A clinical and radiological assessment of incisional hernias following closure of temporary stomas

Aims: The rate of incisional hernia at stoma closure sites is unclear. This study aimed to describe this rate in patients with closed stomas who had definitive post-operative imaging of their abdominal wall. Methods: A retrospective review of patients who had undergone stoma reversal and had a CT or MRI scan of the abdomen >= 2 months following reversal was performed. A radiologist, blinded to the original radiological report and clinical results, reviewed all scans for abdominal wall herniation. This was correlated to documented clinical findings. Results: Fifty-nine patients were included: 49 loop ileostomy and 10 end colostomy reversals. CT scans were performed for 57 patients and MRI for two. The median time from closure to imaging was 10 months (range 3-32 months). The combined clinical and radiological hernia rate was 34% (20/59). Imaging alone produced a rate of 31% (18/59). The clinical rate of hernia detection was 14% (8/59). Using the rate of clinical herniation as the detection standard, imaging had a low positive predictive value (33%, 6/18) but a high negative predictive value (95%, 39/41). Four patients required surgical repair of their stoma site hernia (20%, 4/20). Conclusions: One in three patients undergoing stoma closure developed an incisional hernia. One in five of those with a hernia underwent surgical repair. Definitive imaging may provide an early surrogate marker for late clinically relevant hernias. Consideration of methods to prevent stoma closure site hernias should be considered. (C) 2012 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.