Parastomal Hernia
Definition
A parastomal hernia repair is a hernia that forms next to your ostomy (stoma). Ostomies can be either small bowel, large bowel, permanent or temporary.
Presentation
Parastomal hernias can present as a bulge in your abdomen. It can cause your appliance to not fit properly. It can cause pain and a bowel obstruction. If you are asymptomatic, some parastomal hernias are safer to watch without operating than taking on the risks associated with surgery.
Next steps for you
If you think you have a parastomal hernia, then make an appointment with a hernia expert to discuss your options.
Imaging is useful and your surgeon will likely order a CTSCAN. This can identify the hernia size, contents, and other hernias you may or may not also have.
Repair options are numerous and include:
- open primary repair
- open mesh repair (mesh can be placed inside your abdomen or between the muscle and peritoneum).
- open stoma resiting (placing your stoma in a new location).
- laparoscopic or robotic mesh repair (with a keyhole technique or with an underlay aka Sugarbaker technique). This can be done with or without defect closure.
Some surgical risks include, but are not limited to:
Recurrences, chronic pain, bowel obstruction, enterotomy, mesh erosion, fistula, seroma, hematoma, and infection.
What are the Risk Factors for Developing a Parastomal Hernia?
It's not uncommon to have some weak areas in the wall of the abdomen. Any such area is vulnerable to the strain of various actions. Abdominal weakness may be present from birth or may result from an injury, previous surgery, or simply as a matter of aging.
A parastomal hernia may occur in anyone who has a stoma because the stoma itself is a weak point in the muscle and fascia around the site. However, some factors may increase this risk. These include:
- Obesity
- Smoking
- Persistent coughing
- Heavy lifting
- Straining during bowel movements
- Pulmonary disease
- Malnutrition
How is Parastomal Hernia Repair Performed?
Each parastomal hernia repair may look slightly different. There are various options to choose from. Dr. Jacob recommends treatment based on factors that can influence safety and patient outcomes.
An open approach may be taken to repair the abdominal wall. This involves an incision that allows access to the herniated tissue. If the hernia is quite small, repair may be achieved with sutures. When the hernia is larger or more complicated, which can be the case with recurrent parastomal hernias, the doctor may need to reinforce the abdomen with some type of mesh. Some mesh is permanent and some are made to absorb over time.
Mesh repair can also be done using a laparoscopic technique. This minimally-invasive surgery is performed through a few smaller incisions rather than one larger one. The doctor observes the hernia via a camera that is affixed to a long, narrow tube. Small instruments are used through the additional incisions to make the repair using mesh and/or sutures.
No two parastomal hernia repairs may look the same. During your consultation for treatment, Dr. Jacob will discuss your risk factors, the severity of your hernia, and which repair technique is best suited to achieving an outstanding result.
What is Recovery Like after Parastomal Hernia Repair?
You may have a hospital stay of a few days after parastomal hernia repair. Your initial recovery will be closely monitored by nursing staff and Dr. Jacob. Some soreness and tenderness are to be expected during your early recovery from your hernia surgery. This will be managed with prescription medication and limited physical activity. Although it will take some time to get back to your normal level of activity after your procedure, you will be expected to be up and walking short distances the day following surgery. You will be assisted by a nurse or other clinical support team to ensure your comfort and safety.
