SynthesisTechniques in coloproctology2018
Prophylactic mesh reinforcement of stomas: a cost-effectiveness meta-analysis of randomised controlled trials.
Synthesis in Techniques in coloproctology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 3 syntheses or guidelines pooled it, 21 citations in OpenAlex.
- Pooled it
- Umbrella review of systematic reviews on the efficacy and safety of using mesh in the prevention of parastomal hernias.Hernia : the journal of hernias and abdominal wall surgery · 2024Pooled it
- Italian guidelines for the surgical management of enteral stomas in adults.Techniques in coloproctology · 2019Guideline
- New materials and complications of prostheses in humans: situation in Spain.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2024Review
- EHS Rapid Guideline: Evidence-Informed European Recommendations on Parastomal Hernia Prevention-With ESCP and EAES Participation.Journal of abdominal wall surgery : JAWS · 2023Article
- A Cost-Utility Analysis of Mesh Prophylaxis in the Prevention of Incisional Hernias following Stoma Closure Surgery.International journal of environmental research and public health · 2022Article
- Polydioxanone Internal Support Matrix: A Rationale for Prophylactic Internal Bra Support in Breast Augmentation.Aesthetic surgery journal. Open forum · 2022Article
- [Principles and parallels of prevention and repair of parastomal hernia with meshes].Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 2020Review
- Current Management of Intestinal Stomas and Their Complications.Journal of the anus, rectum and colon · 2020Review
- Parastomal and incisional hernia following laparoscopic/open abdominoperineal resection: is there a real difference?Surgical endoscopy · 2019Article
- Preoperative stoma site marking: a simple practice to reduce stoma-related complications.Techniques in coloproctology · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPrevious meta-analyses of randomised controlled trials (RCTs) have suggested a reduction in parastomal hernias (PSH) with prophylactic mesh. However, concerns persist regarding variably supportive evidence and cost. We performed an updated systematic review and meta-analysis to inform a novel cost-effectiveness analysis.
methodsThe PubMed, EMBASE and Cochrane Centre Register of Controlled Trials databases were searched (February 2018). We included RCTs assessing mesh reinforcement during stoma formation. We assessed PSH rates, subsequent repair, complications and operative time. Odds ratios (OR) and numbers needed to treat (NNT) were generated on intention to treat (ITT) and per protocol (PP) bases. These then informed cost analysis using 2017 UK/USA reimbursement rates and stoma care costs.
resultsEleven RCTs were included. Four hundred fifty-three patients were randomised to mesh (PP 412), with 454 controls (PP 413). Six studies used synthetic meshes, three composite and two biological (91.7% colostomies; 3.64% ileostomies, 4.63% not specified). Reductions were seen in the number of hernias detected clinically and on computed tomography scan. For the former, ITT OR was 0.23 (95% confidence interval 0.11-0.51; p = 0.0003; n = 11); NNT 4.17 (2.56-10.0), with fewer subsequent repairs: OR 0.29 (0.13-0.64; p = 0.002; n = 7; NNT16.7 (10.0-33.3). Reductions persisted for synthetic and composite meshes. Operative time was similar, with zero incidence of mesh infection/fistulation, and fewer peristomal complications. Synthetic mesh demonstrated a favourable cost profile, with composite approximately cost neutral, and biological incurring net costs.
conclusionsReinforcing elective stomas with mesh (primarily synthetic) reduces subsequent PSH rates, complications, repairs and saves money. We recommend that future RCTs compare mesh subtypes, techniques, and applicability to emergency stomas.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.