Effectiveness of prophylactic three-dimensional mesh in preventing parastomal hernia in patients undergoing permanent end colostomy formation for rectal cancer: A systematic review: Prophylactic three-dimensional mesh

Background: Parastomal hernia is a common complication after colostomy, especially end-colostomy. It is unclear whether prophylactic placement of 3-dimensional mesh at the time of stoma formation could prevent parastomal hernia formation after surgery for rectal cancer.

Methods: A systematic review was undertaken to evaluate the efficacy of prophylactic mesh in end-colostomy construction from 2000 to 2025 using MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trails and Clinical trials including CT.gov. Grey literature searches included reference lists of included studies and clinical practice guidelines. Observational studies were also included due to the scarcity of RCTs on this topic. The primary outcome of study was the incidence of parastomal hernia.

Results: Five observational studies and two RCTs were included. 512 patients were included in the review across 7 selected studies. PSH occurred in 10.2% (32/313) of patients with mesh and 50.7% (97/191) of patients without mesh. Thematic analysis identified four overarching themes which could have influenced efficacy of 3-dimensional mesh: 1. Follow ups and parastomal Hernia; 2. Post-operative complications; 3. Surgical technique; 4. Demographic make-up.

Conclusion: Prophylactic placement of 3-dimensional mesh at the time of stoma formation is associated with a significant reduction in the incidence of parastomal hernia. However, findings need to be interpreted with caution due to the heterogeneity of the studies retrieved regarding clinical and non-clinical parameters. Variability with regards to the diagnosis of PSH, surgical technique, sample characteristics (age, gender, and medical history) and methodology (follow up time) limit comparison of results.