Prophylactic measures can significantly lower parastomal hernia rates, impacting surgical choices and patient outcomes.

• Funnel mesh is the most effective intervention, reducing hernia incidence by 91% (OR 0.09, 95% CI 0.05-0.17).
• Stapled mesh and abdominal wall strengthening exercises also show promise, with incidence reductions of 84% (OR 0.16) and 82% (OR 0.18), respectively.

Selecting the right prophylactic approach is crucial for high-risk patients.

• Results are consistent across study types but vary in ileal conduits due to limited data.