Incidence and Risk Factors for Incisional Hernia Following Ileostomy Takedown: A Retrospective Cohort Study.

Abstract

<b>Background</b>: Incisional hernias are a frequent complication following ileostomy closure, with rates reaching 24%. Protective ileostomies are commonly performed in colorectal surgery, but their closure presents a significant risk for abdominal wall defects. Identifying risk factors for incisional hernias at the ileostomy site is crucial for improving patient outcomes. <b>Methods</b>: This retrospective study analyzed data from 95 patients who underwent loop ileostomy closure at two Romanian hospitals between 2018 and 2023. Patient demographics, surgical details, and follow-up data were reviewed. Incisional hernias were diagnosed through clinical examination or radiological imaging. Statistical analyses, including univariate and multivariate regression, were performed to identify independent risk factors. <b>Results</b>: The incidence of incisional hernias at the ileostomy site was 13.7% (13/95). Univariate analysis identified BMI (HR 30.08; <i>p</i> = 0.007), previous hernia (HR 7.99; <i>p</i> = 0.059), radiotherapy (HR 299.15; <i>p</i> = 0.029), and chemotherapy (HR 0.004; <i>p</i> = 0.026) as significant factors. Multivariate analysis confirmed BMI > 30 kg/m² (HR 12.27; <i>p</i> = 0.002) and prior hernia (HR 8.14; <i>p</i> = 0.007) as independent risk factors. <b>Conclusions</b>: Obesity and previous hernias significantly increase the risk of incisional hernias following ileostomy closure. Radiological follow-up enhances early detection, and further studies should explore the benefits of prophylactic mesh reinforcement. Optimizing patient selection and surgical technique may reduce postoperative hernia rates, improving long-term outcomes.