Comparison of different mesh placement techniques for parastomal hernia repair: an updated systematic review and network meta-analysis.

Abstract

<h4>Purpose</h4>We performed a network meta-analysis to evaluate the comparative effectiveness of different mesh placement techniques in parastomal hernia repair on clinical and patient-reported outcomes.<h4>Methods</h4>A comprehensive search was conducted in PubMed, Scopus, Cochrane, and Web of Science for articles published until January 2025, focusing on recurrence rates, cumulative complication rates, operative time, length of hospital stay, surgical site infection rate, and Postoperative bowel obstruction rate. The risk of bias was assessed with ROBINS-I and RoB 2. GRADE assessment was performed to evaluate the body of evidence.<h4>Results</h4>Twenty studies were included in the meta-analysis. Hybrid 3D had lower rates of hernia recurrence than Keyhole (OR 0.20, 95% CI: 0.07-0.59) and had lower rates of surgical site infections than Sugarbaker (OR 0.25, 95% CI: 0.07-0.90). Sandwich had the highest ranking with the lowest recurrence rate (P-score: 0.8188), followed by Hybrid 3D. Hybrid 3D was associated with lower rates of cumulative complications than the keyhole technique (OR 0.33, 95% CI 0.15-0.74) and compared with the Sugarbaker technique (OR 0.35, 95% CI:0.17-0.75). No statistically significant differences were observed between techniques for postoperative bowel obstruction, operative time, or length of hospital stay. However, Hybrid 3D and Sandwich consistently ranked higher for favorable outcomes across these metrics.<h4>Conclusions</h4>These findings suggest that Hybrid 3D and Sandwich techniques offer superior outcomes regarding hernia recurrence and cumulative complications. Further high-quality randomized trials are required to confirm these results.