SP2.02 Non-mesh techniques to reduce stoma morbidity: A review of 21st century’s studies

Abstract Background Prophylactic mesh has been suggested to prevent parastomal hernia (PSH); However, there are growing concern about prophylactic use of meshes and its use in presence of open bowel. Our meta-analysis evaluates efficacy and safety of non-mesh techniques in reducing stoma complications. Methods We conducted a search of literature databases for recent studies since 2000 evaluating stoma complications. Studies comparing non-mesh operative methods as extraperitoneal, para-rectus, and deep fascial fixation techniques to the conventional practice were included. Stoma complications and technique related adverse events were assessed as outcomes. Results Extraperitoneal stoma was compared to the conventional intraperitoneal approach in 2 RCTs and 7 comparative studies. Extraperitoneal technique was associated with a significant reduction in PSH (RR 0.25, P<0.00001), stomal prolapse (RR 0.24, P=0.02) and stoma retraction (RR 0.31, P=0.04). There were no statistical concerns related to stoma necrosis, operative time or bowel obstruction. Para-rectus stoma, when compared to trans-rectus stoma in 2 RCTs and 4 retrospective studies, was associated with less events of PSH; however, this difference was not of a statistical value (RR 1.15, P=0.31). Similarly, 1 RCT and 1 retrospective study investigating deep fascial and skin-only fixations of stoma did not show any statistical differences in stoma complications. Yet, time required to create stomas fixed to skin only was significantly less (Mean Difference 5.07, P<0.00001). Conclusion Extraperitoneal stoma creation is a promising technique to lessen stoma morbidity without safety concerns. Since this effect was dominantly pooled from retrospective studies, high-quality RCTs may give more value to this evidence.