Retrospective observational study on the incidence of incisional hernias after reversal of a temporary diverting ileostomy following rectal carcinoma resection with follow-up CT scans.
BACKGROUND
Wounds resulting from the closure of temporary stomas have a high risk of developing an incisional hernia (IH) with incidences around 30% in studies designed to investigate this outcome. A temporary diverting ileostomy (TDI) is often used in patients after low anterior resection (LAR) for rectal cancer.


METHODS
The OSTRICH study is a retrospective cohort study of rectal cancer patients who had a LAR with a reversed TDI and at least one CT scan during follow-up. Two radiologists independently evaluated all abdominal CT scans to diagnose IH at the ileostomy wound and additionally, IH at the laparotomy site.


RESULTS
From the oncological database of rectal cancer patients treated from 2003 till 2012 (n = 317) a cohort of 153 patients that fulfilled the inclusion criteria was identified. Rectal cancer resection was performed by laparoscopy in 53 patients (34.6%) and by laparotomy in 100 patients (65.4%). A total of 17 IH (11.1%) was diagnosed at the former stoma site after a mean follow-up of 2.6 years. Of these, 8 IH were in patients who had a laparoscopic LAR (15.1%) and 9 IH in patients who had an open LAR (9.0%) (Fisher's exact test; p = 0.28). IH on the other abdominal wall incisions was reported in 69 patients (45.1%). Of these, 10 patients underwent laparoscopic rectal surgery (18.9%) and in 59 patients had open rectal surgery (59.0%) (Fisher's exact test; p < 0.0001).


CONCLUSIONS
We found a lower number of incisional hernias (11.1%) after reversal of ileostomies than expected from the literature. In contrast to the findings at the ileostomy site, a very high frequency of IH (59.0%) after LAR by laparotomy was found, which was significantly higher than after laparoscopic LAR.
Department of Surgery, AZ Maria Middelares Ghent, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium.
G
G
De Keersmaecker
Department of Radiology, AZ Maria Middelares Ghent, Ghent, Belgium.
R
R
Beckers
Department of Radiology, AZ Maria Middelares Ghent, Ghent, Belgium.
E
E
Heindryckx
Department of Surgery, AZ Maria Middelares Ghent, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium.
I
I
Kyle-Leinhase
Department of Surgery, AZ Maria Middelares Ghent, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium.
P
P
Pletinckx
Department of Surgery, AZ Maria Middelares Ghent, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium.
D
D
Claeys
Department of Gastrointestinal Oncology, AZ Maria Middelares Ghent, Ghent, Belgium.
E
E
Vanderstraeten
Department of Gastrointestinal Oncology, AZ Maria Middelares Ghent, Ghent, Belgium.
E
E
Monsaert
Department of Surgery, AZ Maria Middelares Ghent, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium. filip.muysoms@azmmsj.be.
F
F
Muysoms
D000368:Aged; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D015994:Incidence; D000069290:Incisional Hernia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects; D007813:Laparotomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D054047:Surgical Stomas / Q000009:adverse effects; D014057:Tomography, X-Ray Computed
Computer tomography; Diagnosis; Ileostomy; Incidence; Incisional hernia; Rectal cancer