Prophylactic mesh at stoma reversal reduces incisional hernia without increasing early complications: a systematic review and meta-analysis of randomised trials.

Abstract

<h4>Background</h4>Stoma-site incisional hernias (SSIHs) are a common complication following ileostomy or colostomy reversal. Prophylactic mesh placement during stoma closure may reduce this risk, but adoption is limited by concerns regarding mesh safety and uncertainty regarding long-term benefit.<h4>Methods</h4>We conducted a systematic review and meta-analysis of randomised controlled trials comparing prophylactic mesh with standard fascial closure during elective stoma reversal. The primary outcome was SSIH within 12 months. Secondary outcomes included surgical-site infection (SSI), mesh-related complications, anastomotic leak, operative time, and patient-reported outcomes. Risk of bias was assessed using ROB 2.0, and certainty of evidence was evaluated using GRADE.<h4>Results</h4>Three RCTs comprising 957 patients (mesh: n = 477; control: n = 480) were included. Prophylactic mesh significantly reduced SSIH at 12 months (risk ratio 0.25, 95% CI 0.08-0.76), with an absolute risk reduction of 13.6%. SSI (OR 1.21, 95% CI 0.84-1.74) and anastomotic leak (OR 1.08, 95% CI 0.50-2.33) did not differ significantly between groups. Operative time was longer in the mesh group (mean difference + 25.25 min, 95% CI 15.83-34.68). Mesh-related complications were rare, and no explantations occurred. Two trials reported improved hernia-specific quality of life with mesh.<h4>Conclusion</h4>Prophylactic mesh during elective stoma closure significantly reduces SSIH without increasing early complications. While operative time is modestly increased, the clinical benefit and safety profile support routine consideration of mesh, particularly in high-risk patients. Longer-term follow-up and cost-effectiveness data are needed to guide broader implementation.