The weakness in the abdominal wall that allows the inner contents to form a bulge or swelling is known as a hernia. It is a more common problem, with over 10% of people with general surgical workload developing it.
The parastomal hernia forms in the abdominal wall around the stoma. Whether or not you are going to have a hernia in the parastomal area mainly depends on the type of stoma. According to a survey, people with colostomies are more likely to have this problem compared to ones with ileostomies. Similarly, people with end ostomies are more likely to develop parastomal hernias than individuals with loop ostomies. Although most parastomal hernias occur during the first two years after surgery, they can occur in the longer term as well.
The most common problem people with parastomal hernias experience is the swelling at the stoma site. This swelling can lead to mild discomfort or dragging sensation. Sometimes, the trapped bowel may become obstructed. And, this hernia can result in a problem fitting appliance in most cases.
You must visit your doctor after noticing the presence of a parastomal hernia. He will ask you a few questions about the condition and examine you. The examination process may necessitate you to remove the ostomy appliance. He may also put a finger inside the stoma for further examination.
The doctor will decide to run some tests only if it seems necessary. Typically, a CT scan test may be enough to give a clear picture of the loop of the bowel trapped in the abdominal wall.
What causes a hernia?
Several factors come into play when assessing the likelihood of the development of a parastomal hernia. These factors include being overweight or malnourished. Other factors include increased pressure inside the abdomen and cancer. Sometimes, taking steroidal drugs can make the abdominal muscles weaker, allowing loops of bowels to get trapped between those muscles to form a hernia.
Surgeons tend to prevent the development of these hernias by creating the smallest hole in the abdominal wall to create a stoma. They make sure that the hole doesn’t strangulate the bowel.
Prevention
Some surgeons prevent the risk of parastomal hernia by using a synthetic mesh around the stoma during surgery. This mesh serves as a supportive structure. Although the results of this technique are encouraging, only a small number of ostomates have benefited from it so far. Experts are trying to evaluate the effectiveness of this technique before making it a standard procedure of ostomy surgery.
Managing a hernia
The good thing is that most hernias can be managed through conservative methods. Surgery is required only during emergencies, including strangulation, obstruction, and difficulty forming a seal between the ostomy appliance and peristomal skin.
Surgical repair
Your surgeon chooses from a range of options to repair your parastomal hernia surgically. One of these methods is open incision surgery, while others use laparoscopy. The problem with laparoscopy is that the hernia has 50% to 100% chances of recurring. Another way to operate is to move the stoma to another location. This procedure has more chances of success compared to other surgical repair methods.
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