Risk factors associated to incisional hernia in stoma site after stoma closure: a systematic review and meta analysis

Abstract

This study aims to identify which risk factors are associated to 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: 17 studies totaling 2899 patients were included. Incidence proportion between included studies was of 17,78% (CI95%: 13,51 – 22,50%). Out of the evaluated factors obesity (p<0,001, index (p<0,001, Cohen’s d=0.63, SE=011), presence of parastomal hernia (p=0,001, LogOR=1.24, SE=0.38), colostomy (p=0,001 LogOR=-0.71, SE=0.15) and end stoma (p=0,040, LogOR=-0,38, SE=-0,18) were associated to the appearance of incisional hernia in stoma site after stoma closure. 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.