Radiological incidence of parastomal herniation in cancer patients with permanent colostomy: What is the ideal size of the surgical aperture?

Hotouras, Alexander; Murphy, Jamie; Power, Niall; Williams, Norman S.; Chan, Christopher L.

doi:10.1016/j.ijsu.2013.03.010

Cited by 44 publications

(36 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other factors in the literature that have been suggested but not validated include malnutrition, smoking status, chronic coughing, chronic constipation, ascites, corticosteroid use, and postoperative wound sepsis [21]. Technical aspects related to ostomy creation that have been suggested as risk factors for PSH include bringing the stoma out through the resection site [9], an intraperitoneal route as opposed to an extraperitoneal one [7,31,32,33], a laparoscopic approach [31], and increased aperture size [10,29,34]. …”

Section: Risk Factorsmentioning

confidence: 99%

“…Funahashi et al reported a laparoscopic approach as an independent risk factor [31], but no randomized trials comparing a laparoscopic and open approach have been performed. Hotouras et al suggest making the aperture size ≤25 mm in size based on an observational study comparing the aperture size and presence of PSH on CT scan in 43 patients undergoing permanent colostomy for malignancy [34]. However, there have been no clinical trials to date evaluating the ideal aperture size and subsequent risk of PSH.…”

Section: Risk Factorsmentioning

confidence: 99%

See 1 more Smart Citation

Parastomal Hernia: A Growing Problem with New Solutions

et al. 2014

View full text Add to dashboard Cite

Parastomal hernia is one of the most common complications following stoma creation and its prevalence is only expected to increase. It often leads to a decrease in the quality of life for patients due to discomfort, pain, frequent ostomy appliance leakage, or peristomal skin irritation and can result in significantly increased healthcare costs. Surgical technique for parastomal hernia repair has evolved significantly over the past two decades with the introduction of new types of mesh and laparoscopic procedures. The use of prophylactic mesh in high-risk patients at the time of stoma creation has gained attention in lieu of several promising studies that have emerged in the recent days. This review will attempt to demonstrate the burden that parastomal hernias present to patients, surgeons, and the healthcare system and also provide an overview of the current management and surgical techniques at both preventing and treating parastomal hernias. i 2014 S. Karger AG, Basel

show abstract

Section: Risk Factorsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

Parastomal Hernia: A Growing Problem with New Solutions

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Several biological studies have shown moderate levels of wound infection effectively treated conservatively (3-26 %), low recurrence (13-15 %) and low morbidity [18][19][20][21][22]. The possibility of leaving mesh in situ in an infected field is enticing, but a major argument against its use is cost with biologic mesh reported to be about 10 times more expensive than synthetic mesh [7]. There is still a large knowledge gap regarding comparative costs and functional outcomes between these materials, as well as a dearth of truly longterm outcome data.…”

Section: Synthetic Versus Biologic Prosthesesmentioning

confidence: 99%

“…The risk of developing PH has been suggested to be lower after ileostomy than after a colostomy (1-28 % for an ileostomy, 4-48 % for colostomy), with high rates of incisional hernias after colostomy closure [2,3,5,6]. Most hernias develop within 2 years of stoma formation [5][6][7], are asymptomatic and do not require intervention. However, 10-30 % of ostomates have been reported to require surgical intervention [3,5,6], and some studies even report rates as high as 70 % [8].…”

Section: Introductionmentioning

confidence: 99%

“…Risk of recurrence is also higher in these patients. In addition to these factors, location with respect to the abdominal rectus muscle and size of the fascial opening ([35 mm) [7] are also reported to affect development of PH. Proposed etiology of PH formation includes shifts in collagen ratio from mature type I collagen to immature type III collagen during healing, resulting in loss of tensile strength with increased susceptibility to hernia formation [9].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Repair of complex parastomal hernias

et al. 2015

View full text Add to dashboard Cite

Development of parastomal hernias (PH) is very common after stoma formation and carries a risk of subsequent bowel incarceration, obstruction and strangulation. The management of PH remains a challenge for the colorectal surgeon, and there are currently no standardized guidelines for the treatment of PH. Even more difficult is the management of complex parastomal hernias (CPH). We conducted a review of the literature to identify recent developments in the treatment of CPH, including analysis of the use of synthetic and biologic mesh prostheses, method of mesh placement and surgical approach.

show abstract

Radiological progression of end colostomy trephine diameter and area

Economou

Smart

et al. 2018

BJS Open

View full text Add to dashboard Cite

BackgroundDevelopment of a parastomal hernia is common following abdominoperineal excision (APE). The true incidence is difficult to assess fully owing to differing lengths of follow‐up and techniques used to assess herniation; radiological or clinical. The primary aim of this study was to evaluate colostomy diameter by studying the rate of change of axial and sagittal trephine diameters, trephine area, and the ratio of the trephine over time. A secondary aim was to investigate variation in trephine area and variables affecting parasternal hernia over time.MethodsSerial CT scans performed after APE from January 2006 to December 2014 were reviewed. Variables analysed included age, sex, trephine position relative to rectus abdominis muscle (RAM), type of incision for stoma creation, and axial and sagittal trephine diameters measured on follow‐up CT. A Bayesian hierarchical modelling framework was used to examine the relationship of trephine diameters, area and ratio over time.ResultsOf 112 patients undergoing APE, 103 were eligible for analysis; this included 91 colostomies (88·3 per cent) through the RAM and 12 (11·7 per cent) lateral to the RAM. Median age of the patients was 68 years. Sixty patients (58·3 per cent) had a circular and 43 (41·7 per cent) a cruciate incision for stoma creation. The sagittal trephine diameter increased by 0·22 (95 per cent credible interval 0·12 to 0·32) mm/month for both sexes. Women reported a significant increase in axial trephine diameters; the male : female ratio difference was −0·17 (−0·30 to −0·03) mm/month and for trephine areas −6·21 (0·96 to 13·7) mm2/month. Patient age, colostomy trephine location and shape of incision were not statistically significant variables for parasternal hernia.ConclusionFemale sex was the only variable affecting the rate of increase in axial trephine diameter and trephine area over time.

show abstract

Radiological incidence of parastomal herniation in cancer patients with permanent colostomy: What is the ideal size of the surgical aperture?

Cited by 44 publications

References 14 publications

Parastomal Hernia: A Growing Problem with New Solutions

Parastomal Hernia: A Growing Problem with New Solutions

Repair of complex parastomal hernias

Radiological progression of end colostomy trephine diameter and area

Contact Info

Product

Resources

About