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Published on: April 17, 2019
Parastomal hernia: clinical and radiological definitions.
A Jänes1, L Weisby, L A Israelsson
1Department of Surgery, Kirurgkliniken, Sundsvalls Sjukhus, 851 86, Sundsvall, Sweden. arthur.janes@lvn.se
Hernia : the Journal of Hernias and Abdominal Wall Surgery
|December 29, 2010
Summary
A new clinical definition for parastomal hernia (a complication after stoma surgery) shows high correlation with CT scans. This suggests clinical examination alone is sufficient for follow-up, making traditional supine CT scans unreliable for diagnosis.
Area of Science:
- Abdominal Surgery
- Surgical Complications
- Diagnostic Imaging
Background:
- Parastomal hernia is a common complication following stoma formation.
- Previous studies lacked consistent definitions for parastomal hernia, leading to poor correlation between clinical examination and computed tomography (CT) scan findings.
- A standardized clinical definition correlating with CT results is needed.
Purpose of the Study:
- To develop and validate a reproducible clinical definition for parastomal hernia.
- To assess the correlation between a new clinical definition and CT scan findings.
- To determine the reliability of CT scans in diagnosing parastomal hernia.
Main Methods:
- A new clinical definition of parastomal hernia was established: any protrusion near the stoma with patient straining (supine and erect).
- A novel CT scan method involved examining patients in the prone position, defining herniation as intra-abdominal contents beyond the peritoneum or presence of a hernia sac.
- Inter-rater reliability was assessed using Fleiss' Kappa values.
Main Results:
- The new clinical definition demonstrated high reproducibility among surgeons (Kappa=0.85).
- CT scans in the prone position showed high reproducibility among radiologists (Kappa=0.85) and strong correlation with clinical assessment (Kappa=0.80).
- Conventional CT scans in the supine position showed lower correlation (Kappa=0.63).
Conclusions:
- The new CT scan method in the prone position, alongside the revised clinical definition, offers high reproducibility and strong correlation between methods and raters.
- Clinical examination alone is sufficient for follow-up of parastomal hernia due to its strong correlation with radiological findings.
- Conventional supine CT scans are unreliable for diagnosing parastomal hernia.
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