Incidence of Ostomy Site Incisional Hernias after Stoma Closure

2015 ◽  
Vol 81 (12) ◽  
pp. 1244-1248 ◽  
Author(s):  
Stephen P. Sharp ◽  
Jacquelyn K. Francis ◽  
Brian T. Valerian ◽  
Jonathan J. Canete ◽  
A. David Chismark ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Incisional Hernia ◽  
Body Mass ◽  
Late Complication ◽  
Significant Risk ◽  
Operation Time ◽  
Stoma Closure ◽  
Incisional Hernias ◽  
Number Of Patients

This study sought to evaluate the incidence of ostomy site incisional hernias after stoma reversal at a single institution. This is a retrospective analysis from 2001 to 2011 evaluating the following demographics: age, gender, indication for stoma, urgent versus elective operation, time to closure, total follow-up time, the incidence of and reoperation for stoma incisional hernia, diabetes, postoperative wound infection, smoking status within six months of surgery, body mass index, and any immunosuppressive medications. A total of 365 patients were evaluated. The median follow-up time was 30 months. The clinical hernia rate was 19 percent. Significant risk factors for hernia development were age, diabetes, end colostomies, loop colostomies, body mass index >30, and undergoing an urgent operation. The median time to clinical hernia detection was 32 months. Sixty-four percent of patients required surgical repair of their stoma incisional hernia. A significant number of patients undergoing stoma closure developed an incisional hernia at the prior stoma site with the majority requiring definitive repair. These hernias are a late complication after stoma closure and likely why they are under-reported in the literature.

scholarly journals Obesity, Aspirin, and Risk of Colorectal Cancer in Carriers of Hereditary Colorectal Cancer: A Prospective Investigation in the CAPP2 Study

2015 ◽  
Vol 33 (31) ◽  
pp. 3591-3597 ◽  
Author(s):  
Mohammad Movahedi ◽  
D. Timothy Bishop ◽  
Finlay Macrae ◽  
Jukka-Pekka Mecklin ◽  
Gabriela Moeslein ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Body Mass Index ◽  
Body Mass ◽  
Reference Group ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Normal Weight ◽  
Obese People ◽  
Msh6 Mutation

Purpose In the general population, increased adiposity is a significant risk factor for colorectal cancer (CRC), but whether obesity has similar effects in those with hereditary CRC is uncertain. This prospective study investigated the association between body mass index and cancer risk in patients with Lynch syndrome (LS). Patients and Methods Participants with LS were recruited to the CAPP2 study, in which they were randomly assigned to receive aspirin 600 mg per day or aspirin placebo, plus resistant starch 30 g per day or starch placebo (2 × 2 factorial design). Mean intervention period was 25.0 months, and mean follow-up was 55.7 months. Results During follow-up, 55 of 937 participants developed CRC. For obese participants, CRC risk was 2.41× (95% CI, 1.22 to 4.85) greater than for underweight and normal-weight participants (reference group), and CRC risk increased by 7% for each 1-kg/m2 increase in body mass index. The risk of all LS-related cancers in obese people was 1.77× (95% CI, 1.06 to 2.96; P = .03) greater than for the reference group. In subgroup analysis, obesity was associated with 3.72× (95% CI, 1.41 to 9.81) greater CRC risk in patients with LS with MLH1 mutation, but no excess risk was observed in those with MSH2 or MSH6 mutation (P = .5). The obesity-related excess CRC risk was confined to those randomly assigned to the aspirin placebo group (adjusted hazard ratio, 2.75; 95% CI, 1.12 to 6.79; P = .03). Conclusion Obesity is associated with substantially increased CRC risk in patients with LS, but this risk is abrogated in those taking aspirin. Such patients are likely to benefit from obesity prevention and/or regular aspirin.

Using Prophylactic Prolene Mesh to Reduce the Incidence of Incisional Hernia at the Site of Stoma Closure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hassan Sayed Tantawy ◽  
Mohamed Mahfouz Mohamed ◽  
Ahmed Yasser Abdel Halim ◽  
Mostafa Mohamed Abdel Aziz
Keyword(s):  
Incisional Hernia ◽  
Prospective Study ◽  
Clinical Examination ◽  
Stoma Closure ◽  
Prolene Mesh ◽  
Incisional Hernias ◽  
Stoma Site ◽  
A Prospective Study ◽  
Over Time

Abstract Background Incisional hernias at stoma sites are not an infrequent problem, occurring in up to 30% of cases and it also varied in a range of studies from 0-48%. Objectives This is a prospective study to detect the feasibility of application of prolene mesh at the site of stoma closure in reducing the rate of post stomal incisional. INTRODUCTION Abdominal wall hernias are common and are a significant cause of morbidity. Stomas are commonly constructed following colorectal surgery to protect distal anastomosis or when sepsis prevents primary anastomosis. There is a risk of a wide range of morbidity following both stoma formation and stoma reversal (Chow et al., 2009). Incisional hernias at stoma sites are not an infrequent problem, occurring in up to 30% of cases and it also varied in a range of studies from 0-48% (Tilney et al., 2008). They occur over time and are generally under-reported, which may be due to the elderly nature of the population, the significant co-morbidities or early discharge from follow-up (Cingi et al., 2006). One in three patients may develop a hernia after stoma closure, and around half of hernias that are detected require repair.Risk of hernia is greater after colostomy closure than after ileostomy closure(Bhangu et al., 2012). A meta-analysis published in 2012 investigated the incidence of incisional hernia following closure of stoma, The overall mean incisional hernia rate following stoma closures was 7.4%. The authors reported a lower risk of hernia following reversal of ileostomy when compared to respectively (Bhangu et al., 2012). A further systematic review found a similar incidence for stoma site incisional hernias to be 8.3% (0–33.9%) (Nguyen et al., 2014). Two factors should be noted with regard to the incidence of stoma site hernia. Firstly, that the long-term risk is not known and secondly, that clinical examination alone is shown to have a lower detection rate of incisional hernia post stoma closure when compared to clinical imaging (Bhangu et al., 2012; Cingi et al., 2006). Therefore, studies focusing on only clinical examination may be underestimating the prevalence, as radiological detected herniae may become symptomatic over time and may be missed in studies with a short follow-up period. AIM OF THE WORK This is a prospective study to detect the feasibility of application of prolene mesh at the site of stoma closure in reducing the rate of post stomal incisional.

Increased Body Mass Index but Not Common Vitamin D Receptor, Peroxisome Proliferator–Activated Receptor γ, or Cytokine Polymorphisms Confers Predisposition to Posttransplant Diabetes

2011 ◽  
Vol 135 (12) ◽  
pp. 1581-1584 ◽  
Author(s):  
Ping Wang ◽  
Elissa Hudspeth
Keyword(s):  
Body Mass Index ◽  
Vitamin D ◽  
Body Mass ◽  
Vitamin D Receptor ◽  
Solid Organ Transplantation ◽  
Significant Risk ◽  
Peroxisome Proliferator ◽  
Solid Organ ◽  
Peroxisome Proliferator Activated Receptor

Context.—Posttransplant diabetes mellitus (PTDM) is a major complication after solid organ transplantation. The use of corticosteroids and calcineurin inhibitors, especially tacrolimus, are significant risk factors. However, it is not clear what genetic factors modify the risk. Evidence suggests vitamin D deficiency, perturbed glucose homeostasis, and increased inflammation all play roles in the development of diabetes. Objective.—To investigate whether common vitamin D receptor (VDR), cytokine, and peroxisome proliferator–activated receptor γ (PPARγ) polymorphisms are correlated with the development of PTDM. Design.—DNA was isolated from the peripheral blood of 51 kidney transplant recipients with PTDM and 72 patients without diabetes pretransplant or posttransplant at the time of follow-up. The genotypes for 5 polymorphisms, 1 each in VDR, PPARγ, INFγ, TGFβ1, and TNF, were determined using direct sequencing. Age, sex, number of acute rejection episodes, follow-up length, ethnicity, body mass index, and the frequency of alleles and genotypes for each polymorphism were compared between the 2 groups. Results.—Body mass index was the only factor that was statistically different between the 2 groups (P  =  .001). The frequency of different alleles and genotypes for each of the 5 polymorphisms did not differ between the 2 groups. Conclusions.—These results indicate that increased body mass index is a significant risk factor for the development of PTDM. However, none of the genetic polymorphisms studied confer predisposition to PTDM with the current sample size.

scholarly journals P013 HOW TO IMPROVE TREATMENT OF COMPLEX INCISIONAL HERNIAS IN OBESE PATIENTS: A SINGLE-CENTRE STUDY, AN EVALUATION OF LESS-OPEN TECHNIQUE AND FREE-FIXATION TECHNIQUE

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Petr Bystřický ◽  
Stanislav Šuhájek ◽  
Petr Pták
Keyword(s):  
Length Of Stay ◽  
Incisional Hernia ◽  
Operation Time ◽  
Component Separation ◽  
Separation Technique ◽  
Obese Patients ◽  
Open Technique ◽  
Posterior Component Separation ◽  
Incisional Hernias

Abstract Aim Surgery of a complex incisional hernia in an obese patient is a challenging procedure for hernia surgeons. The aim of a new approach is to reduce complications such as pain and wound events, without increasing the number of recurrences. Material and Methods Adults with BMI more than 35 who underwent open, elective operation of a complex incisional hernia (with horizontal diameter more than 12cm) including posterior component separation technique with TAR (transversus abdominis muscle release) and retromuscular synthetic large-pore mesh placement, were identified. Patients were divided into 2 groups: The first group was treated with standard open technique with fixation using interrupted stitches, and the second group was treated with a technique using light hook and no or reduced fixation in the upper and lower pole of the mesh. For post-operative complication evaluation, the Clavien-Dindo classification was used. We have also evaluated an average operation time, length of stay, duration of opioid need. The long-term follow-up was 6 – 48 months. Results There was no significant difference in length of stay, the need of analgetic treatment, and hernia recurrence. Shorter operation time, and lower occurrence of surgical-site infections were reported in the second group, but it was not significant. Conclusions Open posterior component separation technique with TAR using large-pore mesh and no/minimal fixation seems to be a safe and sufficient method of treatment for complex incisional hernias in obese patients. Alternative methods may reduce early complications and pain and do not increase number of recurrences. A larger group of patients and longer follow-up should be needed to improve these findings.

scholarly journals P526 Body mass index and response to TNF-α inhibitors in inflammatory bowel disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S453-S453
Author(s):  
F Nordin ◽  
B Shadbolt ◽  
K Subramaniam
Keyword(s):  
Body Mass Index ◽  
Inflammatory Bowel Disease ◽  
Body Mass ◽  
Bowel Disease ◽  
Significant Risk ◽  
Chimeric Antibody ◽  
Loss Of Response ◽  
Number Of Patients ◽  
Tnf Α ◽  
Inflammatory Bowel

Abstract Background Obesity is an emerging issue in the care of patients with inflammatory bowel disease (IBD). The aim of the study was to evaluate whether the response to TNF-α inhibitors (infliximab and adalimumab) could be influenced by body mass index (BMI) in IBD. Unlike adalimumab (ADA), a recombinant humanised IgG antibody against (TNF-α), the dosing of infliximab (IFX); a monoclonal chimeric antibody is weight-based. Methods We identified a cohort of patients with IBD at a single centre, naïve to biologic therapy and stratified them according to their weight and BMI. The primary outcome is the first occurrence of loss of response defined as clinical deterioration requiring hospitalisation, surgery, corticosteroid use, dose escalation or discontinuation of therapy and/or evidence of activity on endoscopy. Patients were followed up for 4 years. Multivariate analysis with logistic regression were used to compare variables. Results There was a total of 104 IBD patients; 51% (n = 53) were males and the median age was 40 years (19–76 years). The majority (n = 89; 85.6 %) had Crohn’s disease and the rest (n = 15; 14.4%) were diagnosed with ulcerative colitis. The median BMI was 24.5 kg/m2 (13.4–41.5 kg/m2). Patients had been diagnosed with IBD for a total median duration of 13 years (1–50 years). The majority of patients were not active smokers (n = 92; 88.5%) with the rest being current smokers (n = 12; 11.5%). Of the 104 patients, there were an equal number of patients in the IFX (n = 52) and ADA (n = 52) groups. There were no differences in the demographics, types of disease and BMI distribution in the two groups. In terms of loss of response, type of drug (IFX/ADA) was not found to be a significant risk factor (p = 0.250) along with the type of IBD (p = 0.420), age (p = 0.612) and gender (p = 0.600). However, the duration of disease was a significant factor (p = 0.026). There was a trend of accelerated time to loss of response for patients with BMI ≥30 kg/m2, in ADA group, but not significant (p = 0.314) compared with IFX of the same BMI group (Figure 1). For BMI <30 kg/m2 in both groups, there was no difference in time to loss of response (p = 0.259). However, patients on ADA with BMI ≥30 kg/m2 had a significant loss of response compared with patients on IFX with BMI <30 kg/m2 (adjusted HR 5.6; p = 0.038). Conclusion BMI appears to be important in predicting loss of response in IBD however we found no overall association between increased BMI and accelerated loss of response. Further larger studies are needed to evaluate the relationship of BMI and loss of response to ADA.

scholarly journals Surgical proficiency decreases the rate of healing abnormalities using anterior transobturator mesh in cystocele women

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2662
Author(s):  
Jin-Sung Yuk ◽  
Yong Jin Kim ◽  
Kyong Wook Yi ◽  
Jun-Young Hur ◽  
Jung-Ho Shin
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Operation Time ◽  
Bladder Perforation ◽  
University Hospital ◽  
Cure Rate ◽  
Case Volume ◽  
Surgical Case ◽  
Transobturator Mesh

Aims: The objective of this study is to report the outcomes of cystocele repair with anterior transobutrator mesh kits.  Methods: 119 consecutive women with cystoceles were treated between January 2006 and November 2010 by a single surgeon at a university hospital using the anterior transobturator mesh kit procedure. Postoperative follow-up visits were scheduled at 1, 6, and 12 months after surgery. Results: A total of 114 women who were operated on with the anterior transobturator mesh kit completed 12 months of follow-up. The population had a mean age of 65.8 ± 7.0, a body mass index of 25.1 ± 3.0, and a parity average of 4.0 ± 1.7. An overall anatomic cure was reported for 108 patients (94.7%). The Ba point of the POP-Q exam used for grading cystoceles decreased significantly from 2.5 ± 1.6 cm to -2.8 ± 0.8 cm after 12 months (P < 0.01). One patient (0.9%) presented with bladder perforation, and five patients (4.4%) showed with healing abnormalities. Surgical case volume was negatively correlated with healing abnormalities after adjusting for age, body mass index, operation time, and parity (P = 0.15).  Conclusion: The surgeon’s experience decreases the incidence of healing abnormalities using anterior transobturator mesh in cystocele women. The anatomical cure rate of anterior transobturator mesh is quite good.

STEROID RECEPTOR PHENOTYPE, EXPRESSION OF HER-2/NEU, PD-1, PD-L1 AND LYMPHOCYTIC-MACROPHAGAL INFILTRATION OF ENDOMETRIAL CARCINOMAS: COMPARISON OF MODERN MOLECULAR BIOLOGICAL TYPES OF THE DISEASE (THE ROLE OF BODY MASS INDEX)

2020 ◽  
Vol 66 (1) ◽  
pp. 71-78
Author(s):  
Lev Bershteyn ◽  
Aleksandr Ivantsov ◽  
Aglaya Ievleva ◽  
A. Venina ◽  
I. Berlev
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Tumor Tissue ◽  
Immunohistochemical Analysis ◽  
The Body ◽  
Molecular Profile ◽  
Total N ◽  
Number Of Patients ◽  
Her 2

The aim of this study was to evaluate steroid receptors’ status of tumor tissue in different molecular biological types of endometrial cancer (EC), subdivided according to the current classification, and their colonization by lymphocytic and macrophage cells, taking into account body mass index of the patients. Materials and methods: Material from treatment-naive patients with EC (total n = 229) was included; the number of sick persons varied depending on the method used. The average age of patients was close to 60 years, and about 90% of them were postmenopausal. It was possible to divide the results of the work into two main subgroups: a) depending on the molecular biological type of the tumor (determined on the basis of genetic and immunohistochemical analysis), and b) depending on the value of the body mass index (BMI). The latter approach was used in patients with EC type demonstrating a defective mismatch repair of the incorrectly paired nucleotides (MMR-D) and with a type without characteristic molecular profile signs (WCMP), but was not applied (due to the smaller number of patients) in EC types with a POLE gene mutation or with expression of the oncoprotein p53. According to the data obtained, when comparing various types of EC, the lowest values of Allred ER and PR scores were revealed for POLE-mutant and p53 types, while the “triple-negative” variant of the tumor (ER-, PR-, HER2/neu-) was most common in POLE-mutant (45.5% of cases) and WCMP (19.4%) types of EC. The p53+ type of EC is characterized by inclination to the higher expression of the macrophage marker CD68 and lymphocytic Foxp3, as well as mRNA of PD-1 and SALL4. In addition to the said above, for WCMP type of EC is peculiar, on the contrary, a decrease in the expression of lymphocytic markers CD8 (protein) and PD-L1 (mRNA). When assessing the role of BMI, its value of >30.0 (characteristic for obesity) was combined with an inclination to the increase of HER-2/neu expression in the case of MMR-D EC type and to the decrease of HER-2 /neu, FOXp3 and ER expression in WCMP type. Conclusions: The accumulated information (mainly describing here hormonal sensitivity of the tumor tissue and its lymphocytic-macrophage infiltration) additionally confirms our earlier expressed opinion that the differences between women with EC are determined by both the affiliation of the neoplasm to one or another molecular biological type (subdivided according to the contemporary classification), as well as by body mass value and (very likely) the associated hormonal and metabolic attributes.

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