title: The incidence of incisional hernias following ileostomy reversal in colorectal cancer patients treated with anterior resection.
abstract: INTRODUCTION The aim of this study was to identify the rate of incisional hernia formation following ileostomy reversal in patients who underwent anterior resection for colorectal cancer. In addition, we aimed to ascertain risk factors for the development of reversal-site incisional hernias and to record the characteristics of the resultant hernias. MATERIALS AND METHODS Using a prospectively compiled database of colorectal cancer patients who were treated with anterior resection, we identified individuals who had undergone both ileostomy formation and subsequent reversal of their ileostomies from January 2005 to December 2014. Medical records were reviewed to record descriptive patient data about risk factors for hernia formation, operative details and any subsequent operations. Computed tomography reports were reviewed to identify the number, site and characteristics of incisional hernias. RESULTS A total of 121 patients were included in this study; 14.9% (n = 18) developed an incisional hernia at the ileostomy reversal site; 17.4% (n = 21) at a non-ileostomy site and 6.6% (n = 8) developed both. The reversal-site hernias were smaller both in width and length compared with the non-ileostomy-site hernias. Risk factors for the development of reversal-site incisional hernias were higher body mass index (BMI), lower age, open surgery, longer reversal time and a history of previous hernias. We did not detect a difference in the size of the incisional hernias that developed in patients with these specific risk factors. CONCLUSIONS Incisional hernias are a significant complication of ileostomy reversal. Further evaluation of the use of prophylactic mesh to reduce the incidence of incisional hernias may be worthwhile.
authors.affiliation: Colorectal Department, Colchester Hospital University NHS Foundation Trust , Colchester , UK.
authors.forename: Balazs
authors.initials: B
authors.lastname: Fazekas
authors.affiliation: GRN Klinik Weinheim , Weinheim , Germany.
authors.forename: Bence
authors.initials: B
authors.lastname: Fazekas
authors.affiliation: Colorectal Department, Colchester Hospital University NHS Foundation Trust , Colchester , UK.
authors.forename: J
authors.initials: J
authors.lastname: Hendricks
authors.affiliation: Royal Devon and Exeter Hospital , Exeter , UK.
authors.forename: N
authors.initials: N
authors.lastname: Smart
authors.affiliation: Colorectal Department, Colchester Hospital University NHS Foundation Trust , Colchester , UK.
authors.forename: T
authors.initials: T
authors.lastname: Arulampalam
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000601:surgery; D013505:Digestive System Surgical Procedures; D005260:Female; D046449:Hernia, Abdominal / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D007081:Ileostomy; D015994:Incidence; D000069290:Incisional Hernia / Q000000981:diagnostic imaging / Q000453:epidemiology*; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D050177:Overweight / Q000453:epidemiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: Computed Tomography; Ileostomy; Incidence; Incisional Hernia; Rectal Cancer