Incidence and risk factors for parastomal hernia with a permanent colostomy

Abstract

Aim This study aims to explore the incidence and risk factors for permanent colostomy complicated with a parastomal hernia (PSH) after rectal cancer resection. Methods 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. Results 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. Conclusion 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.

Stoma Complications

“…12 Other studies report similar figures, with rates ranging from 2 to 28% for ileostomies and 0 to 48% for colostomies. [29][30][31][32][33][34][35][36] In general, loop stomas-especially loop colostomies-have a higher rate of parastomal hernia formation than end stomas, almost certainly due to size of the fascial defect needed to bring both ends of the intestine through the abdominal wall. Although there is no widely accepted criteria for sizing the fascial defect, most colorectal surgeons recommend keeping the opening as small as possible while still allowing the easy passage of the tip of a finger alongside the intestine since larger openings are associated with higher rates of parastomal hernia.…”

“…[37][38][39] Additional risk factors for hernia formation include older age, female sex, obesity (typically defined as a BMI 25 kg/m 2 ), the presence of medical comorbidities such as diabetes or chronic obstructive pulmonary disease, and perioperative complications. [32][33][34]38 As with other abdominal hernias, parastomal hernias are repaired when they become symptomatic. Acute herniation with incarceration, obstruction, or intestinal ischemia is a surgical emergency.…”

“…12 Other studies report similar figures, with rates ranging from 2 to 28% for ileostomies and 0 to 48% for colostomies. 29 30 31 32 33 34 35 36…”

“…37 38 39 Additional risk factors for hernia formation include older age, female sex, obesity (typically defined as a BMI ≥ 25 kg/m 2 ), the presence of medical comorbidities such as diabetes or chronic obstructive pulmonary disease, and perioperative complications. 32 33 34 38…”

Incidence and risk factors for parastomal hernia with a permanent colostomy

“…We have read with interest the article published by Liu et al 1 Parastomal hernia will bring a heavy burden to patients physically and psychologically. Therefore, correctly understanding the risk factors related to the occurrence of parastomal hernia has important clinical significance.…”