The parastomal hernia

Parastomal hernias are hernias that occur next to an artificial bowel outlet (stoma). Due to the creation of a temporary or permanent artificial bowel outlet, the support function of the abdominal wall is impaired and the abdominal muscles are weakened. If the tissue and the scar of the stoma have not yet grown together and strengthened sufficiently, parastomal hernias can occur.

The gap created by the artificial bowel outlet widens into a hernial orifice, where a parastomal hernia develops. The hernia sac pushes outwards next to the stoma. A protrusion is seen in the area of the stoma. In some cases, parastomal hernias complicate the care of the enterostoma.

A large proportion of patients with a stoma, about 50 to 80%, experience a parastomal hernia.

Risk factors that favour the development of a parastomal hernia:

• Overweight
• Malnutrition
• Smoking reduces collagen formation and nicotine weakens the abdominal wall
• Cortisone and other drugs that weaken the immune system
• Wound infections and wound healing disorders
• High age
• Hereditary collagen disorders
• Disorders of the connective tissue metabolism and connective tissue weaknesses
• Diabetes
• Steroid therapy

After stoma surgery, it may help to wear special support garments or a hernia-belt. Talk to your stoma therapist or doctor about this.

The symptoms can be very different and range from no symptoms to pain and restricted movement.

• Protrusion in the area of the stoma
• Heavy, pulling feeling in or around the stoma
• Protrusion becomes more prominent with physical exertion
• Pain that occurs when lifting, pressing or coughing
• In the case of an incarceration, colicky abdominal pain, abdominal tenderness, fever and nausea.

CAUTION: If you have fever, vomiting, nausea and sudden colicky abdominal pain, it could be an incarcerated hernia. This can be life-threatening. Call us immediately or go to the nearest hospital emergency ward!

To reduce the risk of an incisional hernia, it helps to lose weight and stop smoking if you are overweight before the operation. After abdominal wall surgery, stabilising abdominal bandages can be worn to relieve pressure on the tissue while the wound heals.

If the enterostoma is relocated, the resulting hernial orifice is closed and reinforced with a mesh insert. If it is not possible to reposition the artificial intestinal outlet, the existing gap is narrowed and reinforced with a mesh.

Another possibility is to move the enterostoma to another location and reinforce the artificial intestinal outlet there with an inserted mesh already at the beginning. However, this is no longer practised so often because the biggest risk parameter is usually the condition of the tissue. Even at the new site, the tissue is not very different, so that a parastomal hernia could occur there again.

In the case of a very large hernia sac, the operation must simultaneously attempt to restore the stabilising function of the abdominal wall. This is a great challenge for the surgeon.

Read more about the applicable surgical procedures here.