Risk Factors for Parastomal Hernia Associated with Covering Stoma in Rectal Surgery

Abstract

The definitive risk factors for parastomal hernia (PSH), a complication of stoma construction that can lead to severe morbidity, remain unclear. Therefore, this study aimed to determine risk factors for PSH after rectal surgery in Japanese patients. We retrospectively included 134 patients who underwent rectal tumor surgery and covering stoma construction between January 2012 and October 2016 in our department. Eleven variables, including the presence of sarcopenia determined by computed tomography (CT), were studied as risk factors for PSH. The diagnosis of PSH was based on CT obtained during follow-up after surgery. Our results indicated that the incidence of PSH was 16.4% (22/134). Multivariate analysis revealed that age ≥ 65 years (odds ratio [OR], 9.53; 95% confidence interval [CI], 2.11–71.3; P = 0.009), sarcopenia (OR, 5.08; 95%CI, 1.10–25.8; P = 0.039), umbilical subcutaneous fat thickness ≥ 21.3 mm (OR, 7.91; 95%CI, 2.02–38.9; P = 0.0051), and colostomy (OR, 9.02; 95%CI, 1.58–64.3; P = 0.018) were independent risk factors for PSH. Therefore, older age, sarcopenia, thick subcutaneous fat, and colostomy were risk factors for PSH. With the increasing age and sarcopenia incidence in recent years, reduction of risk factors and preventative approaches for PSH are necessary before rectal surgery.