De Robles Marie Shella, Bakhtiar Arsalan, Young Christopher J
Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Faculty of Medicine and Health, The University of Sydney Central Clinical School, Sydney, New South Wales, Australia.
ANZ J Surg. 2019 Apr;89(4):399-402. doi: 10.1111/ans.14983. Epub 2019 Jan 26.
Incisional hernia following ileostomy reversal can cause significant morbidity, impaired quality of life, and burden on the healthcare system. This study aimed to determine the prevalence of ileostomy site incisional hernia following reversal and to identify possible risk factors for its development.
This was a retrospective cohort study involving consecutive patients who underwent ileostomy reversal between November 1999 to February 2015 by a single surgeon. Primary outcome analysed was incisional hernia occurrence at the previous stoma site.
Two hundred and twenty-four ileostomy reversals were identified. The most common indication for ileostomy construction was colorectal cancer, followed by inflammatory bowel disease and diverticulosis. The stomas were either a loop (75%), end-loop (24%) or end ileostomy (1%). The mean time interval from the stoma creation to reversal was 6.1 months (range 2-69, SD 7.1). After a mean follow-up of 30.7 months (range 10-89, SD 15.1), 12 patients (5%) developed a hernia at the previous stoma. The mean time for hernia occurrence was 25.2 months (range 3-126, SD 32). Patients who developed ileostomy site incisional hernia were more likely to have a higher body mass index (28.1 versus 26.3, P = 0.007).
Although we found a lower rate of incisional hernias after reversal of ileostomies than reported elsewhere in the literature, it remains a significant clinical problem. Obesity is a significant risk factor for ileostomy-site incisional hernia.
回肠造口术回纳术后切口疝可导致严重的发病情况、生活质量受损以及给医疗系统带来负担。本研究旨在确定回纳术后回肠造口部位切口疝的患病率，并识别其发生的可能危险因素。
这是一项回顾性队列研究，纳入了1999年11月至2015年2月间由同一位外科医生连续进行回肠造口术回纳的患者。分析的主要结局是原造口部位切口疝的发生情况。
共识别出224例回肠造口术回纳病例。造口术最常见的指征是结直肠癌，其次是炎症性肠病和憩室病。造口类型为袢式（75%）、端袢式（24%）或末端回肠造口（1%）。从造口形成到回纳的平均时间间隔为6.1个月（范围2 - 69个月，标准差7.1）。平均随访30.7个月（范围10 - 89个月，标准差15.1）后，12例患者（5%）在原造口部位发生了疝。疝发生的平均时间为25.2个月（范围3 - 126个月，标准差32）。发生回肠造口部位切口疝的患者更可能具有较高的体重指数（28.1对26.3，P = 0.007）。
尽管我们发现回肠造口术回纳术后切口疝的发生率低于文献中其他地方报道的，但它仍然是一个重要的临床问题。肥胖是回肠造口部位切口疝的一个重要危险因素。
