Study on clinical features and risk factors of stoma site incisional hernia after prophylactic ileostomy reversal        ZHANG Ye-qian*, DONG Zhong-yi, ZHANG Zi-zhen, et al. *Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200120, China
Corresponding author: ZHANG Zi-zhen, E-mail: zzzhang16@hotmail.com
ZHANG Ye-qian and DONG Zhong-yi are the first authors who contributed equally to the article
Abstract    Objective    To investigate the incidence and risk factors of stoma site incisional hernia (SSIH) after prophylactic ileostomy reversal for colorectal cancer.  Methods    A cohort was established with 249 colorectal cancer patients who had undergone ileostomy reversal from January 2017 to May 2018 in Renji Hospital, School of Medicine, Shanghai Jiao Tong University, and the clinical data were retrospectively analyzed. The occurrence of SSIH, confirmed by follow-up and imaging results, and risk factors related to SSIH were statistically analyzed.  Results    Among the cohort of 249 patients, 42 patients (16.9%) developed SSIH within one year after ileostomy reversal. Logistic regression analysis showed that there were significant differences between the SSIH group and non-SSIH group in patients' age>65 years, the complication of parastomal hernia, distance from primary tumor≥7 cm to anal margin, BMI>24, albumin level ratio (1 day after operation/before opertation) ≤0.85, incisional infection, complication of chronic obstructive pulmonary disease(COPD), and stoma size >2.5 cm (P<0.05). And, complication of parastomal hernia, the distance from the primary tumor to the anal margin≥7 cm, BMI>24, albumin level ratio(1day after the operation/before operation)≤0.85, incisional infection, and stoma size>2.5 cm were independent risk factors for SSIH.  Conclusion    SSIH is a long-term complication with a high incidence of after-prophylactic ileostomy reversal for colorectal cancer. There may be some measures to help reduce the risk of SSIH, such as avoiding prophylactic stoma oversize, preventing parastomal hernia, controlling BMI before the operation, improving albumin level, and preventing incision infection.