The role of prophylactic mesh insertion in the prevention of parastomal hernia

Abstract

Prophylactic mesh insertion during a colostomy may be useful in reducing the risks of surgery associated with the treatment of parastomal hernia (PSH), a risk factor of colostomy. Moreover, the latter would also be useful in reducing stress on both patients and healthcare professionals. To achieve the aim of an evidence based dissertation, the following research question was posed, “Does prosthetic mesh insertion prevent the development of a parastomal hernia in patients having a colostomy?”, with the PICO elements being; P- adults undergoing a colostomy, I- Prophylactic prosthetic mesh insertion during the primary colostomy procedure, C- No mesh insertion, O-Preventing PSH development. Several sources were utilized to obtain relevant literature from peer-reviewed journals in English, published from 2012 onwards. Studies of lower standards such as trials, those involving children/neonatals, the use of other prophylaxis other than mesh insertion or insertion of mesh after the development of a hernia were excluded. Critical appraisal was guided by the appraisal checklist by JBI, AMSTAR and CASP tools. From a total of 955,817 hits, 10 relevant articles were selected to answer the research question; these being 6 meta analyses and systematic reviews, 3 RCTs and 1 casecontrolled study. The main results showed a reduction in PSH development through the use of prophylactic mesh insertion. Based on these findings, the main recommendations refer to further research and education in this field of study before this procedure is implemented in the national standard of care in Malta.