title: Systematic review and meta-analysis of the incidence of incisional hernia at the site of stoma closure.
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.
authors.affiliation: Academic Department of Surgery, West Midlands Research Collaborative, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH, UK. aneelbhangu@doctors.org.uk.
authors.forename: Aneel
authors.initials: A
authors.lastname: Bhangu
authors.affiliation: Academic Department of Surgery, West Midlands Research Collaborative, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH, UK.
authors.forename: Dmitri
authors.initials: D
authors.lastname: Nepogodiev
authors.affiliation: Academic Department of Surgery, West Midlands Research Collaborative, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH, UK.
authors.forename: Kaori
authors.initials: K
authors.lastname: Futaba
mesh_terms: D003125:Colostomy; D046449:Hernia, Abdominal / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D006801:Humans; D007081:Ileostomy; D015994:Incidence; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data