Surgery Department, CHU de Quebec-Laval University, Quebec City, Quebec, Canada.
Laval University, 1050, Avenue de la Médecine, Quebec City, Quebec, Canada.
Langenbecks Arch Surg. 2021 Aug;406(5):1643-1650. doi: 10.1007/s00423-021-02155-3. Epub 2021 Mar 28.
Parastomal hernia (PSH) is a frequent complication of stoma creation during colorectal surgery. Radiological classification systems have been proposed for PSH but are primarily used for research. Our objective was to determine if PSH radiological classification at diagnosis could predict the need for surgical repair during follow-up.
In this retrospective cohort study, we reviewed 705 postoperative CT scans from 154 patients with permanent stoma creation from 2015 to 2018. Patients were included for analysis if a primary PSH was diagnosed on any exam. PSH were classified according to the European Hernia Society (EHS) and Moreno-Matias (MM) classification systems.
The incidence of radiological PSH was 41% (63/154) after a median radiological follow-up of 19.2 months (interquartile range, 10.9-32.9). Surgical repair was required in 17 of 62 patients with a primary PSH. There was no significant correlation between PSH classification and surgical hernia repair for either the EHS (p = 0.56) or MM classification systems (p = 0.35) in a univariate analysis. However, in a multivariate analysis, the type of PSH according to the EHS classification was significantly correlated with PSH repair during follow-up (p = 0.02). Type III PSH were associated with a lower incidence of surgical hernia repair as compared with type I, with a hazard ratio (HR) of 0.01 (95% CI, <0.00-0.20). A similar correlation was not seen using the MM classification (p = 0.10).
EHS classification of PSH was significant correlated with the need for surgical repair during short-term follow-up. Prospective studies are required to establish a potential role in patient care.
造口旁疝（PSH）是结直肠手术后造口时的常见并发症。已经提出了用于 PSH 的放射学分类系统，但主要用于研究。我们的目的是确定诊断时 PSH 的放射学分类是否可以预测随访期间是否需要手术修复。
在这项回顾性队列研究中，我们分析了 2015 年至 2018 年间 154 例永久性造口患者的 705 例术后 CT 扫描。仅在任何检查中诊断为原发性 PSH 的患者才纳入分析。PSH 根据欧洲疝学会（EHS）和莫雷诺-马蒂亚斯（MM）分类系统进行分类。
在中位放射学随访 19.2 个月（四分位距，10.9-32.9）后，放射学 PSH 的发生率为 41%（63/154）。在 62 例原发性 PSH 患者中，有 17 例需要手术修复。在单变量分析中，EHS（p = 0.56）或 MM 分类系统（p = 0.35）均未发现 PSH 分类与手术疝修复之间存在显著相关性。然而，在多变量分析中，EHS 分类的 PSH 类型与随访期间 PSH 修复显著相关（p = 0.02）。与 I 型相比，III 型 PSH 与手术疝修复的发生率较低，风险比（HR）为 0.01（95%CI，<0.00-0.20）。使用 MM 分类未见类似相关性（p = 0.10）。
EHS 分类的 PSH 与短期随访期间需要手术修复显著相关。需要前瞻性研究来确定其在患者护理中的潜在作用。
