Incidence and risk factors of delayed development for stoma site incisional hernia after ileostomy closure in patients undergoing colorectal surgery with temporary ileostomy.

Abstract

Background: Stoma site incisional hernias after ileostomy closure are complex hernias that can be associated with abdominal pain, discomfort, and a diminished quality of life. The aim of this study was to determine the incidence of incisional hernia (IH) following temporary ileostomy reversal in patients undergoing colorectal surgery, and the risk factors associated with its development. Methods: This was an observational study of patients undergoing ileostomy reversal between January 2010 and December 2016. Comorbidities, operative characteristics and postoperative complications were analysed. Bivariable and multivariable analyses were used to assess IH incidence and risk factors. Results: A total of 202 consecutive patients were prospectively evaluated (median follow-up 46 months; range: 12 - 109). Stoma site incisional hernia occurred in 23% of patients (n=47). The reasons for the primary surgery were colorectal cancer (n= 141, 69.8%), inflammatory bowel disease (n=14, 6.9%), emergency surgery (n=35, 17.3%), and other conditions (n=12, 5.9%). Statistically significant risk factors for developing an IH were obesity (higher BMI) (OR 1.15, 95% CI (1.05 – 1.26)). Other comorbidities such as diabetes, immunosuppression, and anaemia, as well as surgical technique variables, surgical wound infection and other post-surgical complications were not predictive of hernia. Conclusions: 23% of patients developed surgical site IH, a higher BMI being the only risk factor found to be statistically significant in the development of an incisional hernia.