Fascial closure techniques at stoma reversal: a systematic review and network meta-analysis of randomized controlled trials

BACKGROUND: Incisional hernia after stoma reversal is a frequent complication, yet the optimal method for fascial closure remains uncertain. This network meta-analysis (NMA) synthesized randomized evidence comparing closure techniques and prophylactic mesh reinforcement. METHODS: A systematic search of MEDLINE (PubMed) and CENTRAL (Cochrane) was performed through October 2025. Randomized controlled trials in adults comparing fascial closure strategies during stoma reversal reporting on the incidence of incisional hernia and/or surgical site infection were included. Random-effects frequentist and Bayesian NMAs were conducted using MetaInsight powered by R packages netmeta, gemtc, BUGSnet, and bnma. Treatment effects were expressed as odds ratios (OR) and risk differences (RD) with 95% confidence or credible intervals. RESULTS: Six RCTs compared standard closure, resorbable mesh, and non-resorbable mesh. Both mesh types reduced incisional hernia compared with no mesh (non-resorbable mesh: OR 0.13 [0.03-0.49]; resorbable mesh: OR 0.54 [0.35-0.84]) without increasing surgical-site infection. Bayesian results and SUCRA rankings were consistent. CONCLUSION: Fascial reinforcement, particularly with non-resorbable mesh, significantly reduces the risk of stoma-site incisional hernia without increasing infection rates. These findings support prophylactic reinforcement in selected patients.