Type of mesh and wall plane in prophylactic mesh after stoma closure: A network meta-analysis

BACKGROUND: Prophylactic mesh placement lowers incisional hernia risk, but the ideal mesh type and anatomical plane remain unclear. This study aims to determine which mesh and placement site are associated with the lowest rates of incisional hernia and surgical site infection after stoma closure.

METHODS: A systematic review of PubMed, the Cochrane Library, and Embase was conducted to identify comparative studies evaluating the type of mesh and/or the anatomical plane of mesh placement in the abdominal wall following stoma closure for the prevention of incisional hernias. A network meta-analysis was performed to assess incisional hernia and surgical site infection.

RESULTS: We included 11 included studies involving 2,148 patients. The use of prosthetic mesh (OR = 0.137, 95%CI 0.056-0.335), bioprosthetic mesh (OR = 0.171, 95%CI 0.061-0.473), and biological mesh (OR = 0.528, 95%CI 0.336-0.828) was associated with a lower risk of incisional hernia compared to no mesh use. Mesh placement in a retromuscular position (OR = 0.068, 95%CI 0.024-0.189), onlay position (OR = 0.224, 95%CI 0.095-0.524), and intraperitoneal position (OR = 0.564, 95%CI 0.366-0.869) was associated with a lower risk of incisional hernia compared to no mesh use. No statistically significant differences were observed in surgical site infection risk between the use of different mesh types or anatomical planes and no mesh placement.

CONCLUSION: Prophylactic placement of prosthetic or bioprosthetic mesh in the retromuscular plane at the time of stoma closure is the most effective approach for reducing the incidence of incisional hernia and surgical site infection.