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A lightweight polypropylene mesh in the sublay (keyhole) position was used. The primary endpoint was the rate of PSH in both groups judged clinically and radiologically (CT) 1 year after surgery. Hernia judged clinically was found in 30% of patients in the nonmesh group and in 29% in the mesh group (<span class="elsevierStyleItalic">P</span>=.866) and by CT was found in 26% and 24% respectively (<span class="elsevierStyleItalic">P</span>=.748). Based on the lack of differences in between the mesh and nonmesh arms, conclude that the prophylactic use of mesh to prevent PSH cannot be recommended.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We have recently reported the results of a meta-analysis and trial sequential analysis (TSA) on the same topic.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The primary outcome was the incidence of PSH with a minimum follow-up of 12 months with a clinical and/or CT diagnosis. We conclude the use of a prophylactic mesh when creating an end colostomy reduces the incidence of PSH. There was a 76% reduction of the incidence of PSH based on clinical diagnosis (n=366 patients) (risk ratio [RR] 0.24, 95% confidence interval [CI] 0.14–0.40; <span class="elsevierStyleItalic">P</span>≤.00001, <span class="elsevierStyleItalic">I</span><span class="elsevierStyleSup">2</span> 6%) and a 39% reduction based on a CT (n=264 patients) (RR 0.61, 95% CI 0.43–0.87; <span class="elsevierStyleItalic">P</span>=.006, <span class="elsevierStyleItalic">I</span><span class="elsevierStyleSup">2</span> 37%). TSA<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> confirmed statistical reliability of data as estimation of the required information size was reached for the primary outcome. A further analysis including the recent RCT<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> confirms the favorable results of prophylactic mesh placement. In this case, there is a 70% reduction of the incidence of PSH based on clinical grounds (RR 0.30, 95% CI 0.13–0.68; <span class="elsevierStyleItalic">I</span><span class="elsevierStyleSup">2</span> 78%) and a 33% reduction based on CT diagnosis (RR 0.67, 95% CI 0.49–0.91; <span class="elsevierStyleItalic">I</span><span class="elsevierStyleSup">2</span> 38%) for a total of 577 and 475 patients, respectively. In other words, after adding the new data<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> the size of the effect of the prophylactic mesh continues to be of a large magnitude, heterogeneity remains low for CT diagnosis (scarce variability among studies as a result of a more objective radiological-based evaluation) while heterogeneity for clinical diagnosis is high (subjectivity of clinical examination in patients with small or incipient PSH).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Meta-analysis has become one of the pillars of evidence-based medicine.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> Meta-analysis of RCTs is not an infallible tool, but helps to improve precision of estimates of effect and settle controversies arising from apparently conflicting studies. A specific strict recommendation against the prophylactic use of mesh to prevent PSH<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> seems inappropriate in the light of results of a rigorously performed meta-analysis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: López-Cano M, Pereira JA, Armengol-Carrasco M, García-Alamino J. Una malla profiláctica funciona en la prevención de la hernia paraestomal. Cir Esp. 2018;96:62–63.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of prophylactic mesh when creating a colostomy does not prevent parastomal hernia. A randomized controlled trial-STOMAMESH" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Odensten" 1 => "K. Strigård" 2 => "J. Rutegård" 3 => "M. Dahlberg" 4 => "U. Ståhle" 5 => "U. Gunnarsson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SLA.0000000000002542" "Revista" => array:3 [ "tituloSerie" => "Ann Surg" "fecha" => "2017" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15912052" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prophylactic mesh to prevent parastomal hernia after end colostomy: a meta-analysis and trial sequential analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. López-Cano" 1 => "H.T. Brandsma" 2 => "K. Bury" 3 => "B. Hansson" 4 => "I. Kyle-Leinhase" 5 => "J.G. 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Wetterslev" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jclinepi.2007.10.007" "Revista" => array:6 [ "tituloSerie" => "J Clin Epidemiol" "fecha" => "2008" "volumen" => "61" "paginaInicial" => "763" "paginaFinal" => "769" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18411040" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Progress in evidence-based medicine: a quarter century on" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B. Djulbegovic" 1 => "G.H. 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Letter to the Editor
To Prevent Parastomal Hernia After Stomal Surgery, a Prophylactic Mesh Does Work
Una malla profiláctica funciona en la prevención de la hernia paraestomal
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Manuel López-Canoa,
, José Antonio Pereirab, Manuel Armengol-Carrascoa, Josep García-Alaminoa,c
Corresponding author
a Unidad de Cirugía de la Pared Abdominal, Servicio de Cirugía General y Digestiva, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
b Departamento de Salud y Ciencias Experimentales, Servicio de Cirugía General y Digestiva, Parc de Salut Mar, Universitat Pompeu Fabra, Barcelona, Spain
c Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, Oxford, United Kingdom
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