Risk factors for the development of a parastomal hernia in patients with enterostomy: a systematic review and meta-analysis

Purpose Parastomal hernia (PSH) is a common and serious complication in patients with enterostomy, but there is no current consensus for the risk factors for PSH from previous studies. Therefore, this study systematically analyzed the risk factors for PSH to provide a reference for prevention and treatment of this condition. Methods Seven databases and 3 registers were systematically searched from database inception to January, 2021. Study quality was assessed by Newcastle–Ottawa Scale. Review Manager 5.3 software was used for statistical analysis. The data that could not be combined quantitatively were only analyzed qualitatively. Results Sixteen studies with 2031 patients were included. Higher BMI (OR, 1.29; 95% CI,1.02–1.63), older age (OR, 1.04; 95% CI, 1.02–1.07), female (OR, 2.55; 95% CI,1.39–4.67), lager aperture size (OR, 2.8; 95%CI, 1.78–4.42), transperitoneal stoma creation (OR, 2.4; 95% CI, 1.33–4.35), and lager waist circumference (OR, 1.01; 95% CI,1.0–1.01) were significant risk factors for PSH. The laparoscopic approach was not a risk factor for PSH (OR, 2.09; 95% CI, 0.83–5.27). Other risk factors, including the thickness of abdominal subcutaneous fat, no mesh, a stoma not through the middle of the rectus abdominis, atrophy of left lower medial part of rectus abdominis, α1(III) procollagen expression level, emergency surgery, no preoperative stoma site marking, end colostomy, smoking, diabetes, peristomal infection, severe abdominal distention, severe cough, chronic obstructive pulmonary disease, operation time and hypertension, were significant on the multivariate analysis of each individual study. Conclusions The current available evidence showed that higher BMI, older age, female, larger aperture size, the creation of a transperitoneal stoma, and a larger waist circumference were independent risk factors for PSH. For factors without exact cutoff value, further explorations are needed in the future. In addition, reference to the limited number of studies in the pooled analysis, these factors still need to be interpreted carefully.