Incidence, risk factors, and a predictive nomogram for stoma-site incisional hernia after ileostomy reversal: A retrospective study.

PURPOSE: The incidence of stoma-site incisional hernia (SSIH) in rectal cancer patients varies widely in the literature. This study aimed to determine the incidence of SSIH, identify its risk factors, investigate the impact of adjuvant therapy, and subsequently develop a predictive model.

METHODS

This was a single-centre, retrospective study involving consecutive patients who underwent radical resection for rectal carcinoma with temporary diverting loop ileostomy and subsequent stoma reversal at our centre from 2020 to 2024. Patient demographic characteristics, comorbidities, operative data, and follow-up information were collected. Logistic univariate and multivariate analyses were used to identify the risk factors for SSIH, following which we constructed a nomogram for SSIH prediction.

RESULTS

331 patients were enrolled in the study, the incidence of stoma site incisional hernia was 24.8% (82/331). Multivariate analysis identified advanced age (≥ 65 years), body mass index (BMI) ≥ 24 kg/m2, stoma diameter ≥ 3 cm, delayed stoma reversal (≥ 6 months), presence of a parastomal hernia, and postoperative surgical site infection (SSI) and a low postoperative-to-preoperative albumin ratio(< 0.85) as independent risk factors. Neither adjuvant chemotherapy, radiotherapy, nor immunotherapy was identified as an independent risk factor for SSIH in the multivariate logistic regression analysis.

CONCLUSION

A nomogram based on perioperative patient factors was constructed to predict the occurrence of stoma site incisional hernia (SSIH) after ileostomy reversal in rectal cancer patients. The nomogram demonstrated strong predictive performance and good calibration, providing clinicians with a valuable tool to identify high-risk patients and implement targeted preventive strategies.