Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 5/2012

01-05-2012

Systematic Review and Meta-analysis of the Incidence of Incisional Hernia at the Site of Stoma Closure

Authors: Aneel Bhangu, Dmitri Nepogodiev, Kaori Futaba, West Midlands Research Collaborative

Published in: World Journal of Surgery | Issue 5/2012

Login to get access

Abstract

Background

The incidence of incisional hernias at the site of stoma closure is surprisingly unclear. A review of the current literature was undertaken to determine how commonly this complication may occur and to assess the quality of evidence available.

Methods

A systematic review was performed to identify studies reporting the incidence of incisional hernia after closure of an ileostomy or colostomy. Studies including children (<16 years old) and studies in which >10% of the total number were trauma patients were excluded.

Results

Thirty-four studies provided outcomes for 2,729 closed stomas. Median follow-up time was 36 months but was only described in seven studies. Closure of loop ileostomies was the most commonly performed procedure (48%). The overall reported hernia rate was 7%, but with a wide range among studies (0–48%). Most studies based their hernia rates on retrospective clinical findings only. A separate analysis of three studies that were specifically designed to assess for stoma site hernias found the clinical hernia rate to be 30% (28/93) and the combined clinical/radiological hernia rate to be 35% (33/93). From 11 studies reporting reoperation rates, 51% of patients who developed a hernia required a surgical repair (34/66). There was a lower risk of hernia following reversal of ileostomy versus colostomy (odds ratio 0.28, 95% confidence interval 0.12–0.65).

Conclusions

One in three patients may develop a hernia after stoma closure, and around half of hernias that are detected require repair. Risk of hernia is greater after colostomy closure than after ileostomy closure. Clinical measures to reduce the development of these hernias warrant consideration.
Literature
1.
Saha AK, Tapping CR, Foley GT et al (2009) Morbidity and mortality after closure of loop ileostomy. Colorectal Dis 11:866–871PubMedCrossRef
2.
Giannakopoulos GF, Veenhof AA, van der Peet DL et al (2009) Morbidity and complications of protective loop ileostomy. Colorectal Dis 11:609–612PubMedCrossRef
3.
4.
Edwards DP, Leppington-Clarke A, Sexton R et al (2001) Stoma-related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomized clinical trial. Br J Surg 88:360–363PubMedCrossRef
5.
Garcia-Botello SA, Garcia-Armengol J, Garcia-Granero E et al (2004) A prospective audit of the complications of loop ileostomy construction and takedown. Dig Surg 21:440–446PubMedCrossRef
6.
Kaidar-Person O, Person B, Wexner SD (2005) Complications of construction and closure of temporary loop ileostomy. J Am Coll Surg 201:759–773PubMedCrossRef
7.
Chow A, Tilney HS, Paraskeva P et al (2009) The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis 24:711–723PubMedCrossRef
8.
9.
Bakx R, Busch OR, Bemelman WA et al (2004) Morbidity of temporary loop ileostomies. Dig Surg 21:277–281PubMedCrossRef
10.
Rondelli F, Reboldi P, Rulli A et al (2009) Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis 24:479–488PubMedCrossRef
11.
Guenaga KF, Lustosa SA, Saad SS et al (2007) Ileostomy or colostomy for temporary decompression of colorectal anastomosis. Cochrane Database Syst Rev 1:CD004647PubMed
12.
13.
Martin L, Foster G (1996) Parastomal hernia. Ann R Coll Surg Engl 78:81–84PubMed
14.
Rubin MS, Schoetz DJ Jr, Matthews JB (1994) Parastomal hernia. Is stoma relocation superior to fascial repair? Arch Surg 129:413–418 discussion 418–419PubMedCrossRef
15.
Cheung MT, Chia NH, Chiu WY (2001) Surgical treatment of parastomal hernia complicating sigmoid colostomies. Dis Colon Rectum 44:266–270PubMedCrossRef
16.
Cingi A, Cakir T, Sever A et al (2006) Enterostomy site hernias: a clinical and computerized tomographic evaluation. Dis Colon Rectum 49:1559–1563PubMedCrossRef
17.
Harbour R, Miller J (2001) A new system for grading recommendations in evidence based guidelines. BMJ 323(7308):334–336PubMedCrossRef
18.
Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700PubMedCrossRef
19.
Thomson JP, Hawley PR (1972) Results of closure of loop transverse colostomies. Br Med J 3(5824):459–462PubMedCrossRef
20.
Rullier E, Le Toux N, Laurent C et al (2001) Loop ileostomy versus loop colostomy for defunctioning low anastomoses during rectal cancer surgery. World J Surg 25:274–277. doi:10.​1007/​s002680020091 discussion 277–278PubMedCrossRef
21.
Porter JA, Salvati EP, Rubin RJ et al (1989) Complications of colostomies. Dis Colon Rectum 32:299–303PubMedCrossRef
22.
Perry GJ, Payne JE, Chapuis PH et al (1983) Complications in colostomy closure. J R Coll Surg Edinb 28:174–177PubMed
23.
Jarrett LN, Balfour TW, Bourke JB (1977) Mortality and morbidity in transverse loop colostomy closure. J R Coll Surg Edinb 22:208–213PubMed
24.
Amin SN, Memon MA, Armitage NC et al (2001) Defunctioning loop ileostomy and stapled side-to-side closure has low morbidity. Ann R Coll Surg Engl 83:246–249PubMed
25.
Chapius P, Killingback M (1979) Colostomy closure: technique and morbidity. Aust N Z J Surg 49:363–368PubMedCrossRef
26.
27.
Cingi A, Solmaz A, Attaallah W et al (2008) Enterostomy closure site hernias: a clinical and ultrasonographic evaluation. Hernia 12:401–405PubMedCrossRef
28.
Edwards DP, Chisholm EM, Donaldson DR (1998) Closure of transverse loop colostomy and loop ileostomy. Ann R Coll Surg Engl 80:33–35PubMed
29.
Dalmia S, Marimuthu K, Nagpal K et al (2005) Intestinal stomas: an analysis of 216 stomas. Brit J Surg 92(suppl 1):85
30.
31.
32.
33.
Hasegawa H, Yoshioka K, Keighley MR (2000) Randomized trial of fecal diversion for sphincter repair. Dis Colon Rectum 43:961–964 discussion 964–965PubMedCrossRef
34.
Hines JR, Harris GD (1977) Colostomy and colostomy closure. Surg Clin North Am 57:1379–1392PubMed
35.
Kaiser AM, Israelit S, Klaristenfeld D et al (2008) Morbidity of ostomy takedown. J Gastrointest Surg 12:437–441PubMedCrossRef
36.
Krand O, Yalti T, Berber I et al (2008) Early vs. delayed closure of temporary covering ileostomy: a prospective study. Hepatogastroenterology 55:142–145PubMed
37.
Lewis P, Bartolo DC (1990) Closure of loop ileostomy after restorative proctocolectomy. Ann R Coll Surg Engl 72:263–265PubMed
38.
Mala T, Nesbakken A (2008) Morbidity related to the use of a protective stoma in anterior resection for rectal cancer. Colorectal Dis 10:785–788PubMedCrossRef
39.
Mealy K, O’Broin E, Donohue J et al (1996) Reversible colostomy: what is the outcome? Dis Colon Rectum 39:1227–1231PubMedCrossRef
40.
Poon RT, Chu KW, Ho JW et al (1999) Prospective evaluation of selective defunctioning stoma for low anterior resection with total mesorectal excision. World J Surg 23:463–467. doi:10.​1007/​PL00012331 discussion 467–468PubMedCrossRef
41.
Rosen MJ, Cobb WS, Kercher KW et al (2005) Laparoscopic restoration of intestinal continuity after Hartmann’s procedure. Am J Surg 189:670–674PubMedCrossRef
42.
Rutegard J, Dahlgren S (1987) Transverse colostomy or loop ileostomy as diverting stoma in colorectal surgery. Acta Chir Scand 153:229–232PubMed
43.
Welten RJ, Jansen A, van de Pavoordt HD (1991) A future role for loop ileostomy in colorectal surgery? Neth J Surg 43:192–194PubMed
44.
Winkler MJ, Volpe PA (1982) Loop transverse colostomy. The case against. Dis Colon Rectum 25:321–326PubMedCrossRef
45.
Yakimets WW (1975) Complications of closure of loop colostomy. Can J Surg 18:366–370PubMed
46.
Hasegawa H, Radley S, Morton DG et al (2000) Stapled versus sutured closure of loop ileostomy: a randomized controlled trial. Ann Surg 231:202–204PubMedCrossRef
47.
Guzmán Valdivia G, Guzmán Valdivia E (1996) Inguinal hernia repair with flap of the anterior sheath of the rectus muscle: preliminary study. Surgery 120:560–562PubMedCrossRef
48.
Rullier E, Goffre B, Bonnel C et al (2001) Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectum. Ann Surg 234:633–640PubMedCrossRef
49.
50.
Wijeyekoon SP, Gurusamy K, El-Gendy K et al (2010) Prevention of parastomal herniation with biologic/composite prosthetic mesh: a systematic review and meta-analysis of randomized controlled trials. J Am Coll Surg 211:637–645PubMedCrossRef
51.
Cavallaro A, Lo Menzo E, Di Vita M et al (2010) Use of biological meshes for abdominal wall reconstruction in highly contaminated fields. World J Gastroenterol 16:1928–1933PubMedCrossRef
52.
Hiles M, Record Ritchie RD, Altizer AM (2009) Are biologic grafts effective for hernia repair?: a systematic review of the literature. Surg Innov 16:26–37PubMedCrossRef
Metadata
Title
Systematic Review and Meta-analysis of the Incidence of Incisional Hernia at the Site of Stoma Closure
Authors
Aneel Bhangu
Dmitri Nepogodiev
Kaori Futaba
West Midlands Research Collaborative
Publication date
01-05-2012
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 5/2012
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-012-1474-7

Other articles of this Issue 5/2012

World Journal of Surgery 5/2012 Go to the issue

OriginalPaper

Risk Associated with Bilobectomy after Neoadjuvant Concurrent Chemoradiotherapy for Stage IIIA-N2 Non-small-cell Lung Cancer

Invited Commentary

Case-based Learning for Patient Safety: The Lessons Learnt Program for UK Junior Doctors

OriginalPaper

Treatment of Necrotizing Pancreatitis: Redefining the Role of Surgery

OriginalPaper

Somatostatin Analogues for the Treatment of Enterocutaneous Fistulas: A Systematic Review and Meta-analysis

OriginalPaper

Cancer Stem Cell Marker Bmi-1 Expression is Associated with Basal-like Phenotype and Poor Survival in Breast Cancer

Letter

Comparison Between Laparoscopy and Noninvasive Tests for the Diagnosis of Tuberculous Peritonitis: Reply