Incidence of and risk factors for stoma-site incisional herniation after reversal

Abstract

BackgroundStoma reversal is often considered a straightforward procedure with low short‐term complication rates. The aim of this study was to determine the rate of incisional hernia following stoma reversal and identify risk factors for its development.MethodsThis was an observational study of consecutive patients who underwent stoma reversal between 2009 and 2015 at a teaching hospital. Patients followed for at least 12 months were eligible. The primary outcome was the development of incisional hernia at the previous stoma site. Independent risk factors were assessed using multivariable logistic regression analysis.ResultsAfter a median follow‐up of 24 (range 12–89) months, 110 of 318 included patients (34·6 per cent) developed an incisional hernia at the previous stoma site. In 85 (77·3 per cent) the hernia was symptomatic, and 72 patients (65·5 per cent) underwent surgical correction. Higher BMI (odds ratio (OR) 1·12, 95 per cent c.i. 1·04 to 1·21), stoma prolapse (OR 3·27, 1·04 to 10·27), parastomal hernia (OR 5·08, 1·30 to 19·85) and hypertension (OR 2·52, 1·14 to 5·54) were identified as independent risk factors for the development of incisional hernia at the previous stoma site. In addition, the risk of incisional hernia was greater in patients with underlying malignant disease who had undergone a colostomy than in those who had had an ileostomy (OR 5·05, 2·28 to 11·23).ConclusionIncisional hernia of the previous stoma site was common and frequently required surgical correction. Higher BMI, reversal of colostomy in patients with an underlying malignancy, stoma prolapse, parastomal hernia and hypertension were identified as independent risk factors.

Incisional hernia rate after ileostomy closure in lateral pararectal stoma versus transrectal stoma placement: follow‐up of the randomized PATRASTOM trial

“…described a rate of herniation at the previous ileostomy site of 34.6 % (110 of 318 patients) in their consecutive series of patients undergoing stoma reversals. Multivariate analysis identified – besides higher BMI, PSH, hypertension and stomal prolapse – previous or ongoing malignancy as an independent risk factor for the development of hernia . The latter is in agreement with the results of a recent systematic review of 33 studies investigating the incidence of and risk factors for SSIH in addition to BMI and diabetes, surgery for malignant disease proved to be significantly associated with SSIH.…”

“…Based on current data, the ‘true’ rate of herniation at the ileostomy site remains unclear and is still a subject of discussion among surgeons . Neither different surgical techniques nor prophylactic mesh implantation could demonstrate strong and reproducible data on incidence and effective prevention of SSIH.…”

Hernia at the stoma site after loop ileostomy reversal

“…Among the radiologically diagnosed hernia patients that received the questionnaire, 86% of the patients reported symptoms. Previous studies have shown an incidence of hernia of up to 34.6% [16,17] (Appendix Table 5). The reasons for the large variations may be multifactorial.…”

“…The incidence of stoma site hernia has been reported between 9.6% and 34.6% [11][12][13][14][15][16][17][18][19] (Appendix Table 5). Differences may be explained by mixed populations with both colostomies and ileostomies [11,12,[15][16][17], and different methods for diagnosis, either computer tomography (CT) scan alone [13,19] or combined with patient evaluation [17,20]. Some previous studies have few patients [11,14] or use old surgical techniques [14].…”

Incidence of and risk factors for stoma‐site incisional herniation after reversal

“…We read with interest the work of Amelung and colleagues, recently published in the journal. This retrospective cohort identified several factors associated with increased hernia risk following ostomy closure.…”