The safety of surgical technique for ileostomy and colostomy in preventing parastomal hernias: an in vitro experimental simulation study

Abstract

Background Parastomal hernia (PH) is a common long-term complication in persons with an ostomy. Although the cause of PH may be multifactorial, the surgical technique employed for the creation of a stoma may be a risk factor for the development of PH. The traditional technique of cruciate fascia incision may predispose to increased pressure zones at the ostomy exit site, thereby increasing the risk of PH. A circular excision of the abdominal fascia at the ostomy exit site enables a uniform pressure distribution, thereby reducing the risk of PH. This hypothesis was tested in this in vitro experimental simulation study. Methods The effect of the surgical technique for ostomy creation on the risk of PH development was investigated in this in vitro experimental simulation study. The pressure development at the stoma site was compared for the traditional cruciate incision vs. circular fascia excision. Results The pressure at the ostomy site was about four-times higher in the tradition cruciate incision technique compared to the circular excision technique. This finding was independent of unilateral (e.g. peritoneal) pressure application. Conclusion The main finding from this study suggests that the traditional cruciate incision of the abdominal fascia for the creation of an intestinal ostomy predisposes to increased pressures at the ostomy site, thus increasing the risk of PH. This effect is not seen in the experimental setting following a circular excision of the fascia. Thus, this surgical aspect may be adopted as a possible means of reducing the risk of parastomal hernia in patients undergoing ostomy surgery.

Assessment of Urostomy Parastomal Herniation Forces Using Incisional Prevention Strategies with an Abdominal Fascia Model

“…Our data suggest that a linear incision is preferred to a cruciate incision, and a cruciate incision is preferred to a circular one. This agrees with the simulation literature, as Ambe [5] suggested an increase in pressure differential for cruciate compared with circular incisions.…”

“…Another factor is the stoma incision type, which is thought to play a role in pressure differential across a fascial defect, based on the simulation data. Specifically, in multiphysics finite element modeling simulations, cruciate incisions generate higher forces needed for herniation across an incision than circular incisions [5] . Finally, approaches to reinforce the urostomy site may alter the risk of PSH development.…”

Early postoperative parastomal evisceration after explorative laparotomy: case report of a rare and potentially life-threatening surgical complication

“…In a recent experimental simulation study, Ambe explored the impact of a circular excision of the fascia in decreasing pressures at the ostomy site. This technique, proposed by the author, aims to diminish the risk of parastomal hernia [ 7 ]. In our comprehensive examination of published literature, the majority of cases (eight out of ten) displayed patient-related risk factors [ 2 , 3 , 6 , 8 – 12 ], with two instances occurring without predisposing factors [ 9 , 13 ].…”