Hernia at the stoma site after loop ileostomy reversal

Abstract

Purpose To estimate the incidence of and risk factors for stoma site hernia after closure of a temporary diverting ileostomy. Method In a non-comparative cohort study, charts (n = 216) and CT-scans (n = 169) from patients who had undergone loop ileostomy closure following low anterior resection for rectal cancer 2010-2015 (mainly open surgery) at three hospitals were evaluated retrospectively. Patients without hernia diagnosis were evaluated cross-sectionally through a questionnaire (n = 158), and patients with symptoms of bulging or pain were contacted and offered a clinical examination or a CT scan including Valsalva maneuver. Results In the chart review, five (2.3%) patients had a diagnosis of incisional hernia at the previous stoma site after 8 months (median). In 12 patients, the CT scan showed a hernia, of which 8 had not been detected previously. The questionnaire was returned by 130 (82%) patients, of which 31% had symptoms of bulging or pain. Less than one in five of patients who reported bulging were diagnosed with hernia, but the absolute majority of the radiologically diagnosed hernias reported symptoms. By combining clinical and radiological diagnosis, the cumulative incidence of hernia was 7.4% during a median follow up time of 30 months. Risk factors for stoma site hernia were male sex and higher BMI. Conclusion Hernia at the previous stoma site was underdiagnosed. Less than a third of symptomatic patients had a hernia diagnosis in routine follow up. Randomized studies are needed to evaluate if prophylactic mesh can be used to prevent hernias, especially in patients with risk factors.

Incisional hernia following ileostomy closure: who's at risk? The Gold Coast experience

“…Our detected rate of IH was consistent with other articles with a range in the literature of 6.1–30% ( 10,15–19,22 ). Consistent with other articles obesity is a strong predictor of IH after ileostomy closure.…”

“…Risk factors for incisional hernia are varied and differ amongst population groups 12–17 . Incidence rates vary throughout studies with rates between 2.3% and 30%, depending on whether clinical or radiological definitions are followed 12–15,18–21 . A diverting ileostomy is formed through a well‐defined and reproducible incision and allows a more homogenous study group to consider benefits of prophylactic mesh placement.…”

“…[12][13][14][15][16][17] Incidence rates vary throughout studies with rates between 2.3% and 30%, depending on whether clinical or radiological definitions are followed. [12][13][14][15][18][19][20][21] A diverting ileostomy is formed through a well-defined and reproducible incision and allows a more homogenous study group to consider benefits of prophylactic mesh placement. This study aimed to calculate our local incidence of IH and potentially identify risk factors that increase the risk.…”

“…Summary of articles reporting on risk factors for IH post ostomy closure [12][13][14]16,18,19,23,24. …”

Prevention of incisional hernia at the site of stoma closure with different reinforcing mesh types: a systematic review and meta-analysis

“…Therefore, we believe that patient selection is the most suitable compromise in the light of current evidence. We suggest an accurate assessment of risk factors of SSIH such as male gender, high BMI, concomitant diseases and presence of a midline incisional hernia [ 50 – 52 ]. According to Fischer’s risk model and stratification system, stoma reversal is considered an independent risk factor for surgically treated incisional hernia [ 53 ].…”