Summary of findings 2. Prosthetic mesh placement compared with standard treatment for the prevention of parastomal hernia: subgroup and sensitivity analyses.
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Participants or population: individuals having a stoma formation Settings: hospital, operating theatre Intervention: prophylactic stomal mesh reinforcement when forming a stoma Comparison: standard stoma formation | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | ||||
| No prosthetic mesh placement | Prosthetic mesh placement | ||||
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Subgroup analysis: Incidence of parastomal hernia at 12 months |
45 per 100 | 21 per 100 (13 to 35) | RR 0.47 (0.29 to 0.78) |
592 (7 studies) |
low1,2 |
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Subgroup analysis:
Incidence of parastomal hernia (laparoscopic surgery) (follow‐up: 6 to 24 months) |
65 per 100 | 42 per 100 (31 to 57) | RR 0.64 (0.47 to 0.87) |
153 (3 studies) |
low1,2 |
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Subgroup analysis:
Incidence of parastomal hernia (open surgery) (follow‐up: 6 to 24 months) |
39 per 100 | 18 per 100 (13 to 24) | RR 0.46 (0.34 to 0.62) |
517 (6 studies) |
moderate1 |
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Subgroup analysis:
Incidence of parastomal hernia (sublay (extraperitoneal) mesh subgroup) (follow‐up: 6 to 24 months) |
34 per 100 | 16 per 100 (12 to 22) | RR 0.48 (0.36 to 0.64) |
619 (7 studies) |
moderate1 |
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Subgroup analysis:
Incidence of parastomal hernia (intraperitoneal mesh subgroup) (follow‐up: 6 to 24 months) |
67 per 100 | 51 per 100 (37 to 71) | RR 0.76 (0.55 to 1.06) |
101 (2 studies) |
moderate3 |
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Incidence of parastomal hernia (worst‐case scenario sensitivity analysis) (follow‐up: 6 to 24 months) |
38 per 100 | 19 per 100 (11 to 31) | RR 0.49 (0.30 to 0.81) |
835 (10 studies) |
low1,2 |
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Incidence of parastomal hernia (best‐case scenario sensitivity analysis) (follow‐up: 6 to 24 months) |
46 per 100 | 18 per 100 (12 to 28) | RR 0.40 (0.26 to 0.61) |
835 (10 studies) |
low1,2 |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio | |||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||||
1Downgraded one level due to heterogeneity. 2Downgraded one level due to high risk of detection and selection bias. 3Downgraded one level due to inconsistency.