Abstract
Objectives: To study the frequency of risk factors affecting the development of parastomal hernias in patients undergoing stoma formation.Study Design: A retrospective descriptive cross-sectional study.Duration of Study: This study was conducted at the Department of General Surgery between January 2017 to December 2020.Methodology: A total of 163 patients aged between 20 and 100 years and who required a stoma formation were included in the study. The patients with incomplete data and those lacking post-operative imaging were excluded. According to this selection criteria, 80 patients were excluded. The data was collected for all patients from the hospital database. This included patient’s demographic information, co-morbidities, pre-surgery patient characteristics, an indication of stoma formation, the location of stoma exit, type of surgery, associated comorbidities, subcutaneous fat thickness, and type of stoma formed. Data were analyzed using IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.Results: The mean age was 68.46 ± 16.50 years, with males in the majority: 48 (57.8%). Most of the patients, 53 (63.8%), had malignant disease. Post-stoma formation, a total of 38 (45.9%) patients developed parastomal hernias, mostly involving the sigmoid colon (n=62, 74.7%). However, there was a statistically significant relationship between paroxysmal sympathetic hyperactivity (PSH) incidence with non-trans-rectus stomas (trans-oblique n=07, junctional n=28) (OR 3.04, CI 1.23-7.5, p=0.014). Furthermore, malignancy was also not an independent predictor of PSH (OR 0.408, CI 0.15-1.2, p=0.056). All other risk factors included in this study were nonsignificant.Conclusion: Our study shows that the incidence of parastomal hernias is rising with a high rate demonstrated in our patients. There was no statistically significant association between patient-related preoperative and operative factors with increased risk of parastomal hernias in our population except for a non-trans-rectus stoma, which was identified as an independent risk factor for parastomal hernias. Based on our findings, we would recommend a trans-rectus stoma over all other stoma sites. However, a much larger study is needed to validate this finding further.
Highlights
Stoma formation is among the most commonly performed surgical procedures to redirect gut contents for various reasons [1]
There was no statistically significant association between patient-related preoperative and operative factors with increased risk of parastomal hernias in our population except for a non-trans-rectus stoma, which was identified as an independent risk factor for parastomal hernias
The incidence of parastomal hernias has been on the rise in recent decades, due to increased surgeries resulting in the formation of stomas and due to the frequent employment of imaging, such as computed tomography, for diagnosis of even small-sized hernias [7]
Summary
Stoma formation is among the most commonly performed surgical procedures to redirect gut contents for various reasons [1]. Parastomal hernia is characterized as the protrusion of abdominal contents through the abdominal wall defect in the locality of the stoma [2]. Parastomal hernias complicate stomas at an incidence of as high as 0% to 48% for end colostomies, 0% to 30.8 % for loop colostomies, and 1.8% to 28.3% for end ileostomies [3]. Sohn et al reported that 37.8% of their patient population who had stomas after surgery developed parastomal hernias; they identified female gender, advancing age, a BMI > 25 kg/m2, and hypertension as independent risk factors for the development of a parastomal hernia [5]. Pennings et al reported chronic obstructive pulmonary disease (COPD), long duration of surgery, and large diameter of stoma as independent risk factors for parastomal hernia development [6]
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