KEYHOLE VERSUS SUGARBAKER MESH CONFIGURATION IN PARASTOMAL HERNIA REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS
Sergio Mazzola Poli de Figueiredo1, Amanda Cyntia Lima Fonseca Rodrigues2, Sérgio Araújo3, Rui-Min D. Mao1, Guilherme Tastaldi1, Jana E. DeJesus*1, Richard Lu1
1Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX; 2Positivo University, Curitiba, PR, Brazil; 3Hospital Regional Hans Dieter Schimidt, Joinville, SC, Brazil
Background:
Parastomal hernias repairs (PHR) are often complex and challenging, even for experienced abdominal wall surgeons. Although the ideal therapeutic option in the setting of a parastomal hernia is to restore intestinal continuity, this is often not feasible, and numerous techniques have been described for PHR. Current guidelines recommend using mesh for elective PHR, but there is a scarcity of evidence comparing different PHR techniques. We aimed to report a meta-analysis comparing the outcomes of Sugarbaker and Keyhole mesh configuration in parastomal hernia repair.
Methods:
A literature search of PubMed, Embase, Scopus and Cochrane Library databases was performed to identify studies comparing Sugarbaker and Keyhole mesh configuration in parastomal hernia repair. Postoperative outcomes were assessed by means of pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics.
Results:
3247 studies were screened and 27 were fully reviewed. Ten studies and 632 patients were included in the meta-analysis. 305 patients (48.3%) with Keyhole and 327 patients (51.7%) with Sugarbaker mesh configuration. 433 patients (68.5%) underwent laparoscopic parastomal hernia repair with intra-peritoneal onlay mesh (IPOM). Sugarbaker mesh configuration was associated with lower hernia recurrence compared to Keyhole (OR 0.39; 95% CI 0.19-0.83; P=0.01; I2=46%). No differences were seen in overall complications, reoperations, stoma outlet obstruction, mesh infection and postoperative bleeding.
Conclusion:
Parastomal hernia repair with Sugarbaker mesh configuration is associated with decreased hernia recurrence compared to Keyhole and had similar rates of overall complications, reoperations, stoma outlet obstruction, mesh infection and postoperative bleeding.
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