title: A clinical and radiological assessment of incisional hernias following closure of temporary stomas.
abstract: OBJECTIVE
  The rate of incisional hernia at stoma closure sites is unclear. This study aimed to describe this rate in patients with closed stomas who had definitive post-operative imaging of their abdominal wall.
  
  
  METHODS
  A retrospective review of patients who had undergone stoma reversal and had a CT or MRI scan of the abdomen ≥2 months following reversal was performed. A radiologist, blinded to the original radiological report and clinical results, reviewed all scans for abdominal wall herniation. This was correlated to documented clinical findings.
  
  
  RESULTS
  Fifty-nine patients were included: 49 loop ileostomy and 10 end colostomy reversals. CT scans were performed for 57 patients and MRI for two. The median time from closure to imaging was 10 months (range 3-32 months). The combined clinical and radiological hernia rate was 34% (20/59). Imaging alone produced a rate of 31% (18/59). The clinical rate of hernia detection was 14% (8/59). Using the rate of clinical herniation as the detection standard, imaging had a low positive predictive value (33%, 6/18) but a high negative predictive value (95%, 39/41). Four patients required surgical repair of their stoma site hernia (20%, 4/20).
  
  
  CONCLUSIONS
  One in three patients undergoing stoma closure developed an incisional hernia. One in five of those with a hernia underwent surgical repair. Definitive imaging may provide an early surrogate marker for late clinically relevant hernias. Consideration of methods to prevent stoma closure site hernias should be considered.
authors.affiliation: Department of Surgery, Sandwell and West Birmingham Hospital, UK. aneelbhangu@doctors.org.uk
authors.forename: Aneel
authors.initials: A
authors.lastname: Bhangu
authors.forename: Lydia
authors.initials: L
authors.lastname: Fletcher
authors.forename: Samantha
authors.initials: S
authors.lastname: Kingdon
authors.forename: Emily
authors.initials: E
authors.lastname: Smith
authors.forename: Dmitri
authors.initials: D
authors.lastname: Nepogodiev
authors.forename: Umair
authors.initials: U
authors.lastname: Janjua
mesh_terms: D003125:Colostomy / Q000009:adverse effects*; D005260:Female; D006555:Hernia, Ventral / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation / Q000009:adverse effects*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*