Risk factors for parastomal hernia in Japanese patients with permanent colostomy

Abstract

PurposeAlthough the definitive risk factors for parastomal hernia development remain unclear, potential contributing factors have been reported from Western countries. The aim of this study was to identify the risk factors for parastomal hernia in Japanese patients with permanent colostomies.MethodsAll patients who received abdominoperineal resection or total pelvic exenteration at our institution between December 2004 and December 2011 were reviewed. Patient-related, operation-related and postoperative variables were evaluated, in both univariate and multivariate analyses, to identify the risk factors for parastomal hernia formation.ResultsOf the 80 patients who underwent colostomy, 22 (27.5 %) developed a parastomal hernia during a median follow-up period of 953 days (range 15–2792 days). Hernia development was significantly associated with increasing patient age and body mass index, a laparoscopic surgical approach and the transperitoneal route of colostomy formation. In the multivariate analysis, the body mass index (p = 0.022), the laparoscopic approach (p = 0.043) and transperitoneal stoma creation (p = 0.021) retained statistical significance.ConclusionsOur findings in Japanese ostomates match those from Western countries: a higher body mass index, the use of a laparoscopic approach and a transperitoneal colostomy are significant independent risk factors for parastomal hernia formation. The precise role of the stoma creation route remains unclear.

Parastomal Hernia: A Growing Problem with New Solutions

“…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]. …”

“…Individual patient characteristics that have been shown to be independent risk factors for PSH development include older age [7,10,28,29], increased BMI [8,30,31], increased waist circumference [30], respiratory comorbidity [8], cancer [8], diabetes mellitus [8], and the presence of other abdominal wall hernias [7]. 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].…”

Actualización de las hernias paraestomales: diagnóstico, tratamiento y prevención

“…a) No exteriorizar el estoma a través de la laparotomía, dados los malos resultados en cuanto a infección, dehiscencia de herida y eventración 4,7,9,16 ; b) La realización del estoma extraperitoneal se ha asociado a una menor tasa de HP respecto a la vía intraperitoneal 7,17,18,19,20 ; c) La ubicación del estoma respecto a los músculos rectos abdominales sigue siendo un tema de debate 8 . Sjodahl et al 21 refieren que la exteriorización del estoma a través del mús-culo recto abdominal, y no lateral a este, está asociado a una menor incidencia de HP, pero en un estudio prospectivo aleatorizado, Hardt et al 22,23 no han demostrado diferencias estadísticamente significativas entre ambas técnicas; d) El tamaño del orificio cutáneo y aponeurótico del estoma también es importante, ya que debe ser suficientemente ancho para permitir el paso del intestino, pero no demasiado para evitar el riesgo de herniación 7 .…”

“…Se estima que el orificio no debe sobrepasar los 3 cm en colostomías y los 2.5 cm en ileostomías 3,8,15,24 ; e) La fijación del intestino a la aponeurosis no reduce el riesgo de herniación 3,7,9 ; f) No queda claro el papel de la laparoscopia para disminuir el riesgo de HP 3,8 . Presenta ventajas en cuanto a morbilidad 25 y parece ser un FR independiente para la aparición de HP 18 , pero no hay estudios aleatorizados que lo demuestren 9 . g) Es fundamental el marcaje preoperatorio del estoma 26 .…”

“…Los FR no técnicos son los siguientes: obesidad 6,7,9,18,27,28 , edad avanzada 4,6,7,9,29 , diabetes mellitus 9 , uso de corticoides 3,4,6,7,29 , enfermedad pulmonar crónica 4,6,7,9,29 , malnutrición 3,4,6,7,29 , perímetro abdominal mayor de 100 cm 30 , espesor del tejido subcutáneo mayor o igual a 23 mm 12 , infección de la herida 3,4,6,7,29 y la presencia de otras hernias de la pared abdominal 9,27 . La enfermedad de Crohn también aparece asociada a mayor riesgo de HP, aunque no así la colitis ulcerosa 8 .…”