Stoma creation is associated with a low incidence of midline incisional hernia after colorectal surgery: the "fighting over the fascia" theory concerning the incision and stoma hole
Stoma creation is associated with a low incidence of midline incisional hernia after colorectal surgery: the "fighting over the fascia" theory concerning the incision and stoma hole
复制标题
造口创建与结直肠手术后中线切口疝的低发生率相关：关于切口和造口孔的“筋膜之争”理论
DOI：
10.1007/s00595-021-02434-y
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Tomoki Ebata
中科院分区：
文献类型：
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作者：
Noriaki Ohara;Kay Uehara;Atsushi Ogura;Masanori Sando;Toshisada Aiba;Yuki Murata;Takashi Mizuno;Kokuryo Toshio;Yukihiro Yokoyama;Satoko Ishigaki;Yuanying Li;Hiroshi Yatsuya;Tomoki Ebata
目的结直肠吻合术后造口旁疝（PH）发生率高于切口疝（IH）。本研究评估了我们的假设，即闭合中线切口时筋膜向内牵引会扩大吻合口并增加PH的发生率。方法回顾性分析了2006年至2016年期间共795例接受结直肠切除术的患者。从非造口组中提取的IH风险因素构建风险分类。然后，分类外推到造口组预测中线IH和PH.ResultsThe IH的发病率为5.3%的造口组和12.5%的非造口组（P= 0.005）。97例永久性造口患者中19.6%发生PH。风险分类是能够预测PH值没有显着差异，但在永久性造口的患者是平衡的，但是，它未能预测IH的造口group.ConclusionThe风险分类构建的非造口组是有用的预测不中线IH，但PH值，这表明造口部位是最脆弱的疝。中线切口与造口之间的“筋膜之争”理论可以解释中线IH与PH之间的因果关系。
PurposeParastomal hernia (PH) develops more frequently than incisional hernia (IH) after colorectal surgery with stoma. This study evaluated our hypothesis that inward traction of the fascia when closing a midline incision widens the stoma hole and increases the incidence of PH.MethodsA total of 795 patients who underwent colorectal resection between 2006 and 2016 were retrospectively analyzed. The risk classification was constructed from IH risk factors extracted from the non-stoma group. Then, the classification was extrapolated to the stoma group for predicting midline IH and PH.ResultsThe incidence of IH was 5.3% in the stoma group and 12.5% in the non-stoma group (p= 0.005). PH developed in 19.6% of 97 patients with permanent stoma. The risk classification was able to predict PH without a significant difference but was well balanced in patients with permanent stoma; however, it failed to predict IH in the stoma group.ConclusionThe risk classification constructed from the non-stoma group was useful for predicting not midline IH but PH, suggesting that the stoma site was the most vulnerable for herniation. The “fighting over the fascia” theory between the midline incision and stoma hole may explain the causal relationship between the midline IH and PH.