Skip to main content
Top
Published in: International Journal of Colorectal Disease 7/2019

Open Access 01-07-2019 | Obesity | Original Article

Parastomal hernias causing symptoms or requiring surgical repair after colorectal cancer surgery—a national population-based cohort study

Authors: Mathilda Tivenius, Pia Näsvall, Gabriel Sandblom

Published in: International Journal of Colorectal Disease | Issue 7/2019

Login to get access

Abstract

Purpose

Parastomal hernia is a complication with high morbidity that affects the patient’s quality of life. The aim of this study was to assess the cumulative incidence of parastomal hernia in patients who have undergone colorectal cancer surgery and to identify potential risk factors that could predispose to the development of this type of hernia in a large population-based cohort over a long follow-up period.

Methods

The Swedish Colorectal Cancer Registry and the National Patient Register were used to collect study cohort data between January 2007 and September 2013. All patients undergoing colorectal cancer surgery including a permanent stoma were included in the study group.

Results

A total of 39,984 patients were registered during the study period. Of these, 7649 received a permanent stoma. Multivariate proportional hazard analysis, based on 6329 patients for whom all covariates could be retrieved, showed that the only independent risk factor for developing a parastomal hernia was BMI ≥ 30 (HR 1.49; 95% CI 1.02–2.17; p < 0.037). A slightly elevated hazard ratio was found for preoperative radiotherapy (HR 1.36; 95% CI 0.96–1.91; p < 0.070). The cumulative incidence of patients diagnosed or surgically treated for parastomal hernia over a follow-up period of 5 years was 7.7% (95% CI 6.1–9.2%).

Conclusions

The cumulative incidence of parastomal hernia causing symptoms or requiring surgery after 5 years was at least 7.7%. Obesity increases the risk of developing parastomal hernia.
Literature
1.
go back to reference Näsvall P, Dahlstrand U, Löwenmark T, Rutegård J, Gunnarsson U, Strigård K (2017) Quality of life in patients with a permanent stoma after rectal cancer surgery. Qual Life Res 26:55–64CrossRefPubMed Näsvall P, Dahlstrand U, Löwenmark T, Rutegård J, Gunnarsson U, Strigård K (2017) Quality of life in patients with a permanent stoma after rectal cancer surgery. Qual Life Res 26:55–64CrossRefPubMed
2.
go back to reference van Dijk SM, Timmermans L, Deerenberg EB, Lamme B, Kleinrensink GJ, Jeekel J, Lange JF (2015) Parastomal hernia: impact on quality of life? World J Surg 39:2595–2601CrossRefPubMed van Dijk SM, Timmermans L, Deerenberg EB, Lamme B, Kleinrensink GJ, Jeekel J, Lange JF (2015) Parastomal hernia: impact on quality of life? World J Surg 39:2595–2601CrossRefPubMed
3.
go back to reference Ripoche J, Basurko C, Fabbro-Perray P, Prudhomme M (2011) Parastomal hernia. A study of the French federation of ostomy patients. J Visc Surg 148:e435–e441CrossRefPubMed Ripoche J, Basurko C, Fabbro-Perray P, Prudhomme M (2011) Parastomal hernia. A study of the French federation of ostomy patients. J Visc Surg 148:e435–e441CrossRefPubMed
5.
go back to reference Śmietański M, Szczepkowski M, Alexandre JA, Berger D, Bury K, Conze J, Hansson B, Janes A, Miserez M, Mandala V, Montgomery A, Morales Conde S, Muysoms F (2014) European hernia society classification of parastomal hernias. Hernia 18:1–6CrossRefPubMed Śmietański M, Szczepkowski M, Alexandre JA, Berger D, Bury K, Conze J, Hansson B, Janes A, Miserez M, Mandala V, Montgomery A, Morales Conde S, Muysoms F (2014) European hernia society classification of parastomal hernias. Hernia 18:1–6CrossRefPubMed
6.
go back to reference Londono-Schimmer EE, Leong AP, Phillips RK (1994) Life table analysis of stomal complications following colostomy. Dis Colon Rectum 37:916–920CrossRefPubMed Londono-Schimmer EE, Leong AP, Phillips RK (1994) Life table analysis of stomal complications following colostomy. Dis Colon Rectum 37:916–920CrossRefPubMed
7.
go back to reference North J (2014) Early intervention, parastomal hernia and quality of life: a research study. Br J Nurs 23(Suppl 5):S14–S18CrossRefPubMed North J (2014) Early intervention, parastomal hernia and quality of life: a research study. Br J Nurs 23(Suppl 5):S14–S18CrossRefPubMed
9.
go back to reference Jänes A, Weisby L, Israelsson LA (2011) Parastomal hernia: clinical and radiological definitions. Hernia 15:189–192CrossRefPubMed Jänes A, Weisby L, Israelsson LA (2011) Parastomal hernia: clinical and radiological definitions. Hernia 15:189–192CrossRefPubMed
10.
go back to reference Gurmu A, Gunnarsson U, Strigård K (2011) Imaging of parastomal hernia using three-dimensional intrastomal ultrasonography. Br J Surg 98:1026–1029CrossRefPubMed Gurmu A, Gunnarsson U, Strigård K (2011) Imaging of parastomal hernia using three-dimensional intrastomal ultrasonography. Br J Surg 98:1026–1029CrossRefPubMed
11.
go back to reference Gurmu A, Matthiessen P, Nilsson S, Påhlman L, Rutegård J, Gunnarsson U (2011) The inter-observer reliability is very low at clinical examination of parastomal hernia. Int J Color Dis 26:89–95CrossRef Gurmu A, Matthiessen P, Nilsson S, Påhlman L, Rutegård J, Gunnarsson U (2011) The inter-observer reliability is very low at clinical examination of parastomal hernia. Int J Color Dis 26:89–95CrossRef
12.
go back to reference Strigård K, Gurmu A, Näsvall P, Påhlman P, Gunnarsson U (2013) Intrastomal 3D ultrasound; an inter- and intra-observer evaluation. Int J Color Dis 28:43–47CrossRef Strigård K, Gurmu A, Näsvall P, Påhlman P, Gunnarsson U (2013) Intrastomal 3D ultrasound; an inter- and intra-observer evaluation. Int J Color Dis 28:43–47CrossRef
13.
go back to reference Näsvall P, Wikner F, Gunnarsson U, Rutegård J, Strigård K (2014) A comparison between intrastomal 3D ultrasonography, CT scanning and findings at surgery in patients with stomal complaints. Int J Color Dis 29:1263–1266CrossRef Näsvall P, Wikner F, Gunnarsson U, Rutegård J, Strigård K (2014) A comparison between intrastomal 3D ultrasonography, CT scanning and findings at surgery in patients with stomal complaints. Int J Color Dis 29:1263–1266CrossRef
14.
go back to reference Hardt J, Meerpohl JJ, Metzendorf MI, Kienle P, Post S, Herrle F (2013) Lateral pararectal versus transrectal stoma placement for prevention of parastomal herniation. Cochrane Database Syst Rev 22:CD009487 Hardt J, Meerpohl JJ, Metzendorf MI, Kienle P, Post S, Herrle F (2013) Lateral pararectal versus transrectal stoma placement for prevention of parastomal herniation. Cochrane Database Syst Rev 22:CD009487
15.
go back to reference Parmar KL, Zammit M, Smith A, Kenyon D, Lees NP (2011) A prospective audit of early stoma complications in colorectal cancer treatment throughout the Greater Manchester and Cheshire colorectal cancer network. Color Dis 13:935–938CrossRef Parmar KL, Zammit M, Smith A, Kenyon D, Lees NP (2011) A prospective audit of early stoma complications in colorectal cancer treatment throughout the Greater Manchester and Cheshire colorectal cancer network. Color Dis 13:935–938CrossRef
17.
go back to reference Osborne W, North J, Williams J (2018) Using a risk assessment tool for parastomal hernia prevention. Br J Nurs 27:15–19CrossRefPubMed Osborne W, North J, Williams J (2018) Using a risk assessment tool for parastomal hernia prevention. Br J Nurs 27:15–19CrossRefPubMed
18.
go back to reference Hong SY, Oh SY, Lee JH, Kim DY, Suh KW (2013) Risk factors for parastomal hernia: based on radiological definition. J Korean Surg Soc 84:43–47CrossRefPubMed Hong SY, Oh SY, Lee JH, Kim DY, Suh KW (2013) Risk factors for parastomal hernia: based on radiological definition. J Korean Surg Soc 84:43–47CrossRefPubMed
19.
go back to reference Barlow L, Westergren K, Holmberg L, Talbäck M (2009) The completeness of the Swedish Cancer Register, a sample survey for year 1998. Acta Oncol 48:27–33CrossRefPubMed Barlow L, Westergren K, Holmberg L, Talbäck M (2009) The completeness of the Swedish Cancer Register, a sample survey for year 1998. Acta Oncol 48:27–33CrossRefPubMed
20.
go back to reference Påhlman L, Bohe M, Cedermark B, Dahlberg M, Lindmark G, Sjödahl R, Ojerskog B, Damber L, Johansson R (2007) The Swedish rectal cancer registry. Br J Surg 94:1285–1292CrossRefPubMed Påhlman L, Bohe M, Cedermark B, Dahlberg M, Lindmark G, Sjödahl R, Ojerskog B, Damber L, Johansson R (2007) The Swedish rectal cancer registry. Br J Surg 94:1285–1292CrossRefPubMed
21.
go back to reference Jörgren F, Johansson R, Damber L, Lindmark G (2013) Validity of the Swedish Rectal Cancer Registry for patients treated with major abdominal surgery between 1995 and 1997. Acta Oncol 52:1707–1714CrossRefPubMed Jörgren F, Johansson R, Damber L, Lindmark G (2013) Validity of the Swedish Rectal Cancer Registry for patients treated with major abdominal surgery between 1995 and 1997. Acta Oncol 52:1707–1714CrossRefPubMed
22.
go back to reference Kodeda K, Nathanaelsson L, Jung B, Olsson H, Jestin P, Sjövall A, Glimelius B, Påhlman L, Syk I (2013) Population-based data from the Swedish Colon Cancer Registry. Br J Surg 100:1100–1107CrossRefPubMed Kodeda K, Nathanaelsson L, Jung B, Olsson H, Jestin P, Sjövall A, Glimelius B, Påhlman L, Syk I (2013) Population-based data from the Swedish Colon Cancer Registry. Br J Surg 100:1100–1107CrossRefPubMed
23.
go back to reference Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, Heurgren M, Olausson PO (2011) External review and validation of the Swedish national inpatient register. BMC Public Health 11:450CrossRefPubMedPubMedCentral Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, Heurgren M, Olausson PO (2011) External review and validation of the Swedish national inpatient register. BMC Public Health 11:450CrossRefPubMedPubMedCentral
24.
go back to reference Forsberg L, Rydh H, Jacobson A, Nygvist K, Heurgren M (2009) Kvalitet och innehåll i patientregistret. Discharge from inpatient treatment 1964–2007 and visits to specialist outpatient care (excluding primary care visits) 1997–2007 [quality and content of the patient register]. National Board of Health and Welfare, Stockholm Forsberg L, Rydh H, Jacobson A, Nygvist K, Heurgren M (2009) Kvalitet och innehåll i patientregistret. Discharge from inpatient treatment 1964–2007 and visits to specialist outpatient care (excluding primary care visits) 1997–2007 [quality and content of the patient register]. National Board of Health and Welfare, Stockholm
25.
go back to reference Ludvigsson JF, Otterblad-Olausson P, Pettersson BU, Ekbom A (2009) The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. Eur J Epidemiol 24:659–667CrossRefPubMedPubMedCentral Ludvigsson JF, Otterblad-Olausson P, Pettersson BU, Ekbom A (2009) The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. Eur J Epidemiol 24:659–667CrossRefPubMedPubMedCentral
26.
go back to reference Sobin LH, Gospodarowicz MK, Wittekind C (2011) TNM classification of malignant tumours, 7th edn. John Wiley & Sons, New York Sobin LH, Gospodarowicz MK, Wittekind C (2011) TNM classification of malignant tumours, 7th edn. John Wiley & Sons, New York
27.
go back to reference Andersen RM, Klausen TW, Danielsen AK, Vinther A, Gögenur I, Thomsen T (2018) 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. Color Dis 20:331–340CrossRef Andersen RM, Klausen TW, Danielsen AK, Vinther A, Gögenur I, Thomsen T (2018) 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. Color Dis 20:331–340CrossRef
28.
go back to reference Temple B, Farley T, Popik K, Ewanyshyn C, Beyer E, Dufault B (2016) Prevalence of parastomal hernia and factors associated with its development. J Wound Ostomy Continence Nurs 43:489–493CrossRefPubMed Temple B, Farley T, Popik K, Ewanyshyn C, Beyer E, Dufault B (2016) Prevalence of parastomal hernia and factors associated with its development. J Wound Ostomy Continence Nurs 43:489–493CrossRefPubMed
30.
go back to reference Funahashi K, Suzuki T, Nagashima Y, Matsuda S, Koike J, Shiokawa H, Ushigome M, Arai K, Kaneko T, Kurihara A, Kaneko H (2014) Risk factors for parastomal hernia in Japanese patients with permanent colostomy. Surg Today 44:1465–1469CrossRefPubMed Funahashi K, Suzuki T, Nagashima Y, Matsuda S, Koike J, Shiokawa H, Ushigome M, Arai K, Kaneko T, Kurihara A, Kaneko H (2014) Risk factors for parastomal hernia in Japanese patients with permanent colostomy. Surg Today 44:1465–1469CrossRefPubMed
31.
go back to reference Brandsma HT, Hansson BME, Aufenacker TJ, van Geldere D, van Lammeren FM, Mahabier C, Steenvoorde P, de Vries Reilingh TS, Wiezer RJ, de Wilt JHW, Bleichrodt RP, Rosman C (2016) Prophylactic mesh placement to prevent parastomal hernia, early results of a prospective multicenter randomized trial. Hernia 20:535–541CrossRefPubMed Brandsma HT, Hansson BME, Aufenacker TJ, van Geldere D, van Lammeren FM, Mahabier C, Steenvoorde P, de Vries Reilingh TS, Wiezer RJ, de Wilt JHW, Bleichrodt RP, Rosman C (2016) Prophylactic mesh placement to prevent parastomal hernia, early results of a prospective multicenter randomized trial. Hernia 20:535–541CrossRefPubMed
33.
go back to reference López-Cano M, Pereira JA, Armengol-Carrasco M, García-Alamino J (2018) To prevent parastomal hernia after Stomal surgery, a prophylactic mesh does work. Cir Esp 96:62–63CrossRefPubMed López-Cano M, Pereira JA, Armengol-Carrasco M, García-Alamino J (2018) To prevent parastomal hernia after Stomal surgery, a prophylactic mesh does work. Cir Esp 96:62–63CrossRefPubMed
35.
go back to reference Cross AJ, Buchwald PL, Frizelle FA, Eglinton TW (2017) Meta-analysis of prophylactic mesh to prevent parastomal hernia. Br J Surg 104:179–186CrossRefPubMed Cross AJ, Buchwald PL, Frizelle FA, Eglinton TW (2017) Meta-analysis of prophylactic mesh to prevent parastomal hernia. Br J Surg 104:179–186CrossRefPubMed
36.
go back to reference Jänes A, Cengiz Y, Israelsson LA (2009) Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study. World J Surg 33:118–121CrossRefPubMed Jänes A, Cengiz Y, Israelsson LA (2009) Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study. World J Surg 33:118–121CrossRefPubMed
38.
go back to reference Antoniou SA, Agresta F, Garcia Alamino JM, Berger D, Berrevoet F, Brandsma HT, Bury K, Conze J, Cuccurullo D, Dietz UA, Fortelny RH, Frei-Lanter C, Hansson B, Helgstrand F, Hotouras A, Jänes A, Kroese LF, Lambrecht JR, Kyle-Leinhase I, López-Cano M, Maggiori L, Mandalà V, Miserez M, Montgomery A, Morales-Conde S, Prudhomme M, Rautio T, Smart N, Śmietański M, Szczepkowski M, Stabilini C, Muysoms FE (2018) European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia 22:183–198CrossRefPubMed Antoniou SA, Agresta F, Garcia Alamino JM, Berger D, Berrevoet F, Brandsma HT, Bury K, Conze J, Cuccurullo D, Dietz UA, Fortelny RH, Frei-Lanter C, Hansson B, Helgstrand F, Hotouras A, Jänes A, Kroese LF, Lambrecht JR, Kyle-Leinhase I, López-Cano M, Maggiori L, Mandalà V, Miserez M, Montgomery A, Morales-Conde S, Prudhomme M, Rautio T, Smart N, Śmietański M, Szczepkowski M, Stabilini C, Muysoms FE (2018) European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia 22:183–198CrossRefPubMed
Metadata
Title
Parastomal hernias causing symptoms or requiring surgical repair after colorectal cancer surgery—a national population-based cohort study
Authors
Mathilda Tivenius
Pia Näsvall
Gabriel Sandblom
Publication date
01-07-2019
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 7/2019
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-019-03292-4

Other articles of this Issue 7/2019

International Journal of Colorectal Disease 7/2019 Go to the issue