Incisional hernia at the site of stoma reversal\u2014incidence and risk factors in a retrospective observational analysis

Andreas Lorenz,Reinhold Kafka-Ritsch,Pamela Kogler,Dietmar Öfner,Alexander Perathoner

doi:10.1007/s00384-019-03310-5

Andreas Lorenz, Reinhold Kafka-Ritsch + Show 3 more

Open Access

https://doi.org/10.1007/s00384-019-03310-5

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Abstract

BackgroundThe closure of a stoma site has a high incidence of incisional hernia (IH) development, reaching 30% in some studies. Location and defect size in the abdominal wall depend on the type of stoma formed, most commonly a loop ileostomy or terminal sigmoid colostomy.MethodsThe retrospective single-centre study includes all consecutive patients who underwent stoma reversal between 2010 and 2016 at the Department of Visceral, Transplant and Thoracic Surgery in Innsbruck. Patient characteristics and follow-up examinations were evaluated for IH at both the stoma reversal site and at any other surgical access sites.ResultsA total of 181 patients (49% female, 51% male) had a stoma reversal operation. A parastomal hernia was present in 5% (n = 9). Follow-up data was available for 140 patients (77%). A postoperative IH at the stoma reversal site developed in 15.7% (n = 22) and in 18.6% (n = 26) at other surgical wounds to the abdominal wall during a median follow-up of 136 weeks. The combination of a preoperative parastomal hernia and a postoperative IH was observed in 2.8% (n = 5). Parastomal herniation, male sex, body mass index over 25, arterial hypertension and concomitant ventral hernia were associated with IH formation at the stoma reversal.ConclusionThe rate of IH at the stoma reversal site was lower than expected from the literature, whereas the rate of IH at other surgical wounds to the abdominal wall was within the expected range.

Highlights

BackgroundFormation of an intestinal stoma is an important tool in the surgeon’s repertoire to control or prevent abdominal sepsis and treat bowel obstruction
Seventeen patients were excluded because a stoma reversal was not performed, a mesh reinforcement was used or the stoma was reestablished at the same site
Almost 60% of patients presented with a body mass index (BMI) in the normal range (18.5–25.0) and comorbidities were infrequent, arterial hypertension in 23% of cases being the diagnosis most often observed

Summary

Introduction

BackgroundFormation of an intestinal stoma is an important tool in the surgeon’s repertoire to control or prevent abdominal sepsis and treat bowel obstruction. This, apart from directly stoma-related morbidity, incentivizes patients and surgeons to carry out a reversal operation restoring the intestinal passage and closing the defect in the abdominal wall. The latter usually involves a direct suture repair of the fascia and various techniques to address the inevitable wound contamination by the abounding commensals of the intestinal tract. Regardless of its direct effect, it influences the discussion of suture materials and preventive measures such as mesh reinforcement These are called for because the incidence of IH is as high as 34%, and the affected patients frequently are subjected to a subsequent hernia repair operation [3]. Parastomal herniation, male sex, body mass index over 25, arterial hypertension and concomitant ventral hernia were associated with IH formation at the stoma reversal

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