Parastomal Hernia

When a stoma is brought out through the wall of the abdomen it must pass through a layer of muscles, making a potential area of weakness. Ideally the abdominal wall muscles should form a good fit around the stoma. In some cases the muscles come away from the edges of the stoma creating gap and hence a weakness for a hernia to form where there is no muscle.

Other factors known to contribute to a stoma hernia are coughing, rapid weight gain or developing an infection in the wound post surgery. The growth of a stoma hernia is normally a gradual process, as the area adjacent to the stoma stretches and becomes weaker. This weakness, or gap, means that every time you strain, cough, sneeze or even stand up, the area of the abdomen next to the stoma bulges, or the stoma itself protrudes as it is pushed forwards by the contents of the abdomen.

As with all hernias the size will slowly increase. Stoma hernias are not normally painful, but are usually more uncomfortable and be seen as an embarrassment as it makes it more difficult to change your bag and may cause a budge under clothing. Although not a painful condition it should be kept an eye on as in rare cases can cause a complication, as the intestine can become trapped or kinked by the hernia this can cause an obstruction, more seriously the intestine may then lose its blood supply, this is know as strangulation and requires emergency surgery to untwist the intestine.

Hernias are defects in the abdominal wall and should not be ignored simply because they might not hurt.

If symptoms are severe enough, the hernia would be repaired. The repair of a stoma hernia means that the abdominal wall tissue is made to fit snugly around the stoma again.

Many different surgical approaches to this problem have been tried, the most common are:

1, – The stoma is moved to a new site on the abdomen.
Or
2 – Repair the hernia around the stoma, leaving the stoma where it is.

Option 1: A new opening is made on the abdomen wall and the stoma moved then the hernia can be repaired as you would repair any other hernia with a fine mesh.

Option 2: To repair the hernia without moving the stoma involves opening the abdominal wall over the hernia adjacent to the stoma and re-suturing the muscle / supporting tissues in that area.