AI Article Synopsis
- The study investigates risk factors for developing incisional hernias at stoma sites after closure to identify patients who might benefit from preventative measures.
- A systematic review of 17 studies involving nearly 2900 patients found a 16.76% incidence rate of hernias linked to higher BMI, presence of parastomal hernia, colostomy, and end stoma, while certain factors like malignant disease were protective.
- The findings support the use of prophylactic mesh placement in high-risk patients as a cost-effective method to reduce the incidence of hernias following stoma closure.
Article Abstract
Background: This study aims to identify which risk factors are associated with the appearance of an incisional hernia in a stoma site after its closure. This in the sake of identifying which patients would benefit from a preventative intervention and thus start implementing a cost-effective protocol for prophylactic mesh placement in high-risk patients.
Methods: A systematic review of PubMed, Cochrane library, and ScienceDirect was performed according to PRISMA guidelines. Studies reporting incidence, risk factors, and follow-up time for appearance of incisional hernia after stoma site closure were included. A fixed-effects and random effects models were used to calculate odds ratios' estimates and standardized mean values with their respective grouped 95% confidence interval. This to evaluate the association between possible risk factors and the appearance of incisional hernia after stoma site closure.
Results: Seventeen studies totaling 2899 patients were included. Incidence proportion between included studies was of 16.76% (CI95% 12.82; 21.62). Out of the evaluated factors higher BMI (p = 0.0001), presence of parastomal hernia (p = 0.0023), colostomy (p = 0,001), and end stoma (p = 0.0405) were associated with the appearance of incisional hernia in stoma site after stoma closure, while malignant disease (p = 0.0084) and rectum anterior resection (p = 0.0011) were found to be protective factors.
Conclusions: Prophylactic mesh placement should be considered as an effective preventative intervention in high-risk patients (obese patients, patients with parastomal hernia, colostomy, and end stoma patients) with the goal of reducing incisional hernia rates in stoma site after closure while remaining cost-effective.
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| http://dx.doi.org/10.1007/s00384-023-04560-0 | DOI Listing |
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