Prevalence of Parastomal Hernia and Factors Associated With Its Development

PURPOSE: The purpose of this study was to identify risk factors for development of a parastomal hernia (PH). DESIGN: Cross-sectional survey. SETTING AND SUBJECTS: The target population comprised 2854 persons receiving services from the Manitoba Ostomy Program. Seven hundred sixty-four responses were received, yielding a response rate of 29.3%. Respondents average age was 70 years (SD = 12.8); 425 (55.6%) had a colostomy, 236 (30.8%) had an ileostomy, 63 (8.2%) had a urostomy, and 40 (5.2%) indicated other types of stomas or fistula. INSTRUMENTS: A questionnaire was developed by the authors that collected the following data: demographics, relevant medical history, personal and lifestyle factors, surgery-related factors, pre- and postoperative care factors, and information about the presence of a PH and physical and lifestyle effects related to a PH. Devices to enable respondents to measure the size of their stoma and abdominal girth were included in the survey package. The survey tool took approximately 30 to 45 minutes to complete. METHODS: An informational pamphlet and introductory letter were mailed 2 weeks before the survey was mailed. This was followed by a reminder letter. Bivariate analyses were completed in order to identify potential associations between all variables and a diagnosis of a PH; multivariate analysis was then completed to determine which factors were associated with an increased likelihood of a PH. RESULTS: Significant univariate associations were found between a diagnosis of a PH and diverticulitis, cirrhosis, benign prostatic enlargement, previous diagnosis of hernia, a smoking history, type of ostomy, stoma size, and continuous variables age and abdominal girth. Multiple regression analysis indicated that patients who underwent stoma surgery for cancer had larger stomas (1.5 to >3 in), and a colostomy were more likely to develop a PH. CONCLUSIONS: The results of this study indicate that PHs are prevalent. Additional research is needed to determine more effective intervention for preventing and managing a PH.