The Risk Factors for Parastomal Hernia Development: A 8-year Retrospective Study in Colorectal Surgery

Year 2023, Volume: 7 Issue: 2, 773 - 781, 31.05.2023

Tayfun Bişgin , Cahide Ayik , Deniz Cenan Berke Manoğlu , Dilek Özden , Selman Sökmen

https://doi.org/10.30621/jbachs.1223861

Abstract

Background: Although parastomal hernia is a common complication of ostomy surgery, the exact risk factors for its development remain unclear. The aim of this study was to determine the incidence and risk factors of parastomal hernia in ostomy patients.
Methods: A retrospective study was conducted. The data from a cohort of 952 ostomy patients' hospital records between 2013 and 2020 were extracted and analyzed. Patients’ ostomy-related characteristics, complication notes, and the occurrence of parastomal hernia were retrieved.
Results: The patients' mean age was 59.6 years (±14.4 years), and 524 (55%) of them were male. Colorectal cancer (476 patients,50%) was the most common etiology for surgery. Parastomal hernia developed in 100 (10.5%) of patients. Age >65 (OR=1.753; 95%CI=1.071-2.869), BMI >24.9 (OR=2.009; 95%CI=1.201-3.362), co-morbidity (OR=1.773; 95%CI=1.021-3.080), laparoscopic surgery (OR=5.643; 95%CI=3.113-10.230), height of ostomy (OR=1.906; 95%CI=1.122-3.236), left lower quadrant ostomy location (OR=2.252; 95%CI=1.319-3.845), prolapse (OR=7.876; 95%CI=3.571-17.372), and other ostomy-related complications (OR=2.888; 95%CI=1.179-7.074) were risk factors based on logistic regression analysis.
Conclusion: The incidence of parastomal hernia was nearly one in ten patients after colorectal surgery with an ostomy. Advanced age, co-morbidity, laparoscopic surgery, the height of the ostomy, the left lower quadrant ostomy location, prolapse, and other ostomy-related complications were independent risk factors.

Keywords

parastomal hernia, ostomy, stoma, colorectal surgery

References

• 1. Carne PW,Robertson GM, Frizelle FA. Parastomal hernia. Br J Surg 2003; 90:784-93.
• 2. Robertson I, Leung E, Hughes D, Spiers M, Donnelly L, Mackenzie I et al. Prospective analysis of stoma-related complications. Colorectal Dis 2005;7(3):279-285.
• 3. Antoniou SA, Agresta F, Garcia Alamino JM, Berger D, Berrevoet F, Brandsma HT et al. European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia 2018;22:183-198.
• 4. Kald A, Juul KN, Hjortsvang H, Sjödahl RI. Quality of life is impaired in patients with peristomal bulging of a sigmoid colostomy. Scand J Gastroenterol 2008;43:627-633.
• 5. Ripoche J, Basurko C, Fabbro-Perray P, Prudhomme M. Parastomal hernia: a study of the French Federation of Ostomy Patients. J Visc Surg 2011;148:e435-41.
• 6. Al Shakarchi J, Williams JG. Systematic review of opn techniques for parastomal hernia repair. Tech Coloproctol 2014;18:427-32.
• 7. Sohn YJ, Moon SM, Shin US, Jee SH. Incidence and risk factors of parastomal hernia. J Korean Soc Coloproctol 2012;28:241-246.
• 8. Hansson BM, Slater NJ, van der Velden AS, Groenewound HM, Buyne OR, de Hingh IH et al. Surgical techniques for parastomal hernia repair: a systematic review of the literature. Ann Surg 2012;255:685-95.
• 9. Helgstrand F, Rosenberg J, Kehlet H, Jorgensen LN, Wara P, Bisgaard T. Risk of morbidity, mortality, and recurrence after parastomal hernia repair: a nationwide study. Dis Colon Rectum 2013;56:1265-72.
• 10. Okorji LM, Kasten KR. Diagnosis and management of parastomal hernias. Dis Colon Rectum 2019;62:158-62.
• 11. Krishnamurty DM, Blatnik J, Mutch M. Stoma complications. Clin Colon Rectal Surg 2017; 30:193-200.
• 12. Serra-Aracil X, Bombardo-Junca J, Moreno-Matias J, Darnell A, Mora-Lopez L, Alcantara-Moral M, et al. Randomized, controlled, prospective trial of the use of a mesh to prevent parastomal hernia. Ann Surg 2009;249:583-587.
• 13. Jones HG, Rees M, Aboumarzouk OM, Brown J, Cragg J, Billings P, et al. Prosthetic mesh placement for the prevention of parastomal herniation. Cochrane Database Syst Rev 2018;7: CD008905.
• 14. Lopez –Borao J, Madrazo-Gonzalez Z, Kreisler E, Biondo S. Prevention of parastomal hernia after abdomino-perineal excision with a prophlactic three-dimensional funnel mesh. Colorectal Dis 2019;21:1326-1334.
• 15. Odensten C, Strigård K, Rutegård J, Dahlberg M, Ståhle U, Gunnarsson U, Näsvall P. Use of Prophylactic Mesh When Creating a Colostomy Does Not Prevent Parastomal Hernia: A Randomized Controlled Trial-STOMAMESH. Ann Surg 2019;269:427-431.
• 16. Funahashi K, Suzuki T, Nagashima Y, Matsuda S, Koike J, Shiokawa H, Ushigome M, Arai K, Kaneko T, Kurihara A, Kaneko H. Risk factors for parastomal hernia in Japanese patients with permanent colostomy. Surg Today 2014;44(8):1465-9.
• 17. Niu N, Du S, Yang D, Zhang L, Wu B, Zhi X, Li J, Xu D, Zhang Y, Meng A. Risk factors for the development of a parastomal hernia in patients with enterostomy: a systematic review and meta-analysis. Int J Colorectal Dis 2022;37(3):507-519.
• 18. Liu L, Zheng L, Zhang M, Hu J, Lu Y, Wang D. Incidence and risk factors for parastomal hernia with a permanent colostomy. J Surg Oncol 2022;126(3):535-543.
• 19. Shiraishi T, Nishizawa Y, Ikeda K, Tsukada Y, Sasaki T, Ito M. Risk factors for parastomal hernia of loop stoma and relationships with other stoma complications in laparoscopic surgery era. BMC Surg 2020;20(1):141.
• 20. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007 Oct 20;370(9596):1453-7.
• 21. Colwell JC, Beitz J. Survey of wound, ostomy and continence (WOC) nurse clinicians on stomal and peristomal complications: a content validation study. J Wound Ostomy Continence Nurs 2007;34(1):57-69.
• 22. Osborne W, North J, Williams J. Using a risk assessment tool for parastomal hernia prevention. Br J Nurs 2018;27(5):15-19.
• 23. Andersen RM, Klausen TW, Danielsen AK, Vinther A, Gögenur I, Thomsen T. Incidence and risk factors for parastomal bulging in patients with ileostomy or colostomy: a register-based study using data from the Danish Stoma Database Capital Region. Colorectal Dis 2018;20(4):331-340.
• 24. Pilgrim CH, McIntyre R, Bailey M. Prospective audit of parastomal hernia: prevalence and associated comorbidities. Dis Colon Rectum 2010;53(1):71-6.
• 25. Nagayoshi K, Nagai S, Hisano K, Mizuuchi Y, Fujita H, Nakamura M. Atrophic change of the abdominal rectus muscle significantly influences the onset of parastomal hernias beyond existing risk factors after end colostomy. Hernia 2021;25(1):141-148.
• 26. Pu YW, Yang XD, Gong W, Xing CG. Etiological analysis of parastomal hernia by computed tomography examination. Wideochir Inne Tech Maloinwazyjne 2019;14(3):387-393.
• 27. Kozan R, Gültekin FA. Controllable risk factor in the development of parastomal hernia; preoperative marking. Turk J Colorectal Dis 2018;28:172-176.
• 28. Zhu DY, Wang T, Zuo W. Clinical analysis on risk factors of the colostomy hernia after rectal cancer miles operations. Journal of Wenzhou Medical University 2015;45:372-375.
• 29. Pennings JP, Kwee TC, Hofman S, Viddeleer AR, Furnée EJB, van Ooijen PMA, de Haas RJ. Clinical and Radiologic Predictors of Parastomal Hernia Development After End Colostomy. AJR Am J Roentgenol 2021;216(1):94-103.
• 30. Smit M, Werner MJM, Lansink-Hartgring AO, Dieperink W, Zijlstra JG, van Meurs M. How central obesity influences intra-abdominal pressure: a prospective, observational study in cardiothoracic surgical patients. Ann Intensive Care 2016;6(1):99.
• 31. Kojima K, Nakamura T, Sato T, Matsubara Y, Naito M, Yamashita K, Watanabe M. Risk factors for parastomal hernia after abdominoperineal resection for rectal cancer. Asian J Endosc Surg 2017;10(3):276-281.
• 32. Randall J, Lord B, Fulham J, Soin B. Parastomal hernias as the predominant stoma complication after laparoscopic colorectal surgery. Surg Laparosc Endosc Percutan Tech 2012;22(5):420-3.
• 33. Ihnát P, Tulinský L, Jonszta T, Koscielnik P, Ihnát Rudinská L, Penka I. Parastomal and incisional hernia following laparoscopic/open abdominoperineal resection: is there a real difference? Surg Endosc 2019;33(6):1789-1794.
• 34. Meisner S, Lehur PA, Moran B, Martins L, Jemec GB. Peristomal skin complications are common, expensive, and difficult to manage: a population based cost modeling study. PLoS One 2012; 7(5):e37813.
• 35. Gooszen AW, Geelkerken RH, Hermans J, Lagaay MB, Gooszen HG. Temporary decompression after colorectal surgery: randomized comparison of loop ileostomy and loop colostomy. Br J Surg 1998;85(1):76-9.