Abstract
Stoma reversal might lead to a stoma site incisional hernia. Recently, prophylactic mesh reinforcement of the stoma site has gained increased attention, supporting the need for accurate data on the incidence of and risk factors for stoma site incisional hernia and to identify high-risk patients. The aim of this study was to assess incidence, risk factors and prevention of stoma site incisional hernias. Embase, MEDLINE, Web of Science, Cochrane and Google Scholar databases were searched. Studies reporting the incidence of stoma site incisional hernia after stoma reversal were included. Study quality was assessed with the Newcastle-Ottawa Scale and Cochrane risk of bias tool. Data on incidence, risk factors and prophylactic mesh reinforcement were extracted. Of 1440 articles found, 33 studies comprising 4679 reversals were included. The overall incidence of incisional hernia was 6.5% [range 0%-38%, median follow-up 27.5 (17.54-36) months]. Eleven studies assessed stoma site incisional hernia as the primary end-point, showing an incidence of 17.7% [range 1.7%-36.1%, median follow-up 28 (15.25-51.70) months]. Body mass index, diabetes and surgery for malignant disease were found to be independent risk factors, as derived from eight studies. Two retrospective comparative cohort studies showed significantly lower rates of stoma site incisional hernia with prophylactic mesh reinforcement compared with nonmesh controls [6.4% vs 36.1% (P = 0.001); 3% vs 19% (P = 0.04)]. Stoma site incisional hernia should not be underestimated as a long-term problem. Body mass index, diabetes and malignancy seem to be potential risk factors. Currently, limited data are available on the outcomes of prophylactic mesh reinforcement to prevent stoma site incisional hernia.
Highlights
Temporary stomas are frequently constructed to defunction a low colorectal anastomosis and during surgery for acute complicated diverticulitis, inflammatory bowel disease and traumatic intestinal injury [1,2,3,4,5,6,7,8]
Two retrospective comparative cohort studies showed significantly lower rates of stoma site incisional hernia with prophylactic mesh reinforcement compared with nonmesh controls [6.4% vs 36.1% (P = 0.001); 3% vs 19% (P = 0.04)]
Stoma site incisional hernia should not be underestimated as a long-term problem
Summary
Temporary stomas are frequently constructed to defunction a low colorectal anastomosis and during surgery for acute complicated diverticulitis, inflammatory bowel disease and traumatic intestinal injury [1,2,3,4,5,6,7,8]. Subsequent stoma reversal is associated with surgical site infection (SSI), anastomotic leakage, postoperative ileus and development of stoma site or midline incisional hernia (MIH) [9,10,11,12,13]. Recent research has shown that prophylactic mesh reinforcement (PMR) in midline laparotomies in highrisk patients significantly decreases the incidence of MIH [16,17], and PMR at the stoma site during permanent stoma construction has been considered to reduce rates of parastomal hernia [18,19,20,21]. Considering the largely comparable pathophysiology, PMR during temporary ostomy takedown to prevent SSIH could be beneficial by potentially obviating complications and re-operations, and has gained increased attention amongst surgeons [17]. Accurate data on incidence and risk factors for the development of SSIH are of importance to correctly assess the clinical value of PMR to prevent SSIH, to facilitate selection of high-risk patients and to aid clinical and shared decision-making [22]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
