末端结肠造口术时放置预防性合成网片可能会降低发生吻合口旁疝的风险,并可能带来类似的围手术期主要发病风险。这两种方法在生活质量和手术修复副乳疝方面可能没有区别。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Nihon Reoroji Gakkaishi
Nihon Reoroji Gakkaishi 工程技术-高分子科学
CiteScore
1.50
自引率
61.50%
发文量
47
审稿时长
>12 weeks
期刊介绍: For the communication among the members, the journal of the Society of Rheology Japan, NIHON REOROJI GAKKAISHI (5 issues per year), was established in 1973 and it is the oldest journal on rheology in Asia. The journal contains original and review articles on rheology and related topics, information for all SRJ events, and reports of domestic/overseas meetings. Articles in Japanese as well as in English are considered for publication, not only from the members but also from the researchers outside. Papers from new emerging areas of the field are particularly welcome. The electronic version of the articles is available via the internet with an open access policy.
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