Incidence, risk factors and prevention of stoma site incisional hernias: a systematic review and meta‐analysis

Lambrichts, D. P. V.; Smet, Gijs H J de; Bogt, Ruben D. van der; Kroese, Leonard F.; Menon, Anand; Jeekel, J.; Kleinrensink, G.J.; Lange, Johan F.

doi:10.1111/codi.14369

Cited by 28 publications

(25 citation statements)

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“…Multivariate analysis identified – besides higher BMI, PSH, hypertension and stomal prolapse – previous or ongoing malignancy as an independent risk factor for the development of hernia . The latter is in agreement with the results of a recent systematic review of 33 studies investigating the incidence of and risk factors for SSIH in addition to BMI and diabetes, surgery for malignant disease proved to be significantly associated with SSIH. Keeping in mind that almost two‐thirds of the participants in the PATRASTOM trial were operated on for rectal cancer, which could be a factor contributing to the high rate of herniation in this cohort.…”

Section: Discussionsupporting

confidence: 89%

Incisional hernia rate after ileostomy closure in lateral pararectal stoma versus transrectal stoma placement: follow‐up of the randomized PATRASTOM trial

et al. 2019

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Aim Because damage to the rectus abdominis muscle during ileostomy placement and reversal might be a risk factor for the development of stoma‐site incisional hernia (SSIH), we hypothesized that positioning of the stoma lateral to the rectus abdominis muscle might prevent SSIH. Method To investigate whether a lateral pararectal stoma position lowers the incidence of SSIH in comparison with a transrectal position, a follow‐up study of the PATRASTOM trial, which had randomized stoma placement (lateral pararectal versus transrectal), was conducted. All former participants were invited simultaneously for a follow‐up visit in September 2016, 2 years after database closure of the PATRASTOM trial. For patients who were not able to attend the follow‐up, the electronic chart as well as MRI/CT scans were reviewed with regard to the presence of SSIH. Results Follow‐up – either clinical or radiological – was available for 47 of the 60 PATRASTOM participants. The median duration of follow‐up was 3.4 years (interquartile range 3.0–4.1 years). SSIH occurred in 3 of 23 patients (13.0%) in the lateral pararectal group compared with 7 of 24 patients (29.2%) in the transrectal group (P = 0.287). Four of the 10 patients diagnosed with SSIH had already undergone or were scheduled for hernia repair. Of the patient and procedure characteristics which may have an impact on the development of incisional hernia none was a significant risk factor for SSIH. Conclusion In the present follow‐up study, no difference in the incidence of SSIH was found between lateral pararectal and transrectal stoma construction in an elective setting.

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Section: Discussionsupporting

confidence: 89%

Incisional hernia rate after ileostomy closure in lateral pararectal stoma versus transrectal stoma placement: follow‐up of the randomized PATRASTOM trial

et al. 2019

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“…Median BMI in patients with stoma site hernia was 28 (IQR: 25-29) kg/m 2 versus 25 (22)(23)(24)(25)(26)(27)(28) in patients without hernia (p = 0.026) ( Table 4). Of the 16 patients with hernia, 14 (88%) were men and 2 (12%) were women, versus 116 (58%) men and 84 (42%) women in patients without hernia (p = 0.031).…”

Section: Risk Factorsmentioning

confidence: 99%

Hernia at the stoma site after loop ileostomy reversal

Eklöv

Viktorsson

Frosztega

et al. 2020

Int J Colorectal Dis

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Purpose To estimate the incidence of and risk factors for stoma site hernia after closure of a temporary diverting ileostomy. Method In a non-comparative cohort study, charts (n = 216) and CT-scans (n = 169) from patients who had undergone loop ileostomy closure following low anterior resection for rectal cancer 2010-2015 (mainly open surgery) at three hospitals were evaluated retrospectively. Patients without hernia diagnosis were evaluated cross-sectionally through a questionnaire (n = 158), and patients with symptoms of bulging or pain were contacted and offered a clinical examination or a CT scan including Valsalva maneuver. Results In the chart review, five (2.3%) patients had a diagnosis of incisional hernia at the previous stoma site after 8 months (median). In 12 patients, the CT scan showed a hernia, of which 8 had not been detected previously. The questionnaire was returned by 130 (82%) patients, of which 31% had symptoms of bulging or pain. Less than one in five of patients who reported bulging were diagnosed with hernia, but the absolute majority of the radiologically diagnosed hernias reported symptoms. By combining clinical and radiological diagnosis, the cumulative incidence of hernia was 7.4% during a median follow up time of 30 months. Risk factors for stoma site hernia were male sex and higher BMI. Conclusion Hernia at the previous stoma site was underdiagnosed. Less than a third of symptomatic patients had a hernia diagnosis in routine follow up. Randomized studies are needed to evaluate if prophylactic mesh can be used to prevent hernias, especially in patients with risk factors.

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“…We thank Dr Wee for his interest in our recently published article . Dr Wee indicated some ambiguities and provided recommendations regarding the methodology and outcomes of our study.…”

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confidence: 99%

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et al. 2018

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Incidence, risk factors and prevention of stoma site incisional hernias: a systematic review and meta‐analysis

Abstract: Stoma site incisional hernia should not be underestimated as a long-term problem. Body mass index, diabetes and malignancy seem to be potential risk factors. Currently, limited data are available on the outcomes of prophylactic mesh reinforcement to prevent stoma site incisional hernia.

Cited by 28 publications

References 70 publications

Incisional hernia rate after ileostomy closure in lateral pararectal stoma versus transrectal stoma placement: follow‐up of the randomized PATRASTOM trial

Incisional hernia rate after ileostomy closure in lateral pararectal stoma versus transrectal stoma placement: follow‐up of the randomized PATRASTOM trial

Hernia at the stoma site after loop ileostomy reversal

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