J Korean Surg Soc.  2011 Aug;81(2):111-114. 10.4174/jkss.2011.81.2.111.

Computed tomography classification for parastomal hernia

• Seo SH
• Kim HJ
• Oh SY
• Lee JH
• Suh KW

• KMID: 2096664
• DOI: http://doi.org/10.4174/jkss.2011.81.2.111

Abstract

PURPOSE
The aim of this study was to investigate the clinical and radiological incidence of parastomal hernia.
METHODS
We reviewed, retrospectively, 83 patients with end colostomy operated on from January 2003 to June 2009 at Ajou University hospital. Age, sex, surgical procedure type, body mass index (weight/length2), stoma size, and respiratory co-morbidity were documented. We compared the incidence of radiological and clinical parastomal hernia.
RESULTS
There were 47 males (56.6%) and 36 females (43.4%). During an overall median follow-up of 30 months (range, 6 to 45 months), 24 patients (28.9%) developed a radiological parastomal hernia postoperatively and 20 patients (24.1%) presented clinical symptoms. Using computed tomography (CT) classification, the groups were as follows: type 0 (40, 48.2%), type Ia (19, 22.9%), type Ib (8, 9.6%), type II (4, 4.8%) and type III (12, 14.5%), with 63 asymptomatic patients and 20 symptomatic patients. The aperture size was significantly different between symptomatic and asymptomatic patients (76.45 mm vs. 49.41 mm; P = 0.000). There was a significant correlation between aperture size and the radiological type (P = 0.003).
CONCLUSION
This study showed the incidence of radiological parastomal hernia is acceptable compared to previous studies. CT classification may be useful to evaluate parastomal hernia.

Keyword

Parastomal hernia; Computed tomography; End colostomy

MeSH Terms

Colostomy
Female
Follow-Up Studies
Hernia
Humans
Incidence
Male
Retrospective Studies
Somatotypes

Reference

1. Pearl RK. Parastomal hernias. World J Surg. 1989. 13:569–572.

2. Martin L, Foster G. Parastomal hernia. Ann R Coll Surg Engl. 1996. 78:81–84.

3. Marimuthu K, Vijayasekar C, Ghosh D, Mathew G. Prevention of parastomal hernia using preperitoneal mesh: a prospective observational study. Colorectal Dis. 2006. 8:672–675.

4. Carne PW, Robertson GM, Frizelle FA. Parastomal hernia. Br J Surg. 2003. 90:784–793.

5. Sjödahl R, Anderberg B, Bolin T. Parastomal hernia in relation to site of the abdominal stoma. Br J Surg. 1988. 75:339–341.

6. Etherington RJ, Williams JG, Hayward MW, Hughes LE. Demonstration of para-ileostomy herniation using computed tomography. Clin Radiol. 1990. 41:333–336.

7. Cheung MT, Chia NH, Chiu WY. Surgical treatment of parastomal hernia complicating sigmoid colostomies. Dis Colon Rectum. 2001. 44:266–270.

8. Carne PW, Frye JN, Robertson GM, Frizelle FA. Parastomal hernia following minimally invasive stoma formation. ANZ J Surg. 2003. 73:843–845.

9. Cingi A, Cakir T, Sever A, Aktan AO. Enterostomy site hernias: a clinical and computerized tomographic evaluation. Dis Colon Rectum. 2006. 49:1559–1563.

10. Moreno-Matias J, Serra-Aracil X, Darnell-Martin A, Bombardo-Junca J, Mora-Lopez L, Alcantara-Moral M, et al. The prevalence of parastomal hernia after formation of an end colostomy. A new clinico-radiological classification. Colorectal Dis. 2009. 11:173–177.

11. Londono-Schimmer EE, Leong AP, Phillips RK. Life table analysis of stomal complications following colostomy. Dis Colon Rectum. 1994. 37:916–920.

12. Israelsson LA. Preventing and treating parastomal hernia. World J Surg. 2005. 29:1086–1089.

13. Serra-Aracil X, Bombardo-Junca J, Moreno-Matias J, Darnell A, Mora-Lopez L, Alcantara-Moral M, et al. Randomized, controlled, prospective trial of the use of a mesh to prevent parastomal hernia. Ann Surg. 2009. 249:583–587.