Skip to main content
Log in

Parastomal hernia: clinical and radiological definitions

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Introduction

Parastomal hernia is a frequent complication after stoma formation. No consistent definition of parastomal hernia has been used in previous studies using clinical examination or computed tomography (CT) scan. The correlation between herniation rates found with clinical examination and CT scan has been poor. A definition of parastomal hernia with clinical examination that correlates with findings from CT scan should be sought.

Methods

Parastomal hernia, was with surgeons’ clinical examination, defined as any protrusion in the vicinity of the stoma with the patient straining in a supine and an erect position. A new CT scan method was developed with the patient examined in the prone position. Radiologists defined herniation as any intra-abdominal content protruding beyond the peritoneum or the presence of a hernia sac. The correlation between investigators and methods were estimated by calculating Fleiss’ Kappa values.

Results

Twenty-seven patients were assessed by three surgeons and three radiologists. For the surgeons, the Kappa value was 0.85. For the radiologists, it was 0.85 with CT scan in the prone position and 0.82 in the supine position. For the surgeons and radiologists collectively, the Kappa value was 0.80 for CT scan in the prone position and 0.63 in the supine position.

Conclusion

With the new CT scan method examining patients in the prone position, the clinical and radiological definitions were highly reproducible and correlated strongly between methods and raters. With the strong correlation between clinical and radiological assessments, clinical examination alone is sufficient as follow-up. Conventional CT scan with the patient supine is not a reliable tool for diagnosing parastomal hernia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2a, b

Similar content being viewed by others

References

  1. Israelsson LA (2008) Parastomal hernias. Surg Clin North Am 88:113–125

    Article  PubMed  Google Scholar 

  2. Carne PW, Robertson GM, Frizelle FA (2003) Parastomal hernia. Br J Surg 90:784–793

    Article  PubMed  CAS  Google Scholar 

  3. Cingi A, Cakir T, Sever A, Aktan AO (2006) Enterostomy site hernias: a clinical and computerized tomographic evaluation. Dis Colon Rectum 49:1559–1563

    Article  PubMed  Google Scholar 

  4. Jänes A, Cengiz Y, Israelsson LA (2004) Randomized clinical trial of the use of a prosthetic mesh to prevent parastomal hernia. Br J Surg 91:280–282

    Article  PubMed  Google Scholar 

  5. Jänes A, Cengiz Y, Israelsson LA (2009) Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study. World J Surg 33:118–121 discussion 122-3

    Article  PubMed  Google Scholar 

  6. Jänes A, Cengiz Y, Israelsson LA (2004) Preventing parastomal hernia with a prosthetic mesh. Arch Surg 139:1356–1358

    Article  PubMed  Google Scholar 

  7. Marimuthu K, Vijayasekar C, Ghosh D, Mathew G (2006) Prevention of parastomal hernia using preperitoneal mesh: a prospective observational study. Colorectal Dis 8:672–675

    Article  PubMed  CAS  Google Scholar 

  8. Hammond TM, Huang A, Prosser K, Frye JN, Williams NS (2008) Parastomal hernia prevention using a novel collagen implant: a randomised controlled phase 1 study. Hernia 12:475–481

    Article  PubMed  CAS  Google Scholar 

  9. Serra-Aracil X, Bombardo-Junca J, Moreno-Matias J, Darnell A, Mora-Lopez L, Alcantara-Moral M, Ayguavives-Garnica I, Navarro-Soto S (2009) Randomized, controlled, prospective trial of the use of a mesh to prevent parastomal hernia. Ann Surg 249:583–587

    Article  PubMed  Google Scholar 

  10. Gögenur I, Mortensen J, Harvald T, Rosenberg J, Fischer A (2006) Prevention of parastomal hernia by placement of a polypropylene mesh at the primary operation. Dis Colon Rectum 49:1131–1135

    Article  PubMed  Google Scholar 

  11. Ortiz H, Sara MJ, Armendariz P, de Miguel M, Marti J, Chocarro C (1994) Does the frequency of paracolostomy hernias depend on the position of the colostomy in the abdominal wall? Int J Colorectal Dis 9:65–67

    Article  PubMed  CAS  Google Scholar 

  12. Helgstrand F, Gögenur I, Rosenberg J (2008) Prevention of parastomal hernia by the placement of a mesh at the primary operation. Hernia 12:577–582

    Article  PubMed  CAS  Google Scholar 

  13. Moreno-Matias J, Serra-Aracil X, Darnell-Martin A, Bombardo-Junca J, Mora-Lopez L, Alcantara-Moral M, Rebasa P, Ayguavives-Garnica I, Navarro-Soto S (2009) The prevalence of parastomal hernia after formation of an end colostomy. A new clinico-radiological classification. Colorectal Dis 11:173–177

    Article  PubMed  CAS  Google Scholar 

  14. Olsen M, Gamble P, Chiu M, Tumia N, Boyle RA, Schemitsch EH (2010) Assessment of accuracy and reliability in preoperative templating for hip resurfacing arthroplasty. J Arthroplasty 25:445–449

    Article  PubMed  Google Scholar 

  15. MKAPPASC.SPS (2008) Available from: ftp://ftp.spss.com/pub/spss/statistics/nichols/macros/mkappasc.sps

Download references

Acknowledgments

We thank Daniel Millbourn, MD, Department of Surgery, Magnus Alm, MD, Department of Radiology, and Magnus Gidlund, MD, Department of Radiology, for assessing the patients and CT scans.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. Jänes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jänes, A., Weisby, L. & Israelsson, L.A. Parastomal hernia: clinical and radiological definitions. Hernia 15, 189–192 (2011). https://doi.org/10.1007/s10029-010-0769-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-010-0769-6

Keywords

Navigation