Risk factors for stoma-site incisional hernia after ileostomy reversal: impact of fascial suture material

Abstract Purpose To determine the incidence of stoma-site incisional hernia (SSIH) after ileostomy reversal and identify the associated risk factors, focusing on fascial suture materials. Methods This single-center retrospective study included 194 patients who underwent ileostomy reversal for colorectal neoplasms (2010–2023) with ≥ 330 days of postoperative computed tomography follow-up. All fascial closures used interrupted absorbable sutures. SSIH was defined on computed tomography. Risk factors were evaluated using logistic regression, and inverse probability of treatment weighting (IPTW) was applied to assess the association between suture materials and SSIH. Results SSIH occurred in 21 patients (10.8%) at a median of 282 days, and five patients (23.8%) underwent hernia repair. In a multivariable analysis, higher body mass index (odds ratio [OR]: 1.24 per kg/m², p = 0.008) and use of braided absorbable sutures (OR: 2.90, p = 0.042) were associated with SSIH. IPTW analysis showed a consistent association with braided absorbable sutures (OR: 3.24, p = 0.013). In an exploratory model that included the calendar period, this association was attenuated. Conclusions SSIH occurred in approximately 10% of patients after ileostomy reversal. A higher body mass index was consistently associated with SSIH. Fascial suture material may be a clinically relevant component of stoma-site closure; however, its independent effect requires further evaluation.