Parastomal hernia

Epidemiology

• Complicates up to 50% of stomas

Presentation

• Mostly asymptomatic
• Bowel obstruction and strangulation are rare

Classification:

• Not clinically relevant
• Devlin:

Management

• Routine repair not recommended
• Indications for repair:
  • Bowel obstruction
  • Problems with pouch fit
  • Cosmetic issues

Surgical approaches: (repair, re-site, repair with mesh)

• Primary fascial repair (high recurrence rate, but abdomen often not entered - reserve for patients who will not tolerate a laparotomy)
  • Peristomal incision
  • Hernia reduction
  • Prosthetic repair
• Stoma relocation
• Prosthetic repair (excellent long-term results with lower recurrence, but higher prosthetic complications - erosion, obstruction, etc)
  • Mesh can be onlay, intra-abdominal Sugarbaker, or retro-rectus
  • Retro-rectus repair is possible that takes down the stoma, covers the old stoma site and the entire midline incision with retro-rectus mesh, and prophylactically covered the new site

For full technique, see separate topic under 'colorectal operations'