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Risk factors associated to incisional hernia in stoma site after stoma closure: A systematic review and meta-analysis

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Abstract

Background

This study aims to identify which risk factors are associated with the appearance of an incisional hernia in a stoma site after its closure. This in the sake of identifying which patients would benefit from a preventative intervention and thus start implementing a cost-effective protocol for prophylactic mesh placement in high-risk patients.

Methods

A systematic review of PubMed, Cochrane library, and ScienceDirect was performed according to PRISMA guidelines. Studies reporting incidence, risk factors, and follow-up time for appearance of incisional hernia after stoma site closure were included. A fixed-effects and random effects models were used to calculate odds ratios’ estimates and standardized mean values with their respective grouped 95% confidence interval. This to evaluate the association between possible risk factors and the appearance of incisional hernia after stoma site closure.

Results

Seventeen studies totaling 2899 patients were included. Incidence proportion between included studies was of 16.76% (CI95% 12.82; 21.62). Out of the evaluated factors higher BMI (p = 0.0001), presence of parastomal hernia (p = 0.0023), colostomy (p = 0,001), and end stoma (p = 0.0405) were associated with the appearance of incisional hernia in stoma site after stoma closure, while malignant disease (p = 0.0084) and rectum anterior resection (p = 0.0011) were found to be protective factors.

Conclusions

Prophylactic mesh placement should be considered as an effective preventative intervention in high-risk patients (obese patients, patients with parastomal hernia, colostomy, and end stoma patients) with the goal of reducing incisional hernia rates in stoma site after closure while remaining cost-effective.

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Availability of data and materials

The data used in the present study are available upon request to the corresponding author.

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Authors and Affiliations

  1. Hospital Universitario Mayor-Méderi, Bogotá, Colombia

    Camilo Ramírez-Giraldo, Danny Conde Monroy, Jorge Navarro-Alean, Daniela Hernández-Álvarez, Susana Rojas-López & Violeta Avendaño-Morales

  2. Universidad del Rosario, Bogotá, Colombia

    Camilo Ramírez-Giraldo, Isabella Van-Londoño, Danny Conde Monroy, Jorge Navarro-Alean, Juliana Hernández-Ferreira & Susana Rojas-López

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  1. Camilo Ramírez-Giraldo
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Contributions

CR-G: Study conception and design, acquisition of data, data analysis and interpretation, drafting of manuscript, critical revision of manuscript. IV-L: Data analysis and interpretation, drafting of manuscript, critical revision of manuscript. DCM: Analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. JN-A: Study conception and design, data acquisition, critical revision of manuscript. JH-F: Study conception and design, data acquisition, critical revision of manuscript. DH-Á: Study conception and design, data acquisition, critical revision of manuscript. SRL: Drafting of manuscript and critical revision of manuscript. VA: Data analysis, drafting of manuscript and critical revision of manuscript.

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Correspondence to Camilo Ramírez-Giraldo.

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Ramírez-Giraldo, C., Van-Londoño, I., Monroy, D.C. et al. Risk factors associated to incisional hernia in stoma site after stoma closure: A systematic review and meta-analysis. Int J Colorectal Dis 38, 267 (2023). https://doi.org/10.1007/s00384-023-04560-0

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