Analysis of risk factors and prevention strategy of incisional hernia after stoma reduction surgery

doi:10.3877/cma.j.issn.1674-392X.2024.06.008

Abstract

Abstract:

Objective

To analyze the clinical characteristics of stoma site incisional hernia(SSIH) after stoma reduction surgery, in order to enhance clinicians' knowledge and attention to SSIH.

Methods

The clinical data of 232 cases of colorectal surgery+prophylactic enterostomy admitted to the Department of Gastrointestinal Surgery of Sichuan Provincial People's Hospital, School of Medicine(Affiliated Hospital of University of Electronic Science and Technology) were retrospectively analyzed from January 2021 to May 2023.SSIH was confirmed by follow-up and imaging results, and the clinical characteristics related to the incision site of SSIH were analyzed.

Results

A total of 30 (12.9%) of the 232 patients developed SSIH.The comparison of the clinical characteristics of the patients with different outcomes showed that compared with the patients without SSIH, the complicated parastomal hernia,postoperative incisional infections, the diameter of the stoma ＞2.5 cm, whether the muscle was detached during the reduction, and the technique of suture closure in the patients with SSIH had statistically significant differences (P＜0.05).The complicated parastomal hernia, incisional infection after reduction, stoma diameter ＞2.5 cm, interrupted suture, and detached muscle were independent risk factors for SSIH after prophylactic stoma reduction (Odds Ratio=10.31, 15.17, 5.348, 8.203, 4.671; 95% confidence interval=2.680-45.210, 4.716-57.180, 1.751-18.380, 2.338-37.880, 1.427-18.910).

Conclusion

Measures such as avoiding excessively large prophylactic ostomy, preventing parastomal hernia, avoiding incisional infection during reduction, reducing muscle detachment during ostomy reduction, and using continuous suture during incision closure can help reduce the incidence of SSIH.

Key words: Ostomy reduction, Incisional hernia, Risk factors, Preventive measures

Kai Lin, Yong Pan, Gaoping Zhao, Chun Yang. Analysis of risk factors and prevention strategy of incisional hernia after stoma reduction surgery[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(06): 634-638.

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Figures/Tables 3

临床特征	非SSIH组(n=202)	SSIH组(n=30)	t/χ²	P值
年龄(岁, $\overset{ˉ}{x}$ ±s)	65.03±12.73	62.75±12.34	0.9404	0.3470
男性[例(%)]	118(58.42)	16(53.33)	0.1075	0.7430
造口存在时间＞6个月[例(%)]	66(32.67)	13(43.33)	0.8897	0.3456
造口直径(cm, $\overset{ˉ}{x}$ ±s)	2.65±0.26	2.48±0.24	3.5802	0.0003
经腹直肌造口[例(%)]	96(47.52)	16(53.33)	0.1587	0.6904
慢吸收缝线关闭造口[例(%)]	119(58.91)	15(50.00)	0.5241	0.4691
回肠造口[例(%)]	180(89.10)	22(73.33)	4.4576	0.0347
合并造口旁疝[例(%)]	12(5.94)	10(33.33)	19.7546	＜0.0001
还纳后切口感染[例(%)]	19(9.41)	15(50.00)	31.2454	＜0.0001
高血压[例(%)]	36(17.82)	6(20.00)	0.0012	0.9720
糖尿病[例(%)]	25(12.38)	5(16.67)	0.1310	0.7174
间断缝合[例(%)]	88(43.56)	24(80.00)	12.4664	0.0004
还纳时离断肌肉[例(%)]	82(40.60)	25(83.33)	17.5195	＜0.0001

临床特征	非SSIH组(n=202)	SSIH组(n=30)	t/χ²	P值
年龄(岁, $\overset{ˉ}{x}$ ±s)	65.03±12.73	62.75±12.34	0.9404	0.3470
男性[例(%)]	118(58.42)	16(53.33)	0.1075	0.7430
造口存在时间＞6个月[例(%)]	66(32.67)	13(43.33)	0.8897	0.3456
造口直径(cm, $\overset{ˉ}{x}$ ±s)	2.65±0.26	2.48±0.24	3.5802	0.0003
经腹直肌造口[例(%)]	96(47.52)	16(53.33)	0.1587	0.6904
慢吸收缝线关闭造口[例(%)]	119(58.91)	15(50.00)	0.5241	0.4691
回肠造口[例(%)]	180(89.10)	22(73.33)	4.4576	0.0347
合并造口旁疝[例(%)]	12(5.94)	10(33.33)	19.7546	＜0.0001
还纳后切口感染[例(%)]	19(9.41)	15(50.00)	31.2454	＜0.0001
高血压[例(%)]	36(17.82)	6(20.00)	0.0012	0.9720
糖尿病[例(%)]	25(12.38)	5(16.67)	0.1310	0.7174
间断缝合[例(%)]	88(43.56)	24(80.00)	12.4664	0.0004
还纳时离断肌肉[例(%)]	82(40.60)	25(83.33)	17.5195	＜0.0001

风险因素	β	标准误	P值	OR	95%CI
合并造口旁疝	2.333	0.7100	0.001	10.31	2.680～45.210
还纳后切口感染	2.719	0.6276	＜0.0001	15.17	4.716～57.180
造口存在时间＞6个月	0.892	0.5776	0.1225	2.44	0.796～7.883
造口直径＞2.5cm	1.677	0.5910	0.0046	5.348	1.751～18.380
造口位置(经腹直肌)	0.495	0.7279	0.4965	1.640	0.372～6.663
性别	0.568	0.5652	0.3146	1.765	0.588～5.544
缝合技术(间断缝合)	1.541	0.6463	0.0171	4.671	1.427～18.910
离断肌肉	2.105	0.6971	0.0025	8.203	2.338～37.880

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