Abstract
Purpose
The incidence of incisional hernia (IH) at ileostomy closure site has not been sufficiently evaluated. Temporary loop ileostomy is routinely used in patients after low anterior resection for rectal cancer. The goal of this study was to compare the IH rates of standard suture skin closure and purse-string skin closure techniques.
Patients and methods
Patients undergoing ileostomy reversal and follow-up CT scan at the University Hospital Frankfurt between January 2009 and December 2015 were retrospectively analyzed regarding IH and associated risk factors. Patients received either direct stitch skin closure (group DC) or purse-string skin closure (group PS).
Results
In total, 111 patients underwent ileostomy reversal in the aforementioned period. In 88 patients, a CT scan was performed 12–24 months after ileostomy reversal for cancer follow-up. Median follow-up was 12 months. Median time interval between ileostoma formation and closure was 12 (± 4 SD) weeks. In 19 of 88 patients (21.5%), an IH was detected. The incidence of IH detected by CT scan was significantly lower in the PS group (n = 7, 12.9%) compared to the DC group (n = 12, 35.2%, p = 0.017).
Conclusions
This retrospective study shows an advantage of the purse-string skin closure technique in ileostomy reversals. The use of this technique for skin closure following ileostomy reversals is recommended to reduce the IH rates. Randomized controlled trials are needed to confirm these findings.
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References
Enker WE (1999) Mesorectal excision (TME) in the operative treatment of rectal cancer. Int J Surg Investig 1(3):253–255.
Kwiatt M, Kawata M (2013) Avoidance and management of stomal complications. Clin Colon Rectal Surg Thieme Medical Publishers 26(2):112–121.
Bhangu A, Fletcher L, Kingdon S, Smith E, Nepogodiev D, Janjua U (2012) A clinical and radiological assessment of incisional hernias following closure of temporary stomas. Surgeon Elsevier 10(6):321–325.
De Keersmaecker G, Beckers R, Heindryckx E, Kyle-Leinhase I, Pletinckx P, Claeys D et al (2016) Retrospective observational study on the incidence of incisional hernias after reversal of a temporary diverting ileostomy following rectal carcinoma resection with follow-up CT scans. Hernia 20(2):271–277.
Liu DSH, Banham E, Yellapu S (2013) Prophylactic mesh reinforcement reduces stomal site incisional hernia after ileostomy closure. World J Surg 37(9):2039–2045.
Banerjee A (1997) Pursestring skin closure after stoma reversal. Dis Colon Rectum 40(8):993–994
Habbe N, Hannes S, Liese J, Woeste G, Bechstein WO, Strey C (2014) The use of purse-string skin closure in loop ileostomy reversals leads to lower wound infection rates—a single high-volume centre experience. Int J Color Dis 29(6):709–714.
Mirbagheri N, Dark J, Skinner S (2013) Factors predicting stomal wound closure infection rates. Tech Coloproctol 17(2):215–220.
Kaidar-Person O, Person B, Wexner SD (2005) Complications of construction and closure of temporary loop ileostomy. J Am Coll Surg 201(5):759–773.
Bhangu A, Nepogodiev D, Futaba K, Collaborative WMR (2012) Systematic review and meta-analysis of the incidence of incisional hernia at the site of stoma closure. World J Surg 36(5):973–983.
Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D, de Beaux AC, Deerenberg EB, East B, Fortelny RH, Gillion JF, Henriksen NA, Israelsson L, Jairam A, Jänes A, Jeekel J, López-Cano M, Miserez M, Morales-Conde S, Sanders DL, Simons MP, Śmietański M, Venclauskas L, Berrevoet F, European Hernia Society (2015) European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 19(1):1–24.
Guzman-Valdivia G (2008) Incisional hernia at the site of a stoma. Hernia 12(5):471–474.
Cingi A, Solmaz A, Attaallah W, Aslan A, Aktan AO (2008) Enterostomy closure site hernias: a clinical and ultrasonographic evaluation. Hernia 12(4):401–405.
Schreinemacher MHF, Vijgen GHEJ, Dagnelie PC, Bloemen JG, Huizinga BF, Bouvy ND (2011) Incisional hernias in temporary stoma wounds: a cohort study. Arch Surg 146(1):94–99.
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Juratli, M.A., Nour-Eldin, NE.A., Ackermann, H. et al. Purse-string closure technique reduces the incidence of incisional hernias following the reversal of temporary ileostomy. Int J Colorectal Dis 33, 973–977 (2018). https://doi.org/10.1007/s00384-018-2986-x
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DOI: https://doi.org/10.1007/s00384-018-2986-x