title: Review of stoma site and midline incisional hernias after stoma reversal.
abstract: BACKGROUND
  The incidence of incisional hernias after stoma reversal is not well reported. The aim of this study was to systematically review the literature reporting data on incisional hernias after stoma reversal. We evaluated both the incidence of stoma site and midline incisional hernias.
  
  
  METHODS
  A systematic review identified studies published between January 1, 1980, and December 31, 2012, reporting the incidence of incisional hernia after stoma reversal at either the stoma site or at the midline incision (in cases requiring laparotomy). Pediatric studies were excluded. Assessment of risk of bias, detection method, and essential study-specific characteristics (follow-up duration, stoma type, age, body mass index, and so forth) was done.
  
  
  RESULTS
  Sixteen studies were included in the analysis; 1613 patients had 1613 stomas formed. Fifteen studies assessed stoma site hernias and five studies assessed midline incisional hernias. The median (range) incidence of stoma site incisional hernias was 8.3% (range 0%-33.9%) and for midline incisional hernias was 44.1% (range 8.7%-58.1%). When evaluating only studies with a low risk of bias, the incidence for stoma site incisional hernias is closer to one in three and for midline incisional hernias is closer to one in two.
  
  
  CONCLUSIONS
  Stoma site and midline incisional hernias are significant clinical complications of stoma reversals. The quality of studies available is poor and heterogeneous. Future prospective randomized controlled trials or observational studies with standardized follow-up and outcome definitions/measurements are needed.
authors.affiliation: Department of General Surgery, University of Texas Health Science Center at Houston, Houston, Texas; Department of General Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Mylan T
authors.initials: MT
authors.lastname: Nguyen
authors.affiliation: Department of General Surgery, University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Uma R
authors.initials: UR
authors.lastname: Phatak
authors.affiliation: Department of General Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Linda T
authors.initials: LT
authors.lastname: Li
authors.affiliation: Dana Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Stephanie C
authors.initials: SC
authors.lastname: Hicks
authors.affiliation: Department of General Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Moffett
authors.affiliation: Department of General Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Nestor A
authors.initials: NA
authors.lastname: Arita
authors.affiliation: Department of General Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Berger
authors.affiliation: Department of General Surgery, University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Lillian S
authors.initials: LS
authors.lastname: Kao
authors.affiliation: Department of General Surgery, University of Texas Health Science Center at Houston, Houston, Texas. Electronic address: mkliang@yahoo.com.
authors.forename: Mike K
authors.initials: MK
authors.lastname: Liang
mesh_terms: D005763:Gastroenterostomy / Q000009:adverse effects*; D046449:Hernia, Abdominal / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D054047:Surgical Stomas / Q000009:adverse effects*
keywords: Incisional hernia; Ostomy; Reversal; Stoma; Takedown