Page 150 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials
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Chapter 7
When comparing the left and the right ARM, no di erence was seen regarding ARM thickness preoperatively. However, postoperatively, a thickening of the left/ipsilateral ARM was seen at 8cm cranial, 3cm cranial and at the level of the colostomy (Table 2) compared with the right/contralateral ARM. When we strati ed the postoperative group in groups, one with and one without parastomal hernia, the left ARM was thicker cranial and at the level of the colostomy in the parastomal hernia group but not in the group without parastomal hernia.
Table 2. Left ARM vs. right ARM data.
No PH (n = 33)
Postoperative 8cm above stoma Postoperative 3cm above stoma Postoperative level stoma Postoperative 3cm below stoma Postoperative 8cm below stoma PH (n = 44)
Postoperative 8cm above stoma Postoperative 3cm above stoma Postoperative level stoma Postoperative 3cm below stoma Postoperative 8cm below stoma
Left ARM*
9.3 (2.1) 10.1 (3.3) 10.8 (3.1) 10.7 (2.8) 11.1 (3.6)
7.9 (2.3) 9.6 (2.4) 10.2 (3.0) 10.2 (2.8) 9.9 (3.3)
Right ARM*
9.1 (2.3) 9.5 (3.2) 10.7 (3.4) 11.7 (3.6) 12 (3.7)
7.4 (2.3) 8.8 (2.9) 9.3 (2.5) 10.1 (3.6) 10.6 (3.9)
P-Value**
0.440 0.137 0.797 0.044 0.017
0.036 0.024 0.004 0.677 0.151
* Values represent the means and
** P-values are two-sided. For continuous variables the paired student t-test was used.
standard deviation in mm
Caudal to the level of the colostomy, the left ARM was thinner than the right ARM. Again, the postoperative group was divided in two groups, one with and one without parastomal hernia. Caudal to the colostomy a thinner left ARM was observed in the group without parastomal hernia at 3cm caudal (10.7 +/-2.8 vs. 11.7 +/-3.6 (p = 0.044) and 8 cm caudal (11.1 +/-3.6 vs. 12 +/-3.7 (p=0.017) . In the group with a parastomal hernia no signi cant di erences in ARM were seen.
Discussion
This is the rst study to show that changes are present in the abdominal wall after colostomy creation. By using the I-Space® system, a midline shift was
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