Aneel Bhangu1, Dmitri Nepogodiev, Kaori Futaba. 1. Academic Department of Surgery, West Midlands Research Collaborative, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH, UK. aneelbhangu@doctors.org.uk
Abstract
BACKGROUND: The incidence of incisional hernias at the site of stoma closure is surprisingly unclear. A review of the current literature was undertaken to determine how commonly this complication may occur and to assess the quality of evidence available. METHODS: A systematic review was performed to identify studies reporting the incidence of incisional hernia after closure of an ileostomy or colostomy. Studies including children (<16 years old) and studies in which >10% of the total number were trauma patients were excluded. RESULTS: Thirty-four studies provided outcomes for 2,729 closed stomas. Median follow-up time was 36 months but was only described in seven studies. Closure of loop ileostomies was the most commonly performed procedure (48%). The overall reported hernia rate was 7%, but with a wide range among studies (0-48%). Most studies based their hernia rates on retrospective clinical findings only. A separate analysis of three studies that were specifically designed to assess for stoma site hernias found the clinical hernia rate to be 30% (28/93) and the combined clinical/radiological hernia rate to be 35% (33/93). From 11 studies reporting reoperation rates, 51% of patients who developed a hernia required a surgical repair (34/66). There was a lower risk of hernia following reversal of ileostomy versus colostomy (odds ratio 0.28, 95% confidence interval 0.12-0.65). CONCLUSIONS: One in three patients may develop a hernia after stoma closure, and around half of hernias that are detected require repair. Risk of hernia is greater after colostomy closure than after ileostomy closure. Clinical measures to reduce the development of these hernias warrant consideration.
BACKGROUND: The incidence of incisional hernias at the site of stoma closure is surprisingly unclear. A review of the current literature was undertaken to determine how commonly this complication may occur and to assess the quality of evidence available. METHODS: A systematic review was performed to identify studies reporting the incidence of incisional hernia after closure of an ileostomy or colostomy. Studies including children (<16 years old) and studies in which >10% of the total number were traumapatients were excluded. RESULTS: Thirty-four studies provided outcomes for 2,729 closed stomas. Median follow-up time was 36 months but was only described in seven studies. Closure of loop ileostomies was the most commonly performed procedure (48%). The overall reported hernia rate was 7%, but with a wide range among studies (0-48%). Most studies based their hernia rates on retrospective clinical findings only. A separate analysis of three studies that were specifically designed to assess for stoma site hernias found the clinical hernia rate to be 30% (28/93) and the combined clinical/radiological hernia rate to be 35% (33/93). From 11 studies reporting reoperation rates, 51% of patients who developed a hernia required a surgical repair (34/66). There was a lower risk of hernia following reversal of ileostomy versus colostomy (odds ratio 0.28, 95% confidence interval 0.12-0.65). CONCLUSIONS: One in three patients may develop a hernia after stoma closure, and around half of hernias that are detected require repair. Risk of hernia is greater after colostomy closure than after ileostomy closure. Clinical measures to reduce the development of these hernias warrant consideration.
Authors: Monica T Young; Grace S Hwang; Gopal Menon; Timothy F Feldmann; Mehraneh D Jafari; Fariba Jafari; Eden Perez; Alessio Pigazzi Journal: World J Surg Date: 2015-11 Impact factor: 3.352
Authors: Ali Rastegarpour; Michael Cheung; Madhurima Vardhan; Mohamed M Ibrahim; Charles E Butler; Howard Levinson Journal: Plast Surg (Oakv) Date: 2016 Impact factor: 0.947
Authors: Mohamed M Ibrahim; Luke P Poveromo; Richard R Glisson; Agustin Cornejo; Alfredo E Farjat; Ken Gall; Howard Levinson Journal: J Biomech Date: 2018-02-02 Impact factor: 2.712
Authors: Femke J Amelung; Frank Ter Borg; Esther C J Consten; Peter D Siersema; Werner A Draaisma Journal: Surg Endosc Date: 2016-04-12 Impact factor: 4.584
Authors: Kevin W Y van Barneveld; Ruben R M Vogels; Geerard L Beets; Stephanie O Breukink; Jan-Willem M Greve; Nicole D Bouvy; Marc H F Schreinemacher Journal: Surg Endosc Date: 2013-12-20 Impact factor: 4.584