EP915 - Two-Layer Fascial Closure of Stoma Sites Dramatically Reduces the Risk of Incisional Hernia

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Purpose/Background: Temporary stoma creations such as an ileostomy or colostomy are widely utilized for a variety of pathologies, typically to prevent breakdown of a new anastomosis. However, the creation and subsequent reversal of stoma sites have various complications, including the development of hernias at the site of the previous stoma. The incidence of incisional hernias at stoma sites is around 10 to 20%, but studies have cited incidence rates anywhere from 0 to 49% . These hernias can elicit significant discomfort and dissatisfaction in patients, and in some severe cases of bowel incarceration can require emergent surgery. Our study sought to compare a novel two-layered stoma site closure technique to the standard single-layered closure technique that is pervasive.

Methods/Interventions: A retrospective review of all patients at a single institution with creation and subsequent reversal of their stomas was conducted in this study. 267 patients were identified who underwent stoma creation. All included patients must have undergone temporary loop stoma creation, either an ileostomy or colostomy, as well as subsequent reversal. Patients were excluded if they had previous stomas at the site as this may impact their predisposition to developing a hernia. Patients also needed to have a viewable CT scan more than three months after their reversal surgery. With these exclusions, we identified a cohort of 82 patients. These CT scans were reviewed by an attending radiologist to confirm the presence of a hernia at the previous stoma site. Competing risks analysis was used to assess the cumulative incidence of hernia following stoma reversal while accounting for death.

Results/Outcomes: In our cohort, 50 patients were male (62%), 46 had colorectal cancer (56.7%), and 47 (58.8%) had previous radiation therapy. The mean age was 57.9 (20.9-79.6). After a median follow up of 12 months (range 3-48 months), only 17 patients had radiographic evidence of incisional hernias at their previous stoma site. Of the 56 patients who underwent single layer fascial closure, 16 patients developed an incisional hernia at the reversal site (28.5%). Only one of the 25 patients closed with a two-layer fascial closure developed a hernia at reversal site (4%). Description was prioritized over inference in the analysis due to sample size limitations, so these differences were not found to be statistically significant.

Conclusion/Discussion: In our cohort, incisional hernias at sites of previous stoma reversal occurred in approximately one-fifth of patients. These data reflect values seen in the published literature for the development of these hernias in the general population. Our data suggest that patients who underwent two-layer fascial closure, or a separate closure of the anterior and posterior sheaths during reversal surgery, had fewer incisional hernias compared to those patients who underwent the traditional one-layer fascial closure. We believe that with a larger patient cohort, statistically significant levels could be reached. If true, utilizing two-layer fascial closures during stoma reversal surgery may help prevent incisional hernias from occurring.