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Objective: Evaluate the incidence of ostomy site incisional hernias after stoma reversal and to determine any significant risk factors that might lead to such hernias.
Design: Single institution retrospective analysis from 2001-2011.
Setting: Tertiary care academic medical center.
Patients: 401 patients included. The following demographics were considered: age, gender, indication for stoma, urgent versus elective operation, time to closure, total follow-up time, the incidence of and reoperation for stoma incisional hernia, diabetes, postoperative wound infection, smoking status within 6 months of surgery, and any immunosuppressive medications.
Interventions: Chart review.
Main Outcome Measures: Incidence of hernia, percentage requiring operative intervention.
Results: Females comprised 42% (170/401) and males 58% (231/401). Elective cases made up 68% (276/401), urgent cases 32% (125/401). Loop ileostomies comprised 70% (281/401), end ileostomies 6% (24/401), loop colostomies 12% (51/401), end colostomies 12% (45/401). Diagnoses were: cancer 26.8%, diverticular disease 13.6%, inflammatory bowel disease 38.2%, and other (including trauma and mesenteric ischemia) 21.4%. Median time to stoma closure was 5 months. Median follow-up time was 20 months. The clinical hernia rate was 19%. Significant risk factors for hernia development (p-value <0.05) were diabetes (RR 1.96), smoking within 6 months of surgery (RR 2.01), end colostomies (RR 3.55), and undergoing an urgent operation (RR 1.85). The median time to clinical hernia detection was 11 months. Sixty-four percent of patients required surgical repair of their stoma incisional hernia.
Conclusions: Nineteen percent of patients undergoing stoma closure developed an incisional hernia. Sixty four percent of these patients required definitive hernia repair. Diabetes, smoking within 6 months of surgery, end colostomies, and undergoing an urgent operation were significant risk factors for the development of stoma site incisional hernias.