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Beverly Hills · 435 N. Bedford Dr., Suite 308Mon–Fri 9:00 am – 5:00 pmMost PPO insurance accepted
Allen KamravaMD · MBA · FACS · FASCRS

Procedure

Parastomal Hernia Repair

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Back to work
2-8 weeks
Success rate
50-90%
Recurrence
10-50%

What it is

What is a Parastomal Hernia?

A parastomal hernia is an incisional hernia that occurs at the site of an ostomy, where a portion of the intestine is brought through the abdominal wall to the skin. It is one of the most common long-term complications of stoma creation, with reported rates as high as 50%. The hernia occurs when there is a weakening of the abdominal wall around the stoma, allowing abdominal contents to bulge out next to the stoma. This can lead to pain, difficulty with appliance fitting, leakage, skin irritation, and, in some cases, bowel obstruction or strangulation.

Am I a candidate?

Who is a Good Candidate for Repair?

Surgical repair is generally reserved for patients with symptomatic parastomal hernias. Ideal candidates are those experiencing significant symptoms that affect their quality of life, such as pain, inability to maintain a seal with their ostomy appliance leading to leakage and skin breakdown, or recurrent episodes of bowel obstruction. Asymptomatic or minimally symptomatic hernias are often managed conservatively with observation and specialized ostomy support belts. Given the high recurrence rates after repair, surgery should be undertaken after a thorough discussion of the risks and benefits, and after optimizing modifiable risk factors like obesity and smoking.

Recovery

What is the Recovery Like?

Recovery depends on the surgical approach used (open vs. laparoscopic/robotic). An open repair, especially one involving a complex abdominal wall reconstruction, will require a hospital stay of several days and a longer recovery period of 6-8 weeks, with restrictions on lifting and strenuous activity. A minimally invasive repair may have a shorter hospital stay and a quicker return to normal activities. Patients will work closely with an ostomy nurse to manage their appliance over the healing abdominal wall. It is crucial to avoid constipation and straining to minimize pressure on the repair.

Risks & considerations

What are the Risks?

Parastomal hernia repair is a complex procedure with a significant risk of both recurrence and other complications. Risks include:

  • Recurrence: This is the most common complication, with rates varying widely depending on the technique used, but can be as high as 50% or more.
  • Surgical Site Infection: The presence of a stoma makes the surgical field contaminated, increasing the risk of wound infection.
  • Mesh-Related Complications: If mesh is used for the repair, there are risks of mesh infection, erosion into the bowel, or chronic pain.
  • Stoma Complications: The stoma itself can be injured during the repair, leading to ischemia, retraction, or stenosis.
  • Bowel Injury: There is a risk of injury to the intestines during the dissection, particularly in reoperative cases with extensive adhesions.

Sources

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