Risk factors associated to incisional hernia in stoma site after stoma closure: A systematic review and meta-analysis

Camilo Ramírez-Giraldo, Isabella Van-Londoño, Danny Conde Monroy, Jorge Navarro-Alean, Juliana Hernández-Ferreira, Daniela Hernández-Álvarez, Susana Rojas-López, Violeta Avendaño-Morales

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: This study aims to identify which risk factors are associated with the appearance of an incisional hernia in a stoma site after its closure. This in the sake of identifying which patients would benefit from a preventative intervention and thus start implementing a cost-effective protocol for prophylactic mesh placement in high-risk patients. Methods: A systematic review of PubMed, Cochrane library, and ScienceDirect was performed according to PRISMA guidelines. Studies reporting incidence, risk factors, and follow-up time for appearance of incisional hernia after stoma site closure were included. A fixed-effects and random effects models were used to calculate odds ratios’ estimates and standardized mean values with their respective grouped 95% confidence interval. This to evaluate the association between possible risk factors and the appearance of incisional hernia after stoma site closure. Results: Seventeen studies totaling 2899 patients were included. Incidence proportion between included studies was of 16.76% (CI95% 12.82; 21.62). Out of the evaluated factors higher BMI (p = 0.0001), presence of parastomal hernia (p = 0.0023), colostomy (p = 0,001), and end stoma (p = 0.0405) were associated with the appearance of incisional hernia in stoma site after stoma closure, while malignant disease (p = 0.0084) and rectum anterior resection (p = 0.0011) were found to be protective factors. Conclusions: Prophylactic mesh placement should be considered as an effective preventative intervention in high-risk patients (obese patients, patients with parastomal hernia, colostomy, and end stoma patients) with the goal of reducing incisional hernia rates in stoma site after closure while remaining cost-effective.

Original languageEnglish
Article number267
Pages (from-to)267
JournalInternational Journal of Colorectal Disease
Volume38
Issue number1
DOIs
StatePublished - Jan 2023

Keywords

  • Incisional hernia
  • Prevention
  • Risk factors
  • Stoma closure
  • Stoma reversal
  • Colostomy/adverse effects
  • Humans
  • Risk Factors
  • Surgical Mesh/adverse effects
  • Surgical Stomas/adverse effects
  • Incisional Hernia/epidemiology

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