Risk Factors For Parastomal Hernia Research Articles

Development and validation of a nomogram prediction model for the risk of parastomal hernia

BackgroundParastomal hernia is one of the potential complications after enterostomy. There is currently no early risk assessment tool for parastomal hernia. MethodsThe current investigation was conducted using retrospective studies. A total of 302 cases were used develop and internally to validate a nomogram prediction model, and 67 cases were used for external validation. Independent risk factors for parastomal hernia after permanent sigmoid colostomy were assessed via univariate analysis and binary logistic regression analysis. The nomogram prediction model was established based on independent risk factors. ResultsBody mass index, serum albumin, age, sex, and stoma diameter were independent risk factors for parastomal hernia. The areas under the receiver operating characteristic curves were 0.909 in the development group and 0.801 in the validation group. The Hosmer-Lemeshow test (P > 0.05) and calibration curves indicated good consistency between actual observations and predicted probabilities. ConclusionsA nomogram prediction model was constructed and validated based on risk factors for parastomal hernia. The nomogram could be generalized to patients undergoing surgery for stoma by specialized surgeons to provide relevant references for stoma patients.

Incidence and risk factors for parastomal hernia with a permanent colostomy.

This study aims to explore the incidence and risk factors for permanent colostomy complicated with a parastomal hernia (PSH) after rectal cancer resection. This was a retrospective study of gastrointestinal surgery performed from January 2013 to December 2017 in patients with colorectal cancer treated at the Affiliated Hospital of Qingdao University. The relevant clinical variables of the patient were analyzed. Kaplan-Meier, univariate, and Cox multivariate analyses were used to evaluate the influencing factors and morbidity of PSH. Among the 211 patients, 65 developed PSH. The cumulative incidence reached 33.5% at 62 months. In the multivariate Cox survival analysis, the results showed that being a woman, aged ≥65 years, having a body mass index(BMI) ≥ 25 kg/m2 , diabetes, and Clavien-Dindo Grade III and IV complications were risk factors for the occurrence of PSH. In our study, the incidence of PSH increased annually and reached a maximum of 33.5% after 62 months. Among the patient-related factors, female sex, age ≥65 years, BMI ≥ 25 kg/m2 , diabetes, and postoperative Clavien-Dindo Grade III and IV complications were significantly associated with the development of PSH. Therefore, intervention measures to prevent patients with this risk factor are advisable.

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

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.

Permanent end-colostomy parastomal hernia prevention using a novel three-dimensional mesh.

Prophylactic mesh placement has been proposed to reduce the high occurrence of parastomal hernia (PSH) after stoma formation. This is an observational study comparing two cohorts of patients: a mesh prophylaxis group (who received mesh prevention since introduction at our Institution) and a no mesh prophylaxis group (retrospectively selected from our historical series). Same exclusion criteria were applied for both groups. The study was conducted at a tertiary referral center for colorectal surgery. 43 patients were operated with mesh prophylaxis between May 2015 and may 2019. 45 patients underwent end-colostomy formation without prophylaxis between April 2011 and April 2015. The primary outcome measure was PSH development at 12-month follow up. Demographic variables and risk factors for PSH were comparable between the two groups. There was no difference between the two cohorts in terms of operative time and main early postoperative outcomes. 37 patients completed the 12-month follow up in each group. PSH occurrence after 12-months was 11% in the mesh prophylaxis group and 54% in the no mesh prophylaxis group (p < 0.0001). There were no differences in long-term complications. 5% of patients who received mesh prophylaxis underwent emergency surgery for bowel occlusion at 7 and 10months after surgery, with partial or complete mesh removal. At multivariate analysis, mesh prophylaxis was a protective factor for PSH development at 12months (p < 0.0001). Prophylactic intraperitoneal mesh placement appears to be effective in preventing PSH.

Risk factors for parastomal hernia of loop stoma and relationships with other stoma complications in laparoscopic surgery era

BackgroundLaparoscopic approach is now a widespread technique used worldwide, but there are few recent studies on risk factors for parastomal hernia. Therefore, this study was performed to analyze the incidence of parastomal hernia in laparoscopic and open surgery in which a loop stoma was created and was intended to be temporary, and to determine risk factors for parastomal hernia formation. Associations between parastomal hernia and other stoma-related complications were also analyzed.MethodsA retrospective analysis of patient and surgical characteristics was performed in 153 consecutive patients who underwent a temporary diverting loop ileostomy or colostomy after surgery related to malignant diseases at our hospital from January to December 2016.ResultsParastomal hernia developed in 77 cases (50.3%), including 39 (25.5%) diagnosed by physical examination and 38 (24.8%) detected by CT alone. On multivariate analysis, a stoma not passing through the middle of the rectus abdominis muscle was the only independent risk factor for parastomal hernia formation (p = 0.005) during the median follow-up of 245.0 days. When we analyzed the factors that were associated with a stoma not passing through the middle of the rectus abdominis muscle, the only independent factor associated with this misplacement of the stoma was a laparoscopic approach (p = 0.012). An analysis of stoma-related complications showed that peristomal skin disorders were significantly associated with parastomal hernia (p = 0.049).ConclusionsThis study showed that a stoma that is not formed through the middle of the rectus abdominis muscle is a risk factor for parastomal hernia formation, and that a laparoscopic approach is associated with this risk factor. Moreover, parastomal hernia is significantly associated with peristomal skin disorders.

Methods of Colostomy Construction: No Effect on Parastomal Hernia Rate: Results from Stoma-const-A Randomized Controlled Trial.

The primary objective of this trial was to compare the parastomal hernia rates 1 year after the construction of an end colostomy by 3 surgical techniques: cruciate incision, circular incision in the fascia and using prophylactic mesh. Secondary objectives were evaluation of postoperative complications, readmissions/reoperations, and risk factors for parastomal hernia. Colostomy construction techniques have been explored with the aim to improve function and reduce stoma complications, but parastomal herniation is frequent with an incidence of approximately 50%. A randomized, multicenter trial was performed in 3 hospitals in Sweden and Denmark; all patients scheduled to receive an end colostomy were asked to participate. Parastomal hernia within 12 months was determined by computed tomography of the abdomen in prone position and by clinical assessment. Complications, readmissions, reoperations, and risk factors were also assessed. Two hundred nine patients were randomized to 1 of the 3 arms of the study. Patient demographics were similar in all 3 groups. Assessment of parastomal hernia was possible in 185 patients. The risk ratio (95% confidence interval) for parastomal hernia was 1.25 (0.83; 1.88), and 1.22 (0.81; 1.84) between cruciate versus circular and cruciate versus mesh groups, respectively. There were no statistically significant differences between the groups with regard to parastomal hernia rate. Age and body mass index were found to be associated with development of a parastomal hernia. We found no significant differences in the rates of parastomal hernia within 12 months of index surgery between the 3 surgical techniques of colostomy construction.

Risk factors for parastomal hernia in patients with colostomy: a scope overview

Risk factors for parastomal hernia in patients with colostomy: a scope overview

Etiological analysis of parastomal hernia by computed tomography examination.

IntroductionParastomal hernia is a common complication after stoma formation. The definitive risk factors for parastomal hernia development remain unclear.AimThis study evaluated the risk factors through computed tomography (CT) scan of patients with parastomal hernia.Material and methodsAll patients who underwent an operation at our institution from January 2008 to February 2014 were included. We recorded patient-related and operation-related variables, and CT scans were checked. All the variables were analyzed with SPSS 19 to identify the risk factors for parastomal hernia formation.ResultsOf the 128 patients who underwent colostomy, 49 (38.3%) developed a parastomal hernia during a median follow-up period of 20.1 months (range: 4–84 months). Hernia development was significantly associated with the thickness of subcutaneous fat in the abdominal wall, the location of the stoma, anteroposterior diameter and horizontal diameter of the body. The defect size of the abdominal wall is another risk factor. The larger the defect size of the abdominal wall, the larger is the parastomal stoma (3.79 ±1.51 vs. 2.13 ±0.74 cm horizontally and 4.90 ±2.25 vs. 2.94 ±0.73 cm vertically, p < 0.001). The hernia contents protrude into the hernial sac through the path of the inner side more than the outer side (77.6% vs. 12.2%).ConclusionsOur findings in Chinese patients with parastomal hernia match those from Western countries: obesity, the location of the stoma, and the defect size of the abdominal wall are significant risk factors for parastomal hernia formation. The mesenteric region is a weak area, which is a site prone to parastomal hernia, and should be protected.

Risk factors for parastomal hernia after abdominoperineal resection for rectal cancer.

This study was designed to identity risk factors for parastomal hernia occurring after abdominoperineal resection for rectal cancer. The study group was comprised of 158 patients with rectal cancer who underwent abdominoperineal resection in our department from January 1990 through December 2014. Twelve variables were studied as risk factors for parastomal hernia. Parastomal hernia developed in 27 patients, including 19 patients who underwent colostomy creation via an intraperitoneal route and 8 patients who underwent colostomy creation via an extraperitoneal route. On univariate analysis, a BMI ≥25kg/m2 was significantly related to the development of parastomal hernia (P=0. 018), and an ASA physical status ≥2 was slightly but not significantly related to parastomal hernia (P=0. 076). Multivariate analysis showed that a BMI ≥25kg/m2 was an independent risk factor (odds ratio=2.9698; P=0. 016). Patients with a BMI ≥25kg/m2 should be instructed about lifestyle modifications to control preoperative bodyweight and to reduce abdominal pressure.

Risk factors for parastomal hernia in Japanese patients with permanent colostomy

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.

Risk factors for parastomal hernia: based on radiological definition

PurposeThe aim of this study was to investigate the clinical and radiological incidence of parastomal hernia and to analyze the risk factors for parastomal hernia.MethodsWe reviewed retrospectively 108 patients with end colostomy from January 2003 to June 2010. Age, sex, surgical procedure type, body mass index (kg/m2), stoma size, and respiratory comorbidity were documented.RESULTSThere were 61 males (56.5%) and 47 females (43.5%). During an overall median follow-up of 25 months (range, 6 to 73 months), 36 patients (33.3%) developed a radiological parastomal hernia postoperatively and 29 patients (26.9%) presented with a clinical parastomal hernia. In multivariate analysis, gender (odds ratio [OR], 6.087; P = 0.008), age (OR, 1.109; P = 0.009) and aperture size (OR, 6.907; P < 0.001) proved to be significant and independent risk factors after logistic regression analysis.ConclusionThis study showed that the incidence of radiological parastomal hernia is higher than clinical parastomal hernia. Risk factors for parastomal hernia proved to be female, age, and aperture size.