Comment to: Retrospective observational study on the incidence of incisional hernias after reversal of a temporary diverting ileostomy following rectal carcinoma resection with follow-up CT scans. De Keersmaecker G, Beckers R, Heindryckx E, Kyle-Leinhase I, Pletinckx P, Claeys D, Vanderstraeten E, Monsaert E, Muysoms F. Hernia 2015 (Epub ahead of print)

Abstract

Dear Sirs Despite some proponents for augmenting the site of ileostomy closure (to avoid later herniation), this Belgian study [1] has suggested that the incidence of herniation is not as high as some believe, as we too reported some time ago [2]. Indeed, if the incidence was really that high such an ‘epidemic’ would have been realized many years ago, as diverting a risky low anastomosis is not a new idea. Furthermore, the authors failed to show a difference in incidence of herniation whether the surgery was performed as an open or laparoscopic procedure. Clearly, closure of the abdominal wall is of paramount importance and must be carried out with diligence at all anatomical levels. In many cases sharp dissection will be necessary to separate the loop of ileum from the fibres of the belly of the rectus abdominis muscle, which may lead to fibre loss (and later, ischaemia, atrophy, weakness and herniation). These changes were evident on serial surveillance CT scans [2]. With this in mind and for some time, we have avoided damaging the rectus muscle when raising a stoma by using the lateral rectus abdominis positioned stoma or ‘‘LRAPS’’ technique (Fig. 1) to their formation [3]. In this dissection the entire width of the rectus muscle is preserved and more importantly, when the ileostomy is reversed, the small bowel is easily separated from the lateral border of the muscle and the inner aspect of the linea semi-lunaris, indicating a paucity of local muscle damage at its earlier construction. Finally, because a temporary LRAPS ileostomy is also above the ‘arcuate line’ of Douglas, we have not detected any herniation either clinically or on CT scanning in our cancer patients.

DOI: 10.1007/s10029-015-1435-9

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Cite this paper

@article{Williamson2015CommentTR, title={Comment to: Retrospective observational study on the incidence of incisional hernias after reversal of a temporary diverting ileostomy following rectal carcinoma resection with follow-up CT scans. De Keersmaecker G, Beckers R, Heindryckx E, Kyle-Leinhase I, Pletinckx P, Claeys D, Vanderstraeten E, Monsaert E, Muysoms F. Hernia 2015 (Epub ahead of print)}, author={Jeremy S Williamson and Gethin L. Williams and Brian M. Stephenson}, journal={Hernia}, year={2015}, volume={20}, pages={279-280} }