Strategies for stoma reversal based on hernia surgery principles
10.7659/j.issn.1005-6947.2024.10.006
- VernacularTitle:基于疝外科理念的肠造口还纳策略
- Author:
Lu CHEN
1
;
Gengwen HUANG
Author Information
1. 中南大学湘雅医院疝和腹壁外科中心,湖南长沙 410008;中南大学湘雅医院普通外科,湖南长沙 410008;中南大学湘雅医院国家老年疾病临床医学研究中心,湖南长沙 410008
- Keywords:
Enterostomy;
Incisional Hernia;
Surgical Mesh
- From:
Chinese Journal of General Surgery
2024;33(10):1594-1599
- CountryChina
- Language:Chinese
-
Abstract:
Stoma reversal surgery is usually performed 3 to 6 months after a temporary stoma creation to restore intestinal continuity.The high incidence of stoma site incisional hernia(SSIH)after stoma closure is a significant concern,as the development of SSIH not only increases psychological and financial burdens on patients but also significantly raises medical risks and societal costs.Therefore,reducing the incidence of SSIH is of great practical importance.The fundamental strategy is to accurately identify high-risk patients based on known risk factors,which include:female sex,age ≥ 68 years,colostomy,BMI ≥ 25 kg/m2,malignancy,emergency surgery,existing parastomal hernia,concurrent midline incisional hernia,and postoperative wound complications,and to implement preventive measures in advance.Given that the abdominal wall defect caused by the stoma resembles the condition of bowel herniation in incisional hernias,applying the principles of incisional hernia repair during stoma reversal surgery-particularly for high-risk patients-can be beneficial.This involves the prophylactic use of a mesh during abdominal closure to reinforce the abdominal wall,which may help prevent the occurrence of incisional hernia without increasing the risk of surgical site infections or other adverse events.However,there is still debate over the optimal type of mesh to use during stoma reversal.In summary,stoma reversal incisions differ from standard abdominal incisions,and employing hernia repair principles for their closure may be a crucial strategy in preventing the development of SSIH.
