Radiological progression of end colostomy trephine diameter and area

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Abdominal Wall Reconstruction

Background:

• Parastomal hernia is a frequent complication after abdominoperineal excision (APE).
• Accurate incidence assessment is challenging due to varied follow-up durations and herniation evaluation methods (radiological vs. clinical).

Purpose of the Study:

• To evaluate colostomy diameter changes post-APE by analyzing trephine dimensions and area over time.
• To identify variables influencing parastomal hernia development and trephine area variations.

Main Methods:

• Retrospective review of serial CT scans from 112 patients who underwent APE.
• Analysis of trephine diameters (axial, sagittal), area, and ratios, considering patient age, sex, stoma site, and incision type.
• Bayesian hierarchical modeling to assess temporal changes and influencing factors.

Main Results:

• The sagittal trephine diameter increased by 0.22 mm/month in both sexes.
• Women showed a significant increase in axial trephine diameters and trephine area over time.
• Patient age, trephine location, and incision shape did not significantly correlate with parastomal hernia development.

Conclusions:

• Female sex is the sole identified variable influencing the rate of increase in axial trephine diameter and trephine area post-APE.
• These findings highlight the importance of sex as a factor in monitoring parastomal hernia development.