Outcomes of surgical techniques for parastomal hernia repair: a bayesian network meta-analysis.

Abstract

<h4>Objectives</h4>To determine the relative efficacy and safety of surgical techniques for parastomal hernia (PH) repair using a Bayesian network meta-analysis (NMA), integrating direct and indirect evidence to generate probabilistic rankings and guide clinical decision-making.<h4>Methods</h4>We conducted a systematic review and Bayesian NMA of 28 studies (1.983) patients) comparing seven PH repair techniques, following PRISMA-NMA guidelines. The primary outcome was parastomal hernia (PH) recurrence; the secondary outcome was cumulative postoperative complications. Random-effects models with a binomial likelihood and a logit link function were used. SUCRA probabilities ranked interventions; node-splitting assessed inconsistency; meta-regression evaluated covariates.<h4>Results</h4>FunnelMesh achieved the highest SUCRA score for recurrence reduction (91.55%), significantly outperforming Keyhole (OR 0.06, 95% CrI: 0.01-0.35) and Repair (OR 0.11, 95% CrI: 0.02-0.55). Sandwich ranked second (80%). For complications, Modified Keyhole (KeyholeM) ranked safest (SUCRA = 91%), with a significantly lower complication risk than Sugarbaker (OR = 0.23; 95% CrI: 0.05-0.94) and Keyhole (OR = 0.22; 95% CrI: 0.04-0.92). Node-splitting revealed inconsistencies in the FunnelMesh comparisons, warranting cautious interpretation. Meta-regression confirmed robustness across stoma type, approach, and follow-up duration.<h4>Conclusions</h4>FunnelMesh and Sandwich offered superior recurrence prevention; KeyholeM provides the optimal balance of low recurrence and minimal complications. The traditional Keyhole technique remained associated with high failure rates, reinforcing current guideline recommendations against its use. These findings provide an evidence-based framework to individualize PH repair strategies based on efficacy and safety trade-offs.<h4>Highlights</h4>Bayesian network meta-analysis comparing all major techniques for parastomal hernia repair. FunnelMesh, Sandwich, and modified Keyhole achieve the best balance of efficacy and safety. Provides an evidence-based framework to guide surgical selection and patient counseling.