Incisional hernia (IH) can be attributed to multiple factors. The presence of a parastomal hernia has shown to be a risk factor for IH after midline laparotomy. Our hypothesis is that this increased risk of IH may be caused by changes in biomechanical forces, such as midline shift to the contralateral side of the colostomy owing to decreased restraining forces at the site of the colostomy, and left abdominal rectus muscle (ARM) atrophy owing to intercostal nerve damage.
Patients were selected if they underwent end-colostomy via open operation between 2004 and 2011. Patients were eligible if computed tomography (CT) had been performed postoperatively. If available, preoperative CTs were collected for case-control analyses. Midline shift was measured using V-scope application in the I-space, a CAVE-like virtual reality system. For the ARM atrophy hypothesis, measurements of ARM were performed at the level of colostomy, and 3 and 8 cm cranial and caudal of the colostomy.
Postoperative CT were available for 77 patients; of these patients, 30 also had a preoperative CT. Median follow-up was 19 months. A mean shift to the right side was identified after preoperative and postoperative comparison; from −1.3 ± 4.6 to 2.1 ± 9.3 (P = .043). Furthermore, during rectus muscle measurements, a thinner left ARM was observed below the level of colostomy.
Creation of a colostomy alters the abdominal wall. Atrophy of the left ARM was seen caudal to the level of the colostomy, and a midline shift to the right side was evident on CT. These changes may explain the increased rate of IH after colostomy creation
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Published online: January 06, 2014
Accepted: December 30, 2013
© 2014 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
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- Can we avoid rectus abdominis muscle atrophy and midline shift after colostomy creation?SurgeryVol. 157Issue 1
- PreviewWe all understand that the creation of a colostomy alters the integrity, compliance, and durability of the anterior abdominal wall in more ways that can be fully appreciated. Furthermore and despite the careful construction of a stoma, which equates to an “iatrogenic” hernia, it is often difficult to comprehend why a number of patients later develop herniation. Indeed, we have all been surprised at the size of the defect when needing to repair a symptomatic hernia at a stoma that had earlier been constructed so carefully.