Parastomal hernia is an independent risk factor for incisional hernia in patients with end colostomy.
BACKGROUND
Incisional hernia (IH) is the most frequent complication after abdominal operation, with an incidence of 11-20% and up to 35% in risk groups. Known risk groups for IH are abdominal aortic aneurysm and obesity. Our hypothesis is that parastomal hernia (PH) might also represent a risk factor for developing IH. Identifying risk factors can help determine the need for preventive measures such as primary mesh augmentation.


METHODS
In a multicenter cross-sectional study, all patients who were operated between 2002 and 2010 by means of a Hartmann procedure or abdominoperineal resection were invited for a follow-up visit to our outpatient clinic. Primary outcome measures were the prevalence of IH and PH. All possible risk factors for IH were scored. A physical examination was performed and, when available, computed tomography was scored for IH and PH.


RESULTS
A total of 150 patients were seen in the outpatient clinic. The median follow-up was 49 months (range, 30-75). IH had a prevalence of 37.1%, and PH had a prevalence of 52.3% during physical examination. On CT the prevalence was even greater, ie, 48.3% and 52.9%. IH and PH were both present in the same patient in 30% of all examined and in 35.6% after CT examination. PH was found to be a risk factor for IH on univariate and multivariate logistic regression analyses of variance, with an odds ratio of 7.2 (95% confidence interval 3.3-15.7). In addition, an emergency operation was found to be a risk factor for IH with an odds ratio of 5.8 in the multivariate analyses.


CONCLUSIONS
Patients with a PH have a 7 times greater chance of developing an IH compared to patients without PH.
Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: l.timmermans@erasmusmc.nl.
Lucas
L
Timmermans
Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Eva B
EB
Deerenberg
Department of Surgery, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands.
Bas
B
Lamme
Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands.
Johannes
J
Jeekel
Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Johan F
JF
Lange
D000368:Aged; D003125:Colostomy / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D006547:Hernia / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors