Background and Aims: Parastomal hernia (PSH) is a common complication after ostomy surgery, which has a high incidence rate and is difficult to repair. Therefore, some studies suggested using prophylactic mesh to strengthen abdominal wall to prevent this complication. However, the effectiveness of prophylactic mesh has been challenged by several recent studies. This study was conducted to systematically evaluate the efficacy of using prophylactic mesh in preventing PSH after ostomy surgery and its safety. 
Methods: The randomized controlled trials (RCTs) concerning using prophylactic mesh for prevention of PSH were collected by searching several national and international databases. The retrieval time was from the inception to March 2020. After literature screening, data extraction and quality assessment by two independent researchers according to the established inclusion and exclusion criteria, Meta-analysis with bias risk assessment was performed using Revaman 5.3 software.
Results: A total of 12 RCTs with a medium or high quality were included, involving 963 patients, of whom 479 cases received prophylactic mesh placement (mesh group) and 484 cases did not receive mesh placement (control group). Results of Meta-analysis showed that mesh group was superior to control group in the prevention of PSH (RR=0.44, 95% CI=0.29–0.65, P<000 1), and as for the colostomy complications, there were no statistical differences between mesh group and control group in the incidence of stoma-related infection (RR=0.92, 95% CI= 0.46–1.81, P=0.80), stoma prolapse (RR=0.29, 95% CI=0.08–1.07, P=0.06), stoma necrosis (RR=0.72, 95% CI=0.32–1.61, P=0.42) stoma stenosis (RR=2.31, 95% CI=0.79–6.81, P=0.13) and stoma requiring repair (RR=0.88, 95% CI=0.48–1.61, P=0.68). Subgroup analysis showed that the surgical type, diagnostic method, mesh position and follow-up time were all not determinants of the heterogeneity across studies (all P>0.05).
Conclusion: The existing studies indicate that using prophylactic mesh during routine ostomy surgery can effectively reduce the incidence of PSH, without increasing the stoma-related complications. However, this conclusion still needs multicenter high-quality RCTs with a large-sample size to further confirm.