Advertisement

World Journal of Surgery

, Volume 36, Issue 5, pp 973–983 | Cite as

Systematic Review and Meta-analysis of the Incidence of Incisional Hernia at the Site of Stoma Closure

  • Aneel Bhangu
  • Dmitri Nepogodiev
  • Kaori Futaba
  • West Midlands Research Collaborative
Article

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.

Keywords

Incisional Hernia Stoma Closure Reoperation Rate Loop Ileostomy Parastomal Hernia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors are grateful for advice and critical comments from the members of the West Midlands Research Collaborative: David Bartlett, Nick Battersby, Melanie Calvert, Marianne Johnstone, Paul Marriott, Pritesh Mistry, Senthurun Mylvaganam, Abhilasha Patel, Thomas Pinkney, Caroline Richardson, Pritam Singh, Lisa Whisker, Professor Dion Morton and the Birmingham Clinical Trials Unit.

Conflict of interest

No conflicts of interest declared.

References

  1. 1.
    Saha AK, Tapping CR, Foley GT et al (2009) Morbidity and mortality after closure of loop ileostomy. Colorectal Dis 11:866–871PubMedCrossRefGoogle Scholar
  2. 2.
    Giannakopoulos GF, Veenhof AA, van der Peet DL et al (2009) Morbidity and complications of protective loop ileostomy. Colorectal Dis 11:609–612PubMedCrossRefGoogle Scholar
  3. 3.
    Mansfield SD, Jensen C, Phair AS et al (2008) Complications of loop ileostomy closure: a retrospective cohort analysis of 123 patients. World J Surg 32:2101–2106. doi: 10.1007/s00268-008-9669-7 PubMedCrossRefGoogle Scholar
  4. 4.
    Edwards DP, Leppington-Clarke A, Sexton R et al (2001) Stoma-related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomized clinical trial. Br J Surg 88:360–363PubMedCrossRefGoogle Scholar
  5. 5.
    Garcia-Botello SA, Garcia-Armengol J, Garcia-Granero E et al (2004) A prospective audit of the complications of loop ileostomy construction and takedown. Dig Surg 21:440–446PubMedCrossRefGoogle Scholar
  6. 6.
    Kaidar-Person O, Person B, Wexner SD (2005) Complications of construction and closure of temporary loop ileostomy. J Am Coll Surg 201:759–773PubMedCrossRefGoogle Scholar
  7. 7.
    Chow A, Tilney HS, Paraskeva P et al (2009) The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis 24:711–723PubMedCrossRefGoogle Scholar
  8. 8.
    Tilney HS, Sains PS, Lovegrove RE et al (2007) Comparison of outcomes following ileostomy versus colostomy for defunctioning colorectal anastomoses. World J Surg 31:1142–1151. doi: 10.1007/s00268-006-0218-y PubMedCrossRefGoogle Scholar
  9. 9.
    Bakx R, Busch OR, Bemelman WA et al (2004) Morbidity of temporary loop ileostomies. Dig Surg 21:277–281PubMedCrossRefGoogle Scholar
  10. 10.
    Rondelli F, Reboldi P, Rulli A et al (2009) Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis 24:479–488PubMedCrossRefGoogle Scholar
  11. 11.
    Guenaga KF, Lustosa SA, Saad SS et al (2007) Ileostomy or colostomy for temporary decompression of colorectal anastomosis. Cochrane Database Syst Rev 1:CD004647PubMedGoogle Scholar
  12. 12.
    Carne PW, Robertson GM, Frizelle FA (2003) Parastomal hernia. Br J Surg 90:784–793PubMedCrossRefGoogle Scholar
  13. 13.
    Martin L, Foster G (1996) Parastomal hernia. Ann R Coll Surg Engl 78:81–84PubMedGoogle Scholar
  14. 14.
    Rubin MS, Schoetz DJ Jr, Matthews JB (1994) Parastomal hernia. Is stoma relocation superior to fascial repair? Arch Surg 129:413–418 discussion 418–419PubMedCrossRefGoogle Scholar
  15. 15.
    Cheung MT, Chia NH, Chiu WY (2001) Surgical treatment of parastomal hernia complicating sigmoid colostomies. Dis Colon Rectum 44:266–270PubMedCrossRefGoogle Scholar
  16. 16.
    Cingi A, Cakir T, Sever A et al (2006) Enterostomy site hernias: a clinical and computerized tomographic evaluation. Dis Colon Rectum 49:1559–1563PubMedCrossRefGoogle Scholar
  17. 17.
    Harbour R, Miller J (2001) A new system for grading recommendations in evidence based guidelines. BMJ 323(7308):334–336PubMedCrossRefGoogle Scholar
  18. 18.
    Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700PubMedCrossRefGoogle Scholar
  19. 19.
    Thomson JP, Hawley PR (1972) Results of closure of loop transverse colostomies. Br Med J 3(5824):459–462PubMedCrossRefGoogle Scholar
  20. 20.
    Rullier E, Le Toux N, Laurent C et al (2001) Loop ileostomy versus loop colostomy for defunctioning low anastomoses during rectal cancer surgery. World J Surg 25:274–277. doi: 10.1007/s002680020091 discussion 277–278PubMedCrossRefGoogle Scholar
  21. 21.
    Porter JA, Salvati EP, Rubin RJ et al (1989) Complications of colostomies. Dis Colon Rectum 32:299–303PubMedCrossRefGoogle Scholar
  22. 22.
    Perry GJ, Payne JE, Chapuis PH et al (1983) Complications in colostomy closure. J R Coll Surg Edinb 28:174–177PubMedGoogle Scholar
  23. 23.
    Jarrett LN, Balfour TW, Bourke JB (1977) Mortality and morbidity in transverse loop colostomy closure. J R Coll Surg Edinb 22:208–213PubMedGoogle Scholar
  24. 24.
    Amin SN, Memon MA, Armitage NC et al (2001) Defunctioning loop ileostomy and stapled side-to-side closure has low morbidity. Ann R Coll Surg Engl 83:246–249PubMedGoogle Scholar
  25. 25.
    Chapius P, Killingback M (1979) Colostomy closure: technique and morbidity. Aust N Z J Surg 49:363–368PubMedCrossRefGoogle Scholar
  26. 26.
    Chen F, Stuart M (1996) The morbidity of defunctioning stomata. Aust N Z J Surg 66:218–221PubMedCrossRefGoogle Scholar
  27. 27.
    Cingi A, Solmaz A, Attaallah W et al (2008) Enterostomy closure site hernias: a clinical and ultrasonographic evaluation. Hernia 12:401–405PubMedCrossRefGoogle Scholar
  28. 28.
    Edwards DP, Chisholm EM, Donaldson DR (1998) Closure of transverse loop colostomy and loop ileostomy. Ann R Coll Surg Engl 80:33–35PubMedGoogle Scholar
  29. 29.
    Dalmia S, Marimuthu K, Nagpal K et al (2005) Intestinal stomas: an analysis of 216 stomas. Brit J Surg 92(suppl 1):85Google Scholar
  30. 30.
    Fasth S, Hulten L (1984) Loop ileostomy: a superior diverting stoma in colorectal surgery. World J Surg 8:401–407. doi: 10.1007/BF01655089 PubMedCrossRefGoogle Scholar
  31. 31.
    Finch DR (1976) The results of colostomy closure. Br J Surg 63:397–399PubMedCrossRefGoogle Scholar
  32. 32.
    Guzmán Valdivia G (2008) Incisional hernia at the site of a stoma. Hernia 12:471–474PubMedCrossRefGoogle Scholar
  33. 33.
    Hasegawa H, Yoshioka K, Keighley MR (2000) Randomized trial of fecal diversion for sphincter repair. Dis Colon Rectum 43:961–964 discussion 964–965PubMedCrossRefGoogle Scholar
  34. 34.
    Hines JR, Harris GD (1977) Colostomy and colostomy closure. Surg Clin North Am 57:1379–1392PubMedGoogle Scholar
  35. 35.
    Kaiser AM, Israelit S, Klaristenfeld D et al (2008) Morbidity of ostomy takedown. J Gastrointest Surg 12:437–441PubMedCrossRefGoogle Scholar
  36. 36.
    Krand O, Yalti T, Berber I et al (2008) Early vs. delayed closure of temporary covering ileostomy: a prospective study. Hepatogastroenterology 55:142–145PubMedGoogle Scholar
  37. 37.
    Lewis P, Bartolo DC (1990) Closure of loop ileostomy after restorative proctocolectomy. Ann R Coll Surg Engl 72:263–265PubMedGoogle Scholar
  38. 38.
    Mala T, Nesbakken A (2008) Morbidity related to the use of a protective stoma in anterior resection for rectal cancer. Colorectal Dis 10:785–788PubMedCrossRefGoogle Scholar
  39. 39.
    Mealy K, O’Broin E, Donohue J et al (1996) Reversible colostomy: what is the outcome? Dis Colon Rectum 39:1227–1231PubMedCrossRefGoogle Scholar
  40. 40.
    Poon RT, Chu KW, Ho JW et al (1999) Prospective evaluation of selective defunctioning stoma for low anterior resection with total mesorectal excision. World J Surg 23:463–467. doi: 10.1007/PL00012331 discussion 467–468PubMedCrossRefGoogle Scholar
  41. 41.
    Rosen MJ, Cobb WS, Kercher KW et al (2005) Laparoscopic restoration of intestinal continuity after Hartmann’s procedure. Am J Surg 189:670–674PubMedCrossRefGoogle Scholar
  42. 42.
    Rutegard J, Dahlgren S (1987) Transverse colostomy or loop ileostomy as diverting stoma in colorectal surgery. Acta Chir Scand 153:229–232PubMedGoogle Scholar
  43. 43.
    Welten RJ, Jansen A, van de Pavoordt HD (1991) A future role for loop ileostomy in colorectal surgery? Neth J Surg 43:192–194PubMedGoogle Scholar
  44. 44.
    Winkler MJ, Volpe PA (1982) Loop transverse colostomy. The case against. Dis Colon Rectum 25:321–326PubMedCrossRefGoogle Scholar
  45. 45.
    Yakimets WW (1975) Complications of closure of loop colostomy. Can J Surg 18:366–370PubMedGoogle Scholar
  46. 46.
    Hasegawa H, Radley S, Morton DG et al (2000) Stapled versus sutured closure of loop ileostomy: a randomized controlled trial. Ann Surg 231:202–204PubMedCrossRefGoogle Scholar
  47. 47.
    Guzmán Valdivia G, Guzmán Valdivia E (1996) Inguinal hernia repair with flap of the anterior sheath of the rectus muscle: preliminary study. Surgery 120:560–562PubMedCrossRefGoogle Scholar
  48. 48.
    Rullier E, Goffre B, Bonnel C et al (2001) Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectum. Ann Surg 234:633–640PubMedCrossRefGoogle Scholar
  49. 49.
    Tam KW, Wei PL, Kuo LJ et al (2010) Systematic review of the use of a mesh to prevent parastomal hernia. World J Surg 34:2723–2729. doi: 10.1007/s00268-010-0739-2 PubMedCrossRefGoogle Scholar
  50. 50.
    Wijeyekoon SP, Gurusamy K, El-Gendy K et al (2010) Prevention of parastomal herniation with biologic/composite prosthetic mesh: a systematic review and meta-analysis of randomized controlled trials. J Am Coll Surg 211:637–645PubMedCrossRefGoogle Scholar
  51. 51.
    Cavallaro A, Lo Menzo E, Di Vita M et al (2010) Use of biological meshes for abdominal wall reconstruction in highly contaminated fields. World J Gastroenterol 16:1928–1933PubMedCrossRefGoogle Scholar
  52. 52.
    Hiles M, Record Ritchie RD, Altizer AM (2009) Are biologic grafts effective for hernia repair?: a systematic review of the literature. Surg Innov 16:26–37PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Aneel Bhangu
    • 1
  • Dmitri Nepogodiev
    • 1
  • Kaori Futaba
    • 1
  • West Midlands Research Collaborative
  1. 1.Academic Department of SurgeryWest Midlands Research CollaborativeEdgbaston, BirminghamUK

Personalised recommendations