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Multicenter Study
. 2023 Jun 10;23(1):201.
doi: 10.1186/s12876-023-02805-4.

Incidence, risk factors, and predictive modeling of stoma site incisional hernia after enterostomy closure: a multicenter retrospective cohort study

Yonghuan Mao #  1   2 , Ling Xi #  3 , Chen Lu  4 , Ji Miao  1 , Qiang Li  5 , Xiaofei Shen  6 , Chunzhao Yu  7   8
Affiliations
Multicenter Study

Incidence, risk factors, and predictive modeling of stoma site incisional hernia after enterostomy closure: a multicenter retrospective cohort study

Yonghuan Mao et al. BMC Gastroenterol. .

Abstract

Purpose: Stoma site incisional hernia (SSIH) is a common complication, but its incidence and risk factors are not well known. The objective of this study is to explore the incidence and risk factors of SSIH and build a predictive model.

Methods: We performed a multicenter retrospective analysis on the patients who underwent enterostomy closure from January 2018 to August 2020. Patient's general condition, perioperative, intraoperative, and follow-up information was collected. The patients were divided into control group (no occurrence) and observation group (occurrence) according to whether SSIH occurred. Univariate and multivariate analysis were used to evaluate the risk factors of SSIH, following which we constructed a nomogram for SSIH prediction.

Results: One hundred fifty-six patients were enrolled in the study. The incidence of SSIH was 24.4% (38 cases), of which 14 were treated with hernia mesh repair, and the others were treated with conservative treatment. Univariate and multivariate analysis showed that age ≥ 68 years (OR 1.045, 95% CI 1.002 ~ 1.089, P = 0.038), colostomy (OR 2.913, 95% CI 1.035 ~ 8.202, P = 0.043), BMI ≥ 25 kg/m2 (OR 1.181, 95% CI 1.010 ~ 1.382, P = 0.037), malignant tumor (OR 4.838, 95% CI 1.508 ~ 15.517, P = 0.008) and emergency surgery (OR 5.327, 95% CI 1.996 ~ 14.434, P = 0.001) are the independent risk factors for SSIH.

Conclusions: Based on the results, a predictive model for the occurrence of SSIH was constructed to screen high-risk groups of SSIH. For patients at high risk for SSIH, how to deal with the follow-up and prevent the occurrence of SSIH is worth further exploration.

Keywords: Enterostomy closure; Prediction model; Risk factors; Stoma site incisional hernia (SSIH).

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Conflict of interest statement

This manuscript has not been previously submitted as a podium or poster presentation. The authors declare no commercial or competing interests.

Figures

Fig. 1
Fig. 1
a: a midline incision for end stoma; b: a stoma incision for loop stoma; c: anastomosis were mechanically sutured; d: postoperative of stoma closure; ●: original stoma site, hernia in this area is called stoma site incisional hernia (SSIH); ▲: midline incision, hernia in this area is called incisional hernia
Fig. 2
Fig. 2
Forest plot
Fig. 3
Fig. 3
Nomogram to predict the probability of SSIH. The nomogram is used by summing each patient-specific value identified on the scale for each variable. The total points projected on the end of the scales show the risk of SSIH. (SSIH, stoma site incisional hernia)
Fig. 4
Fig. 4
a Internally verified ROC curve; (b) and (c): cross validation ROC curve, (b) training cohort (109 cases), (c) validation cohort (47 cases)
Fig. 5
Fig. 5
Calibration plots of the nomogram, which is applied to predict the probability of SSIH occurrence in entire cohort (a), training cohort (b), and verification cohort (c)
See this image and copyright information in PMC

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