Prevention of parastomal hernia after ileal conduit using prophylactic mesh: A meta-analysis of randomized controlled trials.

Abstract

<h4>Purpose</h4>This study aims at assessing the effectiveness of using prophylactic mesh for the prevention of Parastomal hernia (PSH) after cystectomy and ileal conduit.<h4>Methods</h4>PRISMA statement guidelines were followed. A comprehensive literature search was conducted across PubMed, MEDLINE, Cochrane Library, and Embase databases. The primary outcomes analyzed were operation time, clinical hernia, radiological hernia, and complications classified as greater than or less than 3 on the Clavien-Dindo scale.<h4>Results</h4>Three RCTs with a total number of 782 patients were included. The occurrence of clinical hernia significantly favored the mesh group, with a risk ratio (RR) of 0.50 (<i>p</i> < 0.002). However, the occurrence of radiological hernia showed no significant difference between groups, with an RR of 0.72 (<i>p</i> = 0.10). The analysis of operation time significantly favored the no mesh group, with a mean difference (MD) of -28.56 minutes (<i>p</i> < 0.002), indicating shorter operation times compared to the mesh group. Regarding complications, no significant differences were observed between the mesh and no mesh groups. For Clavien-Dindo Grade ≥3 complications, the RR was 1.11 (<i>p</i> = 0.42), and for Clavien-Dindo Grade <3 complications, the RR was 1.15 (<i>p</i> = 0.36).<h4>Conclusion</h4>Prophylactic mesh significantly reduces the incidence of PSH following ileal conduit. However, it does not significantly affect radiological hernia rates or complication rates. Despite longer operation times, its use offers a clear benefit in preventing PSH without substantially increasing complications.