This page will deal with both stoma hernias and stomal or parastomal hernias. Both are considerably different.
Straining, coughing, sneezing and any tension to the abdominal walls particularly reveal a bulge caused by the abdominal contents that protrude through a weak muscle wall. A stoma can constitute new problems. As the stoma precipitates to the abdominal surface a potential decrepitude is created immediately. The snug-fitting abdominal walls around the opening of the stoma give away from its edges, causing a hernia in the space in the abdominal wall alongside the stoma.
Stoma hernias develop gradually due to an infection in a wound during emergence of the stoma. As time passes, the area next to the stoma stretches and becomes weak and any kind of coughing, straining, sneezing or standing up, it bulges. In some cases, the entire stoma protrudes because it is being pushed forward by the abdominal contents.
Stoma hernias are not painful. They are inconvenient and uncomfortable. The size of the stoma hernia is immense causing embarrassment. It can also result in a complication, though rare. The intestine may be trapped within the hernia resulting in obstruction. Going forward, the intestine will lose blood supply leading to strangulation, which is an emergency surgery.
Stoma Hernia Repair
A stoma hernia is repaired with a mesh on the weakened area reinforcing the musculature. The mesh is thin and strong spreading the mechanical load over the whole area.
Stoma hernia surgery is a highly specialized surgery requiring specific precision and skills.
Stomal hernia or Parastomal Hernia
Parastomal hernias are complications commonly of the enterostomies such as colostomy, ureostomy and ileostomy. It is specifically high in patients who have undergone colostomies rather than ileostomies. Parastomal hernias are asymptomatic in nature. But most of them may require surgical repair.
Abdominal pain, intestinal obstruction, changes in the skin and stoma sites, associated stenosis or stomal prolapse are indications for surgery. Parastomal hernia surgery poses a formidable challenge. The defect in the ventral abdominal wall has to remain undisturbed for smooth passage of the stoma.
Causes and risks
- Immunosuppressant drugs
- Obesity ??? one of the major risk factors due to the abnormally enlarged waist
- Emphysema in smokers
- Crohn???s disease
- Ulcerative colitis
Repair of parastomal hernia
All repairs conducted are laparoscopic in nature due to small incisions and lesser healing times.
A laparotomy is done to access the hernia with a midline abdominal incision. A support mesh is placed just below the fascia ??? a technique known as sublay technique.
A midline abdominal incision is made and a tensioned repair is performed laparoscopically, pulling through the tissues of the abdominal wall.
Direct fascial repair
A subcutaneous incision is made next to the stoma, allowing dissection and sutured repair of the hernia directly. A reinforcement mesh is placed, sutured on the top of the fascia and beneath the fat, a process known as Onlay mesh repair.