The Parastomal Hernia: Never Heard of It?

If you’ve noticed swelling or bulging near your stoma, it’s likely you have a parastomal hernia. The bulge or enlargement may appear to come and go or seem larger with certain body positions. If you have had abdominal surgery and have an abdominal stoma, it’s important to be aware of the risk of a parastomal hernia and to pay attention to any changes in the area around your stoma. Regardless of how prominent your hernia is, it’s important to see a hernia repair specialist for treatment.

• What Is a Parastomal Hernia?
• What Causes a Parastomal Hernia?
• What Are the Dangers of Having a Parastomal Hernia?
• How Are Parastomal Hernias Treated?
• How to Prevent Parastomal Hernias
• Types of Surgery for Parastomal Hernias
• Key Takeaways

What Is a Parastomal Hernia?

A stoma is a surgical opening created in the abdomen after the removal of a portion of the bowels or bladder so the body can eliminate waste into a bag. Stomas are often recommended for medical conditions like diverticulitis, inflammatory bowel disease, colon cancer and bladder or bowel obstructions or when there’s severe trauma to the abdomen. Stomas are created when portions of the bowels or colon are damaged or dysfunctional and have to be removed or bypassed to restore proper bowel function. Stomas depending on the patient, can be temporary or permanent, but are usually painless.

A parastomal hernia is a rare type of incisional hernia that typically occurs in post colostomy and ileostomy patients with stomas. The hernia forms when the intestines or contents of the abdominal cavity bulge through the abdominal wall surrounding the opening where the colostomy or ileostomy bag is attached. A parastomal hernia doesn’t always cause discomfort, but it can cause pain and discomfort around the colostomy or ileostomy bag site. The condition can also make wearing certain types of clothing difficult and unpleasant.

What Causes a Parastomal Hernia?

Parastomal hernias are specific to ostomy patients. The risk of developing parastomal hernias is highest during the first two years after ostomy surgery. The rate of recurrence is also high. Currently, almost 80 percent of ostomy patients develop parastomal hernias shortly after surgery.

Some people are more likely to develop parastomal hernias than others. The condition is more common when the tissues around the stoma become weak and allow the contents of the abdominal cavity to bulge through. Patients with the following risk factors are susceptible to parastomal hernias. 

Previous abdominal surgery: If you have had previous abdominal surgery, you may be at an increased risk of developing a parastomal hernia because the tissues around the stoma may be weaker than normal.

Obesity: Being overweight or obese can increase the pressure on the abdominal wall, which can contribute to the development of a parastomal hernia.

Weak stomach muscles: If you have weak abdominal muscles, you may be more prone to developing a parastomal hernia.

Chronic coughing: If you have a condition that causes chronic coughing, such as asthma or COPD, this can put extra strain on the abdominal wall and increase your risk of a parastomal hernia.

Stoma size: If your stoma is larger than average, this may increase your risk of developing a parastomal hernia.

Symptoms of a parastomal hernia may include swelling or bulging around the stoma, pain or discomfort, and difficulty with bowel movements.

What Are the Dangers of Having a Parastomal Hernia?

This type of hernia is serious and can quickly become life-threatening if the intestines become trapped or strangulated and lose their blood supply. A strangulated parastomal hernia often causes nausea, vomiting, and severe abdominal pain.

Below are some common complications associated with having a parastomal hernia. 

• A parastomal hernia can cause pain and discomfort, especially during physical activity or when wearing/using a colostomy or ileostomy bag.
• Stoma complications can occur, making it difficult to wear the colostomy or ileostomy bag properly, which can lead to complications such as leakage or skin irritation.
• The hernia becomes trapped and cannot be manipulated or pushed back into place, causing incarceration. Incarceration is very painful and requires surgery.
• Hernia strangulation reduces blood flow to the intestines and the contents leak into the abdominal cavity, causing serious complications, such as gangrene, peritonitis, and sepsis life-threatening infections that require immediate medical intervention. This is rare.
• Hernia becomes trapped and cannot be reduced (pushed back into place), this is known as incarceration. Incarceration can be very painful and requires surgical intervention.
• Parastomal hernias can cause fistulas to form between the intestine and the skin around the stoma. Fistulas are abnormal connections between two organs or vessels, leading to infections and other complications.
• The hernia can cause the stoma to become blocked, which can lead to problems with bowel movements.

If you have a stoma and suspect you’re experiencing symptoms of a parastomal hernia, make an appointment with a hernia repair specialist for treatment and relief.

How Are Parastomal Hernias Treated?

Parastomal hernias can be dangerous and incredibly difficult to manage without medical treatment. Initial treatments often involve medications to manage symptoms, lifestyle and dietary adjustments to achieve a healthy weight, and medical supervision to monitor the hernia.

Parastomal hernias are rare, but they are a type of incisional hernia that requires immediate medical attention to prevent intestinal obstruction and strangulation. The condition is very serious and can quickly become life-threatening. In most cases, surgery is often necessary at some point to repair the hernia.

Parastomal hernia treatments include the following:

Hernia Support: Some patients use hernia support belts to keep the hernia in place to alleviate the discomfort and pain associated with parastomal hernias. 

Losing Weight: Losing weight can help obese or overweight patients reduce their risk of parastomal hernia development and recurrence.

Stoma Relocation: In some cases, it may be necessary to move the stoma to a different location on the abdominal wall to help prevent the hernia from recurring.

Hernia Repair Surgery: In some cases, surgery may be necessary to repair the hernia. There are several surgical options for repairing a parastomal hernia, including open surgery and laparoscopic (minimally invasive) surgery. Your surgeon will recommend the best option for you based on your individual circumstances.

Parastomal hernia treatment is influenced by many factors, including patient, health, medical history, hernia history, hernia type and severity. Parastomal hernia repair surgery patients and those who are obese or with a history of previous abdominal operations have the highest risk of hernia recurrence.

How to Prevent Parastomal Hernias

Parastomal hernias are common after abdominal surgery to create a stoma and can develop later on due to the strain on the abdominal wall from the stoma. Below are some recommendations on how to prevent parastomal hernias:

Follow your surgeon’s instructions carefully during the recovery period. This includes using proper body mechanics when lifting and to avoid lifting heavy items and straining to prevent undue strain on the surgical site.

Choose the right size and type of stoma appliance. The appliance should fit snugly around the stoma to provide support and prevent bulging.

Wear a supportive belt or binder around the stoma to help hold it in place and provide additional support.

Practice good posture and body mechanics when lifting, bending, and moving to avoid putting unnecessary strain on the abdominal muscles.

Eat a healthy, balanced diet to help maintain a healthy weight and strengthen the abdominal muscles.

Avoid smoking, which can weaken the muscles and increase the risk of a parastomal hernia.

Dr. Khosravi provides patients with guidance on how to prevent parastomal hernias before and after their procedure.

Types of Surgery for Parastomal Hernias

Dr. Abtin Khosravi, MD, offers the following types of hernia repair surgeries for parastomal hernias at Orange County Robotic General Surgery.

Open/Conventional Hernia Repair Surgery

This is the traditional surgical approach for repairing a parastomal hernia. It involves making a large incision in the abdominal wall to access the hernia. The surgeon will then push the herniated tissue back into place and repair the weak area in the abdominal wall with sutures or mesh. 

Conventional hernia repairs procedures are often performed on patients with certain medical conditions, complex or advanced hernias, and those who do not qualify for laparoscopic surgery. Conventional surgery patients require several more weeks to heal and recover, have more post-operative activity and dietary restrictions, and are more likely to experience complications, including hernia recurrence.

Laparoscopic Parastomal Hernia Repair Surgery

This is a minimally invasive hernia repair procedure. To perform the surgery, Dr. Khosravi makes several small incisions in the abdominal wall so he can insert a laparoscope (a thin tube with a camera on the end) to visualize the hernia and small instruments to repair it.

Robotic-Assisted Hernia Repair Surgery

Robotic-assisted hernia repair is a type of laparoscopic surgery that Dr. Khosravi performs using a robotic system. He sits at a console and uses hand controls to manipulate the robotic arms with small surgical instruments to perform the procedure utilizing laparoscopic practices.

Both laparoscopic and robotic hernia repairs are minimally invasive hernia treatments that offer patients less post-operative pain and discomfort, faster recoveries, better outcomes and significantly lower the risk of parastomal hernia recurrence.

Patients must adhere to all post-operative and follow-up care recommendations to reduce their complication risks to ensure a successful outcome.

Key Takeaways

Parastomal hernias occur when the tissues around the stoma become weak and allow the contents of the abdominal cavity to bulge through. Parastomal hernias can cause discomfort and pain, and can make it difficult to wear the colostomy or ileostomy bag properly. Treatment usually includes a hernia support belt, losing weight, medication, or hernia repair surgery.

If you suspect you or a loved one has a parastomal hernia, schedule a consultation with Dr. Abtin Khosravi, MD, founder and director of Orange County Robotics General Surgery to learn the benefits and risks of each treatment option before making a decision. Dr. Khosravi will recommend the best surgical approach for you based on your individual circumstances and the specifics of your hernia.

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