Does the parastomal hernia rate depend on the method of stoma formation? (meta-analysis and review)

AIM: to compare the effectiveness of different techniques for parastomal hernia prevention.MATERIALS AND METHODS: a systematic review and meta-analysis were performed in accordance with the PRISMA recommendations for the entire period up to 09/08/2023. The search for papers is carried out in PubMed with keywords “extraperitoneal”, “transperitoneal”, “intraperitoneal”, “rectal cancer”, “abdominoperineal resection”, “parastomal hernia”, “colostomy”, “stoma”, “end colostomy”, “prophylactic mesh”, “mesh”. As a result of the literature selection, 28 studies were included in the meta-analysis — 15 studies for end colostomy with and without an implant; 5 studies comparing intra-abdominal and extraperitoneal end colostomy; 8 studies comparing stoma channels through the rectus abdominis shield (transrectal stoma) and lateral stoma.RESULTS: the incidence of parastomal hernias is significantly lower for extraperitoneal stoma (p = 0.05) than intraabdominal one (OR = 3.40, CI 1.01–11.44) without significant increase in postoperative morbidity rate (OR = 1.04, CI 0.53–2.02, p = 0.92, OR = 2.22, CI 0.67–7.30, p = 0.19). Mesh significantly decreases the incidence of parastomal hernias (OR = 1.87, CI 1.16–3.01, p < 0.0001) without a consistent increase in postoperative morbidity rate (OR = 0.93, CI 0.47–1.82, p = 0.82). No significant differences were obtained between lateral and transrectal colostomies in the incidence of parastomal hernia (OR = 1.14, CI 0.52–2.52, p = 0.74).CONCLUSION: the extraperitoneal colostomy and meshes reduce the risk of parastomal hernia.