Should simultaneous stoma closure and incisional hernia repair be avoided?

Purpose Patients scheduled for stoma closure may also have an incisional hernia. Studies have reported acceptable outcomes after contaminated ventral hernia repair, but whether stoma closure and incisional hernia repair should be performed as a combined procedure is unknown. This study examined combined stoma closure and incisional hernia repair compared with incisional hernia repair only. Methods This was a nationwide propensity-score matched study. Patients who underwent elective incisional hernia repair from 2007-2017 were identified in the Danish Hernia Database. All patients who underwent concurrent stoma closure were matched 1:3 with patients who underwent incisional hernia repair only. The primary outcome was reoperation for hernia recurrence, whereas secondary outcomes included anastomotic leakage, length of hospital stay, and 30-day reoperation and readmission rates. Results In total, 516 patients were included. The risk of reoperation for recurrence was increased after concurrent stoma closure compared with incisional hernia repair only (hazard ratio 1.69, 95% confidence interval 1.01-2.82,p = 0.044). Seven (5.4%) patients who underwent incisional hernia repair concurrent to stoma closure were reoperated for anastomotic leakage. Length of hospital stay and reoperation rates within 30 days were increased after concurrent stoma closure compared with incisional hernia repair only (median 8 versus 3 days,p < 0.001 and 29.5% versus 18.6%,p = 0.013), whereas there was no difference in 30-day readmission rates (p = 0.251). Conclusions Stoma closure and incisional hernia repair should be performed as a dual-stage procedure to decrease the risk of hernia recurrence.

Automated summary

This study compared the outcomes of combined stoma closure and incisional hernia repair with incisional hernia repair only, finding that the risk of hernia recurrence reoperation was increased after concurrent stoma closure. Patients who underwent concurrent stoma closure also had longer hospital stays and higher 30-day reoperation rates compared to those who underwent incisional hernia repair only.