Waist Circumference is an Independent Risk Factor for the Development of Parastomal Hernia After Permanent Colostomy

PURPOSE: This study was performed to evaluate the risk factors of parastomal hernia after abdominoperineal rectal amputation. METHODS: This was a retrospective study of consecutive patients who underwent abdominoperineal rectal amputation for rectal cancer between January 1999 and August 2006. The effects of age, sex, surgical approach, chemotherapy, waist circumference, and body mass index on the development of a parastomal hernia were analyzed. RESULTS: Forty-one patients underwent 19 open and 22 laparoscopic abdominoperineal rectal amputations. A parastomal hernia developed in 19 patients (46 percent) after a median follow-up period of 31 (range, 5-80) months. We observed ten hernias in the open group and nine in the laparoscopic group (P = 0.453). There were no significant differences in the type of surgical approach, age, sex, or adjuvant therapy in patients who developed a parastomal hernia compared with those who did not. Waist circumference proved to be an independent risk factor (P = 0.011). When the waist circumference exceeds the calculated threshold of 100 cm, there is a 75 percent probability to develop a parastomal hernia. CONCLUSIONS: Abdominal obesity increases the risk of developing a parastomal hernia, therefore, it might be advisable to place a prophylactic mesh during colostomy formation when the patient's waist exceeds 100 cm.