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Surgery Today

08-05-2024 | Incisional Hernia | Original Article

Increased risk of incisional hernia after stoma closure in patients with colorectal cancer

Authors: Naoki Takada, Yasuhiro Takano, Atsuko Okamoto, Takafumi Nakano, Yuta Imaizumi, Hiroshi Sugano, Yasuhiro Takeda, Masahisa Ohkuma, Makoto Kosuge, Ken Eto

Published in: Surgery Today

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Abstract

Purpose

Stoma construction and closure are common surgical strategies in patients with colorectal cancer. The present study evaluated the influence of multiple incisional sites resulting from stoma closure on incisional hernia after colorectal cancer surgery.

Methods

The study included 1681 patients who underwent colorectal cancer surgery. Multiple incisional sites were defined as the coexistence of incisions at the midline and stoma closure sites. We retrospectively investigated the relationship between the presence of multiple incisional sites and incisional hernia development in patients with colorectal cancer.

Results

Among the 1681 patients, 420 (25%) underwent stoma construction, with a stoma closure-to-construction ratio of 33% (139/420), and 155 (9.2%) developed incisional hernias after colorectal cancer surgery. In the multivariate analysis, female sex (p < 0.001), body mass index (p < 0.001), multiple incisional sites (p = 0.001), wound infection (p = 0.003), and postoperative chemotherapy (p = 0.030) were independent predictors of incisional hernia. In the multiple incisional sites group, the age (p < 0.001), surgical approach (laparoscopic) (p = 0.013), wound infection rate (p = 0.046), small bowel obstruction rate (p < 0.001), and anastomotic leakage rate (p = 0.008) were higher in those in the single incisional site group.

Conclusions

Multiple incisional sites resulting from stoma closure are associated with the development of incisional hernia following colorectal cancer surgery.
Literature
1.
Ando Y, Takahashi A, Fujii M, Hasegawa H, Kimura T, Yamamoto H, et al. Survey regarding gastrointestinal stoma construction and closure in Japan. Ann Gastroenterol Surg. 2022;6:212–26.CrossRefPubMed
2.
Yamada T, Okabayashi K, Hasegawa H, Tsuruta M, Abe Y, Ishida T, et al. Age, preoperative subcutaneous fat area, and open laparotomy are risk factors for incisional hernia following colorectal cancer surgery. Ann Surg Oncol. 2016;23(Suppl 2):S236–41.CrossRefPubMed
3.
4.
Burger JW, Lange JF, Halm JA, Kleinrensink GJ, Jeekel H. Incisional hernia: early complication of abdominal surgery. World J Surg. 2005;29:1608–13.CrossRefPubMed
5.
Jensen KK, Krarup PM, Scheike T, Jorgensen LN, Mynster T. Incisional hernias after open versus laparoscopic surgery for colonic cancer: a nationwide cohort study. Surg Endosc. 2016;30:4469–79.CrossRefPubMed
6.
Skipworth JR, Khan Y, Motson RW, Arulampalam TH, Engledow AH. Incisional hernia rates following laparoscopic colorectal resection. Int J Surg. 2010;8:470–3.CrossRefPubMed
7.
Mudge M, Hughes LE. Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg. 1985;72:70–1.CrossRefPubMed
8.
Yahchouchy-Chouillard E, Aura T, Picone O, Etienne JC, Fingerhut A. Incisional hernias. I. Related risk factors. Dig Surg. 2003;20:3–9.CrossRefPubMed
9.
Fukuoka H, Watanabe J, Masanori O, Suwa Y, Suwa H, Ishibe A, et al. The risk factors for incisional hernia after laparoscopic colorectal surgery: a multicenter retrospective study at Yokohama Clinical Oncology Group. Surg Endosc. 2021;35:3471–8.CrossRefPubMed
10.
Veld J, Umans D, van Halsema E, Amelung F, Fernandes D, Lee MS, et al. Self-expandable metal stent (SEMS) placement or emergency surgery as palliative treatment for obstructive colorectal cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol. 2020;155: 103110.CrossRefPubMed
11.
Ahmad NZ, Abbas MH, Khan SU, Parvaiz A. A meta-analysis of the role of diverting ileostomy after rectal cancer surgery. Int J Colorectal Dis. 2021;36:445–55.CrossRefPubMed
12.
Yao H, An Y, Zhang Z. The application of defunctioning stomas after low anterior resection of rectal cancer. Surg Today. 2019;49:451–9.CrossRefPubMed
13.
Kaneko T, Funahashi K, Ushigome M, Kagami S, Goto M, Koda T, et al. Incidence of and risk factors for incisional hernia after closure of temporary ileostomy for colorectal malignancy. Hernia. 2019;23:743–8.CrossRefPubMed
14.
Millbourn D, Wimo A, Israelsson LA. Cost analysis of the use of small stitches when closing midline abdominal incisions. Hernia. 2014;18:775–80.CrossRefPubMed
15.
Saijo F, Tokumura H, Narushima Y, Matsumura N, Sato K, Okazaki Y. The quality of life after laparoscopic ventral and incisional hernia repair with closure and non-closure of fascial defect. Surg Today. 2019;49:942–7.CrossRefPubMed
16.
Sadava EE, Kerman Cabo J, Carballo FH, Bun ME, Rotholtz NA. Incisional hernia after laparoscopic colorectal surgery. Is there any factor associated? Surg Endosc. 2014;28:3421–4.CrossRefPubMed
17.
Jairam AP, Timmermans L, Eker HH, Pierik R, van Klaveren D, Steyerberg EW, et al. Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement versus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomised controlled trial. Lancet. 2017;390:567–76.CrossRefPubMed
18.
Mingoli A, Puggioni A, Sgarzini G, Luciani G, Corzani F, Ciccarone F, et al. Incidence of incisional hernia following emergency abdominal surgery. Ital J Gastroenterol Hepatol. 1999;31:449–53.PubMed
19.
Walming S, Angenete E, Block M, Bock D, Gessler B, Haglind E. Retrospective review of risk factors for surgical wound dehiscence and incisional hernia. BMC Surg. 2017;17:19.CrossRefPubMedPubMedCentral
20.
Murray BW, Cipher DJ, Pham T, Anthony T. The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery. Am J Surg. 2011;202:558–60.CrossRefPubMed
21.
Yamamoto M, Takakura Y, Ikeda S, Itamoto T, Urushihara T, Egi H. Visceral obesity is a significant risk factor for incisional hernia after laparoscopic colorectal surgery: a single-center review. Asian J Endosc Surg. 2018;11:373–7.CrossRefPubMed
22.
Söderbäck H, Gunnarsson U, Hellman P, Sandblom G. Incisional hernia after surgery for colorectal cancer: a population-based register study. Int J Colorectal Dis. 2018;33:1411–7.CrossRefPubMedPubMedCentral
23.
Esser N, Legrand-Poels S, Piette J, Scheen AJ, Paquot N. Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes. Diabetes Res Clin Pract. 2014;105:141–50.CrossRefPubMed
24.
25.
Kawai T, Autieri MV, Scalia R. Adipose tissue inflammation and metabolic dysfunction in obesity. Am J Physiol Cell Physiol. 2021;320:C375–91.CrossRefPubMed
26.
Takano Y, Kodera K, Tsukihara S, Takahashi S, Yasunobu K, Kanno H, et al. The impact of sarcobesity on incisional hernia after laparoscopic colorectal cancer surgery. Int J Colorectal Dis. 2023;38:124.CrossRefPubMed
27.
European Society of Coloproctology (ESCP) collaborating group. Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi-centre, prospective audit. Colorectal Dis. 2018;20(Suppl 6):15–32.CrossRef
28.
Itatsu K, Yokoyama Y, Sugawara G, Kubota H, Tojima Y, Kurumiya Y, et al. Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg. 2014;101:1439–47.CrossRefPubMed
29.
Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J (Clin Res Ed). 1982;284:931–3.CrossRefPubMed
30.
Santos DA, Zhang L, Do KA, Bednarski BK, Robinson Ledet C, Limmer A, et al. Chemotherapy and abdominal wall closure technique increase the probability of postoperative ventral incisional hernia in patients with colon cancer. Am Surg. 2023;89:98–107.CrossRefPubMed
31.
Lee L, Abou-Khalil M, Liberman S, Boutros M, Fried GM, Feldman LS. Incidence of incisional hernia in the specimen extraction site for laparoscopic colorectal surgery: systematic review and meta-analysis. Surg Endosc. 2017;31:5083–93.CrossRefPubMed
Metadata
Title
Increased risk of incisional hernia after stoma closure in patients with colorectal cancer
Authors
Naoki Takada
Yasuhiro Takano
Atsuko Okamoto
Takafumi Nakano
Yuta Imaizumi
Hiroshi Sugano
Yasuhiro Takeda
Masahisa Ohkuma
Makoto Kosuge
Ken Eto
Publication date
08-05-2024
Publisher
Springer Nature Singapore
Published in
Surgery Today
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-024-02866-2