The incidence of incisional hernias following ileostomy reversal in colorectal cancer patients treated with anterior resection

Abstract

INTRODUCTION The aim of this study was to identify the rate of incisional hernia formation following ileostomy reversal in patients who underwent anterior resection for colorectal cancer. In addition, we aimed to ascertain risk factors for the development of reversal-site incisional hernias and to record the characteristics of the resultant hernias. MATERIALS AND METHODS Using a prospectively compiled database of colorectal cancer patients who were treated with anterior resection, we identified individuals who had undergone both ileostomy formation and subsequent reversal of their ileostomies from January 2005 to December 2014. Medical records were reviewed to record descriptive patient data about risk factors for hernia formation, operative details and any subsequent operations. Computed tomography reports were reviewed to identify the number, site and characteristics of incisional hernias. RESULTS A total of 121 patients were included in this study; 14.9% (n = 18) developed an incisional hernia at the ileostomy reversal site; 17.4% (n = 21) at a non-ileostomy site and 6.6% (n = 8) developed both. The reversal-site hernias were smaller both in width and length compared with the non-ileostomy-site hernias. Risk factors for the development of reversal-site incisional hernias were higher body mass index (BMI), lower age, open surgery, longer reversal time and a history of previous hernias. We did not detect a difference in the size of the incisional hernias that developed in patients with these specific risk factors. CONCLUSIONS Incisional hernias are a significant complication of ileostomy reversal. Further evaluation of the use of prophylactic mesh to reduce the incidence of incisional hernias may be worthwhile.

Hernia at the stoma site after loop ileostomy reversal

“…Hernias may be more common after reversal of large bowel ostomies principally because of the larger size of the abdominal wall defect. But even in studies including only loop ileostomy reversals, the incidences have been reported higher than in our study: 11.1% [19], 14.9% [13], and 23.9% [20], respectively. All of them primarily used CT scans for evaluation.…”

“…Colostomies had a higher risk than ileostomies in Sharp et al [12], but in other studies a colostomy was a risk factor only in patients with malignant disease [17]. Other risk factors for developing hernia after stoma reversal that have been reported are surgical site infection [11,18], diabetes [12], age [12], urgent operation [12], longer time between primary surgery and reversal [13], and hypertension [17,20]. One study did not find any significant risk factors at all [19].…”

“…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].…”

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

“…It is interesting that hypertension is associated with abdominal wall failure, a relationship previously identified in our own work following loop ileostomy closure. The significance of BMI and hypertension appear to be overtaking smoking as a risk factor, as smoking was not a significant factor in this analysis or others. Optimizing BP and weight reduction are logical ways to reduce the incidence of hernia, as well as the selective use of prophylactic mesh implants in high‐risk patients.…”