Incidence and risk factors for incisional hernia after temporary loop ileostomy closure: choosing candidates for prophylactic mesh placement
- 27 Downloads
The primary aim of this study was to identify the incisional hernia rate after temporary loop ileostomy closure. Secondary outcomes were determining the risk factors linked to this incisional hernia, which could improve the patient selection for mesh prophylaxis.
Retrospective cohort study of all consecutive patients with temporary loop ileostomy reversal through a peristomal incision from 1st January 2011 to 1st January 2017 at our centre. Data were extracted from electronic clinical records: baseline patient characteristics, surgical factors and postoperative events. CT scans performed during follow-up were precisely analysed. Survival analysis was applied to identify risk factors for hernia development.
129 patients were analysed of whom 15 (11.6%) developed an incisional hernia at previous ileostomy site. The median time for incisional hernia development was 11 months (IQR = 7–21) and the median follow-up time was 37 months (IQR = 22–57). The identified patient risk factors for hernia development in survival analysis were female sex, older age, higher Body Mass Index, clinically significant parastomal hernia, clinically detectable midline incisional hernia and major postoperative complications ranked as Clavien–Dindo grade III and IV.
Incisional hernia after temporary loop ileostomy is a relevant problem that affects at least one in every ten patients. The previously cited risk factors might favour its development, therefore the use of a prophylactic mesh should be considered in those high-risk patients.
Compliance with ethical standards
Conflict of interest
Barranquero, Tobaruela, Bajawi, Muñoz, Die Trill, Garcia-Perez declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Committee (Comité de Ética de la Investigación con Medicamentos, 050-19 resolution) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Human and animal rights
This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all participants before ileostomy closure. Permission to omit the informed consent for analysis of the already available data was obtained from the Institutional Research Committee (050-19 resolution).
- 13.National Healthcare Safety Network, Centers for Disease Control and Prevention (2017) Surgical site infection (SSI) event. http://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accesed 1 Mar 2019
- 18.Camacho-Mauries D, Rodriguez-Díaz JL, Salgado-Nesme N, González QH, Vergara-Fernández O (2013) Randomized clinical trial of intestinal ostomy takedown comparing pursestring wound closure vs conventional closure to eliminate the risk of wound infection. Dis Colon Rectum 56(2):205–211CrossRefGoogle Scholar
- 19.Sureshkumar S, Jubel K, Ali MS et al (2018) Comparing surgical site infection and scar cosmesis between conventional linear skin closure versus purse-string skin closure in stoma reversal—a randomized controlled trial. Cureus 10(2):e2181Google Scholar
- 20.ClinicalTrials.gov (2019) Bethesda (MD): National Library of Medicine (US). Identifier: NCT02238964, Reinforcement of Closure of Stoma Site (ROCSS). https://clinicaltrials.gov/ct2/show/NCT02238964. Accessed 17 Mar 2019
- 21.ClinicalTrials.gov (2019) Bethesda (MD): National Library of Medicine (US). Identifier: NCT02226887, Prophylaxis of Ileostomy Closure Site Hernia by Placing Mesh (ILEOCLOSE). https://clinicaltrials.gov/ct2/show/NCT02226887. Accessed 17 Mar 2019