ArticleANZ journal of surgery2026
Integration of Clinical Risk Factors With Radiological Metrics Associated With PSH: The Impact of Stoma Site Features, Obesity and Muscle Atrophy.
Article in ANZ journal of surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimTo determine our incidence of parastomal hernia (PSH) after end colostomy formation and to integrate clinical and novel computed tomography (CT)-derived stoma-site risk factors.
methodsWe performed a retrospective study of adults undergoing operations resulting in permanent end colostomy at Dunedin Hospital, New Zealand (2009-2022), who had at least one pre- or post-operative abdominal CT scan. PSH and risk factors were identified clinically from electronic medical records or radiologically using the Moreno-Matias classification. Radiological variables included abdominal wall width, rectus muscle-to-subcutaneous fat ratio, rectus density, intraperitoneal area, aperture size and stoma location within the rectus muscle; univariable and multivariable logistic regression identified independent predictors of PSH.
resultsAmong 217 patients, 64 (29%) were diagnosed with PSH, with approximately half symptomatic. Univariable analysis identified six risk factors: body mass index, diabetes, abdominal wall width, abdominal wall muscle-to-fat ratio, fascial defect diameter and stoma position within the rectus. In adjusted analyses, larger defect diameter (OR: 3.24 per 1 cm increase, 95% CI; 1.96-5.91), abdominal wall muscle-to-fat ratio (OR: 0.68 per 10% increase, 95% CI: 0.49-0.88) and lateral stoma position (OR: 2.79, 95% CI: 1.03-7.86) were independently associated with PSH.
conclusionCombining clinical information with CT-based morphological assessment identified aperture size and abdominal wall muscle-to-fat ratio as key risk factors, and precise central transrectus stoma placement as a risk factor of interest. These findings may inform preoperative risk stratification, technical optimisation of stoma construction and selection of patients for prophylactic interventions.
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