Abstract
Background
Stomal site incisional hernia is a common complication following ileostomy closure. The effectiveness of prophylactic mesh placement at the time of stomal closure is unknown because of fear of mesh infection and subsequent wound complications. The present study investigated whether prophylactic mesh placement reduces the rate of incisional hernia after ileostomy closure without increasing wound complications. The study was based on retrospective review of consecutive ileostomy closures undertaken at a tertiary referral center between January 2007 and December 2011. Hernias were identified through clinical examination and computed tomography.
Results
Eighty-three cases of ileostomy closure were reviewed; 47 patients received mesh reinforcement, and 36 underwent non-mesh closure (controls). In total, 16 (19.3 %) patients developed incisional hernia, 13 (36.1 %) of which occurred in the control group; 3 (6.4 %), in the mesh group [odds ratio (OR): 8.29; 95 % confidence interval (CI) 2.14–32.08; p = 0.001]. Incisional hernia repair was performed in 3 (23 %) patients in the control group; no hernias in the mesh group required surgery. There was no significant difference in wound infection rates between mesh (2 patients, 4.3 %) and control (1 patient, 2.8 %) groups. No mesh infection was found. Multivariate analysis demonstrated that malignancy (OR: 21.93, 95 % CI 1.58–303.95; p = 0.021) and diabetes (OR: 20.98, 95 % CI 3.23–136.31; p = 0.001) independently predicted incisional herniation, while mesh reinforcement prevented hernia development (OR: 0.06, 95 % CI 0.01–0.36; p = 0.002).
Conclusions
Mesh placement significantly reduced the incidence of incisional hernia following ileostomy closure, but without increasing complication rates. This technique should be strongly considered in patients at high risk of hernia development.
Similar content being viewed by others
References
Bhangu A, Nepogodiev D, Futaba K (2012) Systematic review and meta-analysis of the incidence of incisional hernia at the site of stoma closure. World J Surg 36:973–983. doi:10.1007/s00268-012-1474-7
Cingi A, Cakir T, Sever A et al (2006) Enterostomy site hernias: a clinical and computerized tomographic evaluation. Dis Colon Rectum 49:1559–1563
Cingi A, Solmaz A, Attaallah W et al (2008) Enterostomy closure site hernias: a clinical and ultrasonographic evaluation. Hernia 12:401–405
Guzman-Valdivia G (2008) Incisional hernia at the site of a stoma. Hernia 12:471–474
Schreinemacher MH, Vijgen GH, Dagnelie PC et al (2011) Incisional hernias in temporary stoma wounds: a cohort study. Arch Surg 146:94–99
Haggar FA, Boushey RP (2009) Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg 22:191–197
Hamel MB, Henderson WG, Khuri SF et al (2005) Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc 53:424–429
McGugan E, Burton H, Nixon SJ et al (2000) Deaths following hernia surgery: room for improvement. J R Coll Surg Edinb 45:183–186
van Ramshorst GH, Nieuwenhuizen J, Hop WC et al (2010) Abdominal wound dehiscence in adults: development and validation of a risk model. World J Surg 34:20–27. doi:10.1007/s00268-009-0277-y
Riou JP, Cohen JR, Johnson H Jr (1992) Factors influencing wound dehiscence. Am J Surg 163:324–330
Arumugam PJ, Bevan L, Macdonald L et al (2003) A prospective audit of stomas: analysis of risk factors and complications and their management. Colorectal Dis 5:49–52
Sauerland S, Walgenbach M, Habermalz B et al (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 3:CD007781
Herbert GS, Tausch TJ, Carter PL (2009) Prophylactic mesh to prevent incisional hernia: a note of caution. Am J Surg 197:595–598 discussion 598
Curro G, Centorrino T, Musolino C et al (2011) Incisional hernia prophylaxis in morbidly obese patients undergoing biliopancreatic diversion. Obes Surg 21:1559–1563
Strzelczyk JM, Szymanski D, Nowicki ME et al (2006) Randomized clinical trial of postoperative hernia prophylaxis in open bariatric surgery. Br J Surg 93:1347–1350
Kelly ME, Behrman SW (2002) The safety and efficacy of prosthetic hernia repair in clean-contaminated and contaminated wounds. Am Surg 68:524–528 discussion 528–529
Birolini C, Utiyama EM, Rodrigues AJ et al (2000) Elective colonic operation and prosthetic repair of incisional hernia: does contamination contraindicate abdominal wall prosthesis use? J Am Coll Surg 191:366–372
Llaguna OH, Avgerinos DV, Nagda P et al (2011) Does prophylactic biologic mesh placement protect against the development of incisional hernia in high-risk patients? World J Surg 35:1651–1655. doi:10.1007/s00268-011-1131-6
Bevis PM, Windhaber RA, Lear PA et al (2010) Randomized clinical trial of mesh versus sutured wound closure after open abdominal aortic aneurysm surgery. Br J Surg 97:1497–1502
Janes A, Cengiz Y, Israelsson LA (2004) Randomized clinical trial of the use of a prosthetic mesh to prevent parastomal hernia. Br J Surg 91:280–282
Janes A, Cengiz Y, Israelsson LA (2009) Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study. World J Surg 33:118–121. doi:10.1007/s00268-008-9785-4 discussion 122–123
El-Khadrawy OH, Moussa G, Mansour O et al (2009) Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients. Hernia 13:267–274
Bhangu A, Fletcher L, Kingdon S et al (2012) A clinical and radiological assessment of incisional hernias following closure of temporary stomas. Surgeon 10:321–325
Pokorny H, Herkner H, Jakesz R et al (2005) Mortality and complications after stoma closure. Arch Surg 140:956–960 discussion 960
van de Pavoordt HD, Fazio VW, Jagelman DG et al (1987) The outcome of loop ileostomy closure in 293 cases. Int J Colorectal Dis 2:214–217
Sanchez-Manuel FJ, Lozano-Garcia J, Seco-Gil JL (2012) Antibiotic prophylaxis for hernia repair. Cochrane Database Syst Rev 2:CD003769
den Hartog D, Dur AH, Tuinebreijer WE et al (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev 3:CD006438
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Liu, D.S.H., Banham, E. & Yellapu, S. Prophylactic Mesh Reinforcement Reduces Stomal Site Incisional Hernia after Ileostomy Closure. World J Surg 37, 2039–2045 (2013). https://doi.org/10.1007/s00268-013-2109-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-013-2109-3