Risk factors for parastomal hernia in Japanese patients with permanent colostomy

Kimihiko Funahashi,Mitsunori Ushigome,Hironori Kaneko,Yasuo Nagashima,Akiharu Kurihara,Tomoaki Kaneko,Kenichiro Arai,Junichi Koike,Takayuki Suzuki,Hiroyuki Shiokawa,Satoshi Matsuda

doi:10.1007/s00595-013-0721-3

Kimihiko Funahashi, Mitsunori Ushigome + Show 9 more

Open Access

https://doi.org/10.1007/s00595-013-0721-3

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Abstract

PurposeAlthough the definitive risk factors for parastomal hernia development remain unclear, potential contributing factors have been reported from Western countries. The aim of this study was to identify the risk factors for parastomal hernia in Japanese patients with permanent colostomies.MethodsAll patients who received abdominoperineal resection or total pelvic exenteration at our institution between December 2004 and December 2011 were reviewed. Patient-related, operation-related and postoperative variables were evaluated, in both univariate and multivariate analyses, to identify the risk factors for parastomal hernia formation.ResultsOf the 80 patients who underwent colostomy, 22 (27.5 %) developed a parastomal hernia during a median follow-up period of 953 days (range 15–2792 days). Hernia development was significantly associated with increasing patient age and body mass index, a laparoscopic surgical approach and the transperitoneal route of colostomy formation. In the multivariate analysis, the body mass index (p = 0.022), the laparoscopic approach (p = 0.043) and transperitoneal stoma creation (p = 0.021) retained statistical significance.ConclusionsOur findings in Japanese ostomates match those from Western countries: a higher body mass index, the use of a laparoscopic approach and a transperitoneal colostomy are significant independent risk factors for parastomal hernia formation. The precise role of the stoma creation route remains unclear.

Highlights

Advances in surgical techniques have enabled more frequent sphincter preservation in patients with rectal malignancy, but have not eliminated the need for permanent colostomy
Purpose the definitive risk factors for parastomal hernia development remain unclear, potential contributing factors have been reported from Western countries
Hernia development was significantly associated with increasing patient age and body mass index, a laparoscopic surgical approach and the transperitoneal route of colostomy formation

Summary

Introduction

Advances in surgical techniques have enabled more frequent sphincter preservation in patients with rectal malignancy, but have not eliminated the need for permanent colostomy. A parastomal hernia, defined as an incisional hernia at the site of an intestinal stoma, is a late complication with an incidence of 0–48 % in ostomates with loop- or end colostomies, according to a review by Carne et al [1]. Corticosteroid use, increasing age and wound infection are believed to be potential contributing factors to parastomal hernia in Western countries [2], the definitive risk factors are still unclear; this is true in Eastern countries, including Japan. In 2012, Korean researchers found that female sex, aperture size, age over 60 years, a body mass index (BMI) [25 kg/m2 and hypertension are probable risk factors for parastomal hernia [3, 4], but there is still controversy over defining these risk factors, and there have been no reports addressing Japanese patients.

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