When to use a prophylactic mesh after stoma closure: a case–control study

Purpose The closure of a stoma is frequently associated with an acceptable morbidity and mortality. One of the most frequent complications is incisional hernia at the stoma site, which occurs in 20%–40% of cases, higher than incisions in other parts of the abdomen. The objective of this study was to identify the risk factors associated with the presentation of incisional hernia after stoma closure, this in order to select patients who are candidates for prophylactic mesh placement during closure. Methods An unpaired case–control study was conducted. This study involved 164 patients who underwent a stoma closure between January 2014 and December 2019. Associated factors for the development of incisional hernia at the site of the stoma after closure were identified, for which it was performed a logistic regression analysis. Results 41 cases and 123 controls were analyzed, with a mean follow-up of 35.21 ± 18.42 months, the mean age for performing the stoma closure was 65.28 ± 14.07 years, the most frequent cause for performing the stoma was malignant disease (65.85%). Risk factor for the development of incisional hernia at the stoma site after its closure was identified as a history of parastomal hernia (OR 5.90, CI95% 1.97–17.68). Conclusions The use of prophylactic mesh at stoma closure should be considered in patients with a history of parastomal hernia since these patients present a significantly higher risk of developing a hernia.

Surgical treatment of stoma-related hernias: retrospective cohort study of damage claims to the Swedish National Patient Insurance Company 2010–2016

Background Parastomal hernia and stoma-site hernia are common stoma complications. Parastomal hernia repair is associated with high complication and recurrence rates. Insurance data can provide novel information on the consequences of perioperative complications from the patient’s point of view. The aim was to investigate what types of complications associated with stoma-related hernia surgery that cause patients to apply for economic compensation through the patient insurance system and to investigate demographic and clinical differences among cases based on gender and type of center at which the surgery was performed. Methods A national patient damage claim database was searched for ICD-10 codes related to parastomal and stoma-site hernia surgery over a seven-year period. Medical records were screened for claims associated with parastomal hernia repair, relocation or reversal due to parastomal hernia, or stoma-site hernia repair. Claims were classified according to one of four primary complaints: surgical, anesthetic, medical or other. Clinical and demographic differences between genders and hospital types were investigated. Reasons for non-compensation were analyzed. Results Thirty claims met the inclusion criteria. Eighteen were related to parastomal hernia repair, seven to stoma-site hernia repair, three to stoma reversal and two to relocation due to parastomal hernia. Twenty-five claims were primarily surgical, two related to anesthesia and three classified as other. Seven claims were granted compensation. No demographic or clinical differences were found apart from female gender being associated with previous parastomal hernia repair [6 women and 0 men (p = 0.02)]. Conclusion Surgical complaints predominated. Few claims were compensated, reflecting the complexity and unsatisfactory outcomes of these procedures. Many claims were identified in relation to the incidence of stoma-related hernia surgery. Trial registration Due to its retrospective and descriptive nature, the study was not registered in any registry.

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

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.

Feeding gastrostomy stoma site cutaneous myiasis: a rare entity

Infestation of any dead or necrotic tissues by the larvae of flies (maggots) is myiasis. This form of habitation is not restricted to any particular tissues in the body and can occur anywhere. However, myiasis at the surgical stoma site is very rare. We present a 55-year-old woman diagnosed with metastatic carcinoma of the oesophagus who underwent feeding gastrostomy (FG). The patient later presented with worms at the FG site. We removed the FG tube, cleared all the maggots, thoroughly cleaned the wound and placed a new FG tube. Although its occurrences have been reported enough in medical history, there are only two documented cases of percutaneous endoscopic gastrostomy stoma site myiasis. Hence, we present the first case in the literature of cutaneous myiasis around an FG stoma site.

The effect of preoperative stoma site marking on risk of stoma-related complications in patients with intestinal ostomy—protocol of a systematic review and meta-analysis

Background An intestinal ostomy is an artificial bowel opening created on the skin. Procedure-related mortality is extremely rare. However, the presence of an ostomy may be associated with significant morbidity. Complications negatively affect the quality of life of ostomates. Preoperative stoma site marking can reduce stoma-related complications and is recommended by several guidelines. However, there is no consensus on the procedure and recommendations are based on low-quality evidence. The objective of the systematic review will be to investigate if preoperative stoma site marking compared to no preoperative marking in patients undergoing intestinal stoma surgery reduces or prevents the rate of stoma-related complications. Methods We will include (cluster-) randomised controlled trials and cohort studies that involve patients with intestinal ostomies comparing preoperative stoma site marking to no preoperative marking and report at least one patient-relevant outcome. For study identification, we will systematically search MEDLINE/PubMed, EMBASE, CENTRAL and CINHAL as well as Google Scholar, trial registries, conference proceedings and reference lists. Additionally, we will contact experts in the field. Two reviewers will independently perform study selection and data extraction. Outcomes will be prioritised based on findings from telephone interviews with five ostomates and five ostomy and wound nurses prior to conducting the review. Outcomes may include but are not limited to stoma-related complications (infection, parastomal abscess, hernia, mucocutaneous separation, dermatological complications, stoma necrosis, stenosis, retraction and prolapse) or other patient-relevant postoperative endpoints (quality of life, revision rate, dependence on professional care, mortality, length of stay and readmission). We will use the ROBINS-I or the Cochrane risk of bias tool to assess the risk of bias of the included studies. We will perform a meta-analysis and assess the certainty of evidence using the GRADE approach. Discussion With the results of the systematic review, we aim to provide information for future clinical guidelines and influence clinical routine with regard to preoperative stoma site marking in patients undergoing ostomy surgery. When the evidence of our systematic review is low, it would still be a useful basis for future clinical trials by identifying data gaps. Systematic review registration PROSPERO registration number: CRD42021226647

The effect of pre-operative stoma-site marking on peristomal skin health and quality of life

Aim: To determine the effect of pre-operative stoma-site marking (siting) on ostomates' peristomal skin health and quality of life (QoL). Methods: The Uses and Attitudes in Ostomy (U&A Ostomy) study was conducted across 148 stoma units in Spain. Specialist stoma care nurses personally assessed each ostomate and collected demographic and clinical data. This included whether the stoma was sited before surgery, the stoma's characteristics, the type of appliance used, any stoma-related complications and frequency of leakage. Participants were also assessed using the Discolouration, Erosion, Tissue overgrowth (DET) Ostomy Skin Tool (0–15), Global Wellbeing scale (0–10) and Stoma-QoL scale (0–100). Findings: The study included 871 ostomates. Of these, 64% were male and 36% were female, the mean age was 64±13 years and the mean BMI was 26.5±11; 57.5% had a colostomy, 28.6% had an ileostomy and 13.9% had a urostomy. A stoma site had been pre-operatively marked and respected in 53.1%, marked but not respected in 2.1% and not marked in 44.8% of the cases. The proportion of new ostomates whose stoma had been sited was seen to have increased in recent years. Stoma siting was associated with a permanent ostomy (p=.0001), absence of effluent leakage (p=.008), absence of complications (p<.0001), lower DET score (p.0007), higher Stoma-QoL score (p=.018) and higher global wellbeing score (p=.0018). Multivariate analysis revealed that pre-operative stoma siting (p<.0001) and type of ostomy (p<.0001) were independent predictors of optimal peristomal skin (DET score 0). The Stoma-QoL score was higher in ostomates with pre-operative stoma siting (58.3±10.2 vs 57±10.3; p=.018). Global wellbeing was also higher in those with pre-operative stoma siting (7.6±1.8 vs 7.19±1.9; p=.0018). Conclusions: In Spain, pre-operative stoma siting is not yet consistently applied in practice, despite the educative efforts made by health professionals. Stoma siting is a first-line opportunity to reduce the occurrence of peristomal skin complications (PSCs), and thus it is associated with fewer PSCs and greater self-perceived QoL. More effort is needed to extend this practice to the majority of patients undergoing stoma-forming surgery.