Incidence of Ostomy Site Incisional Hernias after Stoma Closure

Abstract

This study sought to evaluate the incidence of ostomy site incisional hernias after stoma reversal at a single institution. This is a retrospective analysis from 2001 to 2011 evaluating the following demographics: age, gender, indication for stoma, urgent versus elective operation, time to closure, total follow-up time, the incidence of and reoperation for stoma incisional hernia, diabetes, postoperative wound infection, smoking status within six months of surgery, body mass index, and any immunosuppressive medications. A total of 365 patients were evaluated. The median follow-up time was 30 months. The clinical hernia rate was 19 percent. Significant risk factors for hernia development were age, diabetes, end colostomies, loop colostomies, body mass index >30, and undergoing an urgent operation. The median time to clinical hernia detection was 32 months. Sixty-four percent of patients required surgical repair of their stoma incisional hernia. A significant number of patients undergoing stoma closure developed an incisional hernia at the prior stoma site with the majority requiring definitive repair. These hernias are a late complication after stoma closure and likely why they are under-reported in the literature.

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

“…The effects of hypertension on wound healing are less clear; possibly chronic microvascular changes secondary to hypertension could impair adequate tissue perfusion, thereby reducing proper wound healing and contributing to possible wound dehiscence. It is likely that other factors identified in previous studies, such as diabetes mellitus and wound infection, are also independent risk factors for hernia development. The low incidence of these factors in the present study might explain why they were not identified.…”

“…Several previous studies have looked at possible risk factors for incisional hernia following stoma reversal. High BMI and having a temporary colostomy were identified as significant risk factors in several of these studies , . Parastomal hernia, stoma prolapse and hypertension have not been identified previously; most of these factors were not included in other studies.…”

Hernia at the stoma site after loop ileostomy reversal

“…The reasons for the large variations may be multifactorial. Many of the studies include both small and large bowel ostomies [11,12,[15][16][17]. Hernias may be more common after reversal of large bowel ostomies principally because of the larger size of the abdominal wall defect.…”

“…High BMI and male sex were significant risk factors in this study. BMI has been shown to be a risk factor in many other studies [12,13,17,18] and is a factor to consider when choosing a technique for the reversal of the ostomy. Other studies have found female sex to be a risk factor for recurrence after incisional hernia repair [27].…”

“…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].…”