Is the abnormal protrusion of the intestines through a stoma.
This type of hernias is the most common complication of a colostomy or an ileostomy.
The incidence of parastomal hernias varies widely. In fact, 20% to 50% of the patients who undergo such procedures seem to be prone to developing this condition.
In most cases, it takes time for a Parastomal Hernia to appear as this condition can remain latent for years.
A Parastomal Hernia appears as a bulge or a swelling in a stoma (also known as ostomy), an artificial opening in the stomach, small bowel, or colon, which is the result of a surgical procedure.
This surgically made opening allows faeces or urine (either from the intestine or the urinary tract) to pass.
Depending upon how large is the opening creating the weak spot in the tissues, and how much of the intestines protrude through that area, it will be possible to notice either a small bulge or a significant large protrusion.
Causes of Parastomal Hernia
Having a stoma can weaken the abdominal muscles, which causes them to pull away from the surgically made opening.
While that could lead to the development of a Parastomal Hernia, several other factors can play a significant role in causing this condition.
Some of such factors are the ones listed here below:
- Malnutrition: poor nutrition around the time of the surgical procedure that creates the stoma will delay normal healing, and result in a weakness in the abdominal wall
- Smoking: a bad habit that can cause a postoperative mesh infection after a laparoscopic procedure
- Chronic coughing: it can put some pressure on the abdomen and weaken the tissues around the stoma
- Chronic constipation: it can cause strain on the muscles around the surgically made opening
- Infection after stoma surgery: it would likely decrease the natural strength of the abdominal wall muscle, which could induce this type of hernias.
- Obesity: patients who are obese are more prone to develop a Parastomal Hernia than those of average weight
Other factors could be the use of corticosteroids, asthma, or a combination of these and several of the factors already mentioned.
Symptoms
A Parastomal Hernia usually grows and develops gradually over time. While its size increases, patients and healthcare providers can notice some of the signs listed below:
- Pain or discomfort around the stoma
- Trouble keeping the stoma appliance in place
- Bulging around the stoma, especially when coughing
People sometimes describe the pain caused by a Parastomal Hernia as a sense of fullness or tightness, or a substantial weight in the affected area that, while not always painful, feels uncomfortable.
In some rare cases, a Parastomal Hernia can cause the intestine to become trapped or kinked inside the protruded area, which results in intestinal obstruction and loss of blood supply (potentially deadly complications).
Diagnosis
Medical experts recommend the use of Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI) to assess the extent and severity of the condition.
Parastomal Hernia Treatment
In several cases, all it takes for someone to deal with a Parastomal Hernia is making some lifestyle changes. Wearing a hernia belt can also help to ease the symptoms.
Belts need to be measured or sized to appropriately fit the patient’s abdomen, as well as ensuring correct placement of an opening within the hernia belt.
A medical expert can help people who suffer from this condition to decide which belt is better suited to manage a Parastomal Hernia.
However, 20% of Parastomal Hernias are prevalent issues with required treatments that can pose difficulties due to the significant rates of recurrence and morbidities of the repair.
In such case, doctors have to repair these hernias surgically. In this regard, patients have several options to get their condition treated, they include:
Closing the stoma
Usually, closure of the stoma is the best approach to repair a Parastomal Hernia. This option is only available for those patients with enough healthy bowel left to reattach the end that forms the stoma.
Primary hernia repair
This procedure involves the reduction of the protrusion, excision of the hernia sac as well as the attenuated and scar tissue, and the reapproximation of healthy connective tissues with suture.
Relocation of the stoma
This treatment is an especially risky one. It involves closing a stoma affected by a Parastomal Hernia, moving it by opening a new stoma on another part of the abdomen.
However, there is a risk of developing another hernia around the new stoma.
Mesh
It is the most common surgical procedure that doctors use to repair Parastomal Hernias
Medical experts can use either a synthetic or biological mesh, although they consider the biological mesh to be more comfortable.
A surgeon dissects the skin around the stoma to enter the hernia site. Once there, the mesh gets fixed deeper over the face of the aponeurosis all around the stoma with sutures.
The mesh also gets fixed to the external surface of the colon with sutures.
Eventually, this mesh incorporates to the tissue around it, creating a stable area in the abdomen and preventing these hernias from forming again.