SP9.13 Biological or synthetic mesh for parastomal hernia repair: An evidence synthesis by a systematic review

Abstract Objective Parastomal hernia (PSH) is a common colorectal condition which needs surgical repair. The objective of this study is to compare the postoperative surgical outcomes in patients undergoing PSH repair using biological versus synthetic mesh. Materials and methods Comparative studies reporting postoperative outcomes in patients undergoing PSH repair using biological versus synthetic mesh were selected from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5. Results Four comparative studies (one RCT, one retrospective and two prospective studies) on 252 patients were found suitable for meta-analysis according to the inclusion criteria. In the random effects model analysis, surgical site infection rate [risk ratio 0.84, 95%, CI (0.54, 1.31), Z = 0.76, p < 0.46], mesh erosion leading to re-operation rate [risk ratio 1.01, 95%, CI (0.21, 4.89), Z = 0.01, p = 0.99] and PSH recurrence rate [risk ratio 1.06, 95%, CI (0.61, 1.86), Z = 0.21, p = 0.83] were statistically similar between biological mesh and synthetic mesh groups. There was no heterogeneity (Tau2 = 0.00; Chi2 = 1.38, df = 3; (p = 0.71; I2 = 0 %) between included studies. Conclusion PSH repair may be performed by using synthetic mesh without higher risk of infective complications and mesh erosion. However, stronger evidence in the form of major, multicentre, randomised, controlled trial is needed before recommending a routine use of synthetic mesh in PSH repair.