Effectiveness of a three-layer closure technique for preventing stoma-site incisional hernia after stoma closure in patients with rectal cancer.

PURPOSE: Stoma-site incisional hernia is a concerning complication following ileostomy closure. We conducted this study to investigate the effectiveness of a three-layer closure technique for preventing stoma-site incisional hernia after ileostomy closure in patients with rectal cancer.

METHODS

This single-center pre-post comparative study included 169 patients who underwent diverting loop ileostomy closure after rectal cancer surgery between April 2016 and May 2025. The three-layer closure technique replaced the single-layer technique in July 2020, and the outcomes before and after this change were compared. Firth-corrected multivariate analysis was performed to identify independent risk factors for stoma-site incisional hernia.

RESULTS

Stoma-site incisional hernias developed in 12 patients (7.1%). The incidence of stoma-site incisional hernia was significantly lower in the three-layer closure group than in the single-layer closure group (1.1% vs. 13%, P = 0.002). The Firth-corrected multivariate analysis identified that the three-layer closure technique (odds ratio 0.12, 95% confidence interval 0.01-0.55, P = 0.004) was an independent protective factor.

CONCLUSIONS

The three-layer closure technique reduced stoma-site incisional hernia significantly after ileostomy closure in patients with rectal cancer, suggesting that anatomically layered reconstruction provides superior abdominal wall integrity to single-layer closure.