The rate of ileostomy site incisional hernias: more common than we think?

IF 2.6 2区医学 Q1 SURGERY

Hernia Pub Date : 2024-12-01 Epub Date: 2024-09-26 DOI:10.1007/s10029-024-03163-0

Megan Obi, Lucas Beffa, Megan Melland-Smith, Nir Messer, Arielle Kanters, Sami Judeeba, Kevin Baier, Benjamin Miller, David Krpata, Ajita Prabhu, Scott R Steele, Michael Rosen, Stefan D Holubar, Clayton Petro

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引用次数: 0

Abstract

Purpose: Incisional hernias (IH) rates after diverting loop ileostomy reversal (DLI-R) have been reported up to 24%. We aimed to characterize the incidence rate and risk factors associated with DLI-R site IH formation within 1-year in a large patient cohort.

Methods: A retrospective review at a single quaternary referral center hospital of adult patients who underwent DLI-R over a 5-year period and abdominal computerized tomography (CT) imaging performed within 1-year for any indication postoperatively was conducted. All CTs scans were independently reviewed by staff surgeons to determine the presence of a fascial defect at the DLI-R site.

Results: 2,196 patients underwent DLI-R; of these, 569 (25.9%) underwent CT imaging for any indication. Mean patient age, 54.8 (± 14.9), BMI 27.6 kg/m². 87 (15%) patients had a parastomal hernia at time of DLI-R. After median follow-up of 10 months, 203 patients (35.7%) had IH at the DLI-R site. Age (p = 0.14), sex (p = 0.39), race (p = 0.75), and smoking status (p = 0.82) weren't associated with IH after DLI-R. Comorbidities weren't significantly associated with IH following DLI-R. In univariate analysis, increased BMI (p < 0.001), presence of a parastomal hernia (p = 0.008), and suture type (p = 0.01) were associated with IH development. On multivariate analysis, BMI remained significant, and polyglyconate compared to polydioxanone suture were associated with higher rates of IH (p < 0.001).

Conclusion: We observed that the rate of incisional hernias within 1-year of diverting ileostomy reversal was indeed common at 36%. Granted, a high percentage of the population was excluded due to heterogeneity in radiographic evaluation that could be mitigated in future prospective studies. Our study suggests that IH preventative strategies include weight loss for overweight and obese patients prior to DLI-R and that the optimal suture for DLI-R is polydioxanone.

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回肠造口部位切口疝的发生率：比我们想象的更常见？

目的：据报道，憩室回肠造口术（DLI-R）后切口疝（IH）的发生率高达 24%。我们的目的是在一个大型患者队列中描述 1 年内 DLI-R 切口疝形成的发生率和相关风险因素：方法：我们在一家四级转诊中心医院对 5 年内接受过 DLI-R 的成年患者进行了回顾性研究，并在术后 1 年内因任何原因进行了腹部计算机断层扫描（CT）。结果：2196 名患者接受了 DLI-R；其中 569 人（25.9%）因任何原因接受了 CT 扫描。患者平均年龄为 54.8 (± 14.9)，体重指数为 27.6 kg/m2。87名（15%）患者在接受DLI-R检查时患有腹股沟旁疝。中位随访10个月后，203名患者（35.7%）在DLI-R部位出现IH。年龄（p = 0.14）、性别（p = 0.39）、种族（p = 0.75）和吸烟状况（p = 0.82）与DLI-R后的IH无关。合并症与DLI-R后的IH无明显关系。在单变量分析中，体重指数（BMI）的增加（P我们观察到，在回肠造口术翻转术后 1 年内，切口疝的发生率高达 36%。当然，由于放射学评估的异质性，有很高比例的人群被排除在外，这可以在未来的前瞻性研究中得到缓解。我们的研究表明，IH 预防策略包括超重和肥胖患者在进行 DLI-R 前减轻体重，以及 DLI-R 的最佳缝合线是聚二氧杂环戊酮。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.