The inter-observer reliability is very low at clinical examination of parastomal hernia.
ABSTRACT Parastomal hernia in patients with a permanent colostomy is common. The aim of this study was to evaluate the reliability of the diagnosis based on clinical examination and to compare this examination with the result of a specially designed questionnaire and computerised tomography (CT) scan.
Forty-one patients operated upon with an abdominoperineal resection due to rectal cancer at three hospitals between 1996 and 2002 were included. At minimum of 4 years after the operation, they underwent clinical examination by two or three independent surgeons, answered a colostomy questionnaire and were offered a CT scan of the abdominal wall.
At Hospital I, 17 patients were examined by three surgeons, with inter-observer kappa values between 0.35 and 0.64. At Hospital II, 13 patients were examined by three surgeons, the kappa values ranged between 0.29 and 0.43. At Hospital III, 11 patients were examined by two surgeons, with kappa value of 0.73. The kappa value between CT scan and the colostomy questionnaire was 0.45.
The inter-observer reliability was low, indicating that parastomal hernia is difficult to diagnose by patient history and clinical examination. Some herniae may not be detected by CT scan, and the correlation to patient-reported complaints is low. A more sensitive radiological method to detect parastomal hernia is needed.
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ABSTRACT: Since there are no reliable investigative tools for imaging parastomal hernia, new techniques are needed. The aim of this study was to assess the validity of intrastomal three-dimensional ultrasonography (3D) as an alternative to CT scanning for the assessment of stomal complaints.International Journal of Colorectal Disease 07/2014; · 2.42 Impact Factor
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ABSTRACT: The aim of this study was to investigate the clinical and radiological incidence of parastomal hernia and to analyze the risk factors for parastomal hernia. We reviewed retrospectively 108 patients with end colostomy from January 2003 to June 2010. Age, sex, surgical procedure type, body mass index (kg/m(2)), stoma size, and respiratory comorbidity were documented. There were 61 males (56.5%) and 47 females (43.5%). During an overall median follow-up of 25 months (range, 6 to 73 months), 36 patients (33.3%) developed a radiological parastomal hernia postoperatively and 29 patients (26.9%) presented with a clinical parastomal hernia. In multivariate analysis, gender (odds ratio [OR], 6.087; P = 0.008), age (OR, 1.109; P = 0.009) and aperture size (OR, 6.907; P < 0.001) proved to be significant and independent risk factors after logistic regression analysis. This study showed that the incidence of radiological parastomal hernia is higher than clinical parastomal hernia. Risk factors for parastomal hernia proved to be female, age, and aperture size.Journal of the Korean Surgical Society 01/2013; 84(1):43-7. · 0.62 Impact Factor
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ABSTRACT: Despite advances in surgery including new prosthetic materials and the advent of laparoscopy, the treatment of parastomal hernias remains a challenge for the surgeon. This is mainly due to the very high recurrence rate. Adequate management requires preoperative multidisciplinary consultation to offer the most appropriate surgical solution to each patient. We propose a review of current knowledge about this complication.Journal de Chirurgie Viscérale. 10/2012; 149(5):S16–S20.