Parastomal Hernias

What is a parastomal hernia?

A parastomal hernia is where some tissue pokes through the site of a surgical hole made in the abdominal wall when a stoma has been made. This happens when the hole in the abdominal wall has stretched over time.

Parastomal hernias are common and can be difficult to manage.  It is probable that some degree of parastomal hernia always occurs, but may not cause any problems. Up to half of all patients develop a parastomal hernia, usually within the first two years from surgery.

What are the symptoms of a parastomal hernia?

The key symptom of a parastomal hernia is a bulge in your abdominal wall where you have a stoma.

Sometimes the bulge appears after a strain (e.g. lifting or coughing).

Parastomal hernias are not usually painful. Although, many people feel an ache over a hernia, which worsens after doing any activity.

Most of the time, the main issue with the hernia is how it looks. Sometimes a large hernia may interfere with placement of stoma bags. But, if you have a hernia and develop any of the following symptoms, you need to seek immediate treatment:

  • sudden severe pain
  • vomiting
  • the hernia becomes firm or tender, or can’t be pushed back in (if it usually can)
  • difficulty passing stools or wind.

These symptoms may mean:

  • the blood supply to the tissue in the hernia has been cut off (strangulated hernia)
  • a loop of bowel has gone into the hernia and become blocked (bowel obstruction).

These are medical emergencies.

What causes parastomal hernias?

Parastomal hernias occur because there is a weak point in the abdominal wall where a surgical hole has been created in order to form a stoma. This creates a weak point for abdominal contents to poke through.

There are several things that can affect healing:

  • infection of the surgery site
  • obesity
  • smoking
  • malnutrition
  • general poor health
  • too much tension at the wound.

Straining (e.g. coughing, heavy lifting, constipation) increases pressure at the stoma site.

How are parastomal hernias diagnosed?

Your GP or hernia specialist will usually be able to diagnose a parastomal hernia from your history and by examining you.

Occasionally, a CT might be needed to confirm the diagnosis and see the extent of the problem.

How are parastomal hernias treated?

Surgery is recommended for parastomal hernias that:

  • are causing pain or discomfort
  • have a high risk of trapping abdominal organs
  • interfere with your quality of life.

Sometimes the risk of surgery is greater than the benefit. This may be the case for people who are in poor health, obese or smoke.

Hernia specialists repair hernias in two different ways, open or laparoscopic surgery.

Open surgery

Here your specialist surgeon makes an incision near the hernia and gently pushes the bulging tissue back into place. Next, the weak tissue layer is sewn back together, so that nothing can bulge through. In most cases, a piece of mesh is placed to create a patch. This takes the strain off the tissue wall and prevents the hernia happening again.

Laparoscopic surgery

During this surgery, your specialist surgeon makes several small incisions. A tube with a camera is inserted through one and other tools to repair the hernia through the others. A mesh patch is also used with laparoscopic surgery.

Your hernia specialist will help you decide if surgery is right for you and which procedure is the best option.