What Is an Ostomy Hernia?

After some bowel and bladder surgery, sometimes the doctor needs to make a stoma on the abdominal wall to achieve temporary or permanent diversion of the stool. If there is a defect near the stoma, the contents of the abdominal cavity come out through the defect near the stoma, and a parastoma is formed. It is a common complication after an ostomy, with an incidence of 10% to 50%. Diagnosis of a parastoma is easy, and surgery is the only way to cure a parastoma. Surgery needs to be repaired with patches, including multiple surgical methods, which can be achieved through open and laparoscopic approaches. Parastoma hernia repair is the most difficult and risky in the operation of abdominal hernia, and the recurrence rate is higher.

Basic Information

Visiting department

General Surgery

Common locations

Abdominal wall

Common causes

Caused by a local defect in the abdominal wall

Common symptoms

Reconstituted mass next to the stoma, which increases after standing or exertion; abdominal discomfort, abdominal pain, bloating, bowel incarceration, strangulation and necrosis, etc.

Causes of parastoma

The main reason for the occurrence of parastomas comes from the stoma itself. The stoma is bound to cause a local abdominal wall defect. The size of the holes in the abdominal wall stoma is difficult to be exactly accurate. If it is too small, it will cause the stoma to be narrow and difficult to defecate. In severe cases, it is necessary to perform surgery again to relieve the stenosis. If the hole of the stoma is slightly larger, small pores can be formed beside the stoma. It has a strong impact on the tissues around the stoma. Over time, it is easy to enlarge the original pores next to the stoma, which leads to the occurrence of hernias next to the stoma.

The incidence of parastomal hernias is higher if the patient has a combination of factors such as severe cough, difficulty urinating, and ascites that increase intra-abdominal pressure. In addition, poor nutritional status of the patient, wound infection at the postoperative stoma location, and improper manipulation during surgery can also increase the incidence of parastomas.

Clinical manifestations of parastoma

The main manifestation of a parastoma is a reproducible mass near the stoma, which increases after standing and exertion, and can be recovered after early supine, but patients with parastoma are prone to intestinal adhesions, which makes the hernia contents difficult. Receiving the situation. In the early stage of the patient, there were no other clinical symptoms except for the tumor. However, as the course of the disease prolonged, the parastoma would gradually become larger. First, it would affect the patient's daily life, increase the difficulty of stoma care, and damage the tightness of the stoma device. Stool or urine leakage irritates the skin; on the other hand, intestinal adhesions caused by the stoma of the intestinal canal in the hernia sac and repeated protrusion and retraction of the contents of the hernia can cause the intestinal contents to pass through the hernia sac and block the patient's abdomen Discomfort, abdominal pain, bloating and other manifestations, some patients will have bowel incarceration or strangulation and necrosis, threatening the patient's life.

Parastoma

Physical examination

When the patient stands, there is a bulging mass next to the stoma. When lying, the mass, which is the content of the hernia sac, will return to the abdominal cavity.

Palpation

The defect can be touched near the stoma; the contents of the hernia cannot be fully absorbed in some patients, and the size of the defect cannot be completely detected.

3.CT inspection

CT examination can help clear diagnosis and judge the size of the defect and hernia contents. Incarcerated patients can also see the presence of intestinal obstruction in the abdominal cavity.

Diagnosis of parastoma

The clinical diagnosis of parastomas is not difficult. A clear and clear diagnosis can be obtained based on the patient's history of stoma surgery, and related symptoms and signs and CT examination.

Parastoma Hernia Treatment

Non-surgical treatment can be used for patients with small hernia defects, few prolapsed contents, no discomfort symptoms, and physical conditions that are difficult to tolerate surgery. For patients with advanced cancer, including after palliative surgery and those with abdominal or distant metastases Patients should also be treated non-surgically. However, if the patient has the following conditions, surgery should be considered as soon as possible. Large hernias near the stoma; Difficulty in receiving hernia exudates, with the risk of acute incarceration and strangulated intestinal obstruction; Prolapse of the intestine at the stoma, causing incomplete or complete obstruction of the stoma Or dysfunction; seriously affect the patient's aesthetics and quality of life, seriously affect the stoma care.

Non-surgical treatment

The most important method for non-surgical treatment is to use localized compression of the ostomy band to prevent localized compression of the defect and further hernia contents. At the same time, diseases that increase intra-abdominal pressure should be treated. Non-surgical treatment cannot obtain a curative effect, and can only delay the further development of the parastoma and prevent incarceration.

2. Surgical treatment

According to whether the stoma is displaced, it can be divided into two types: stoma repair in situ repair and stoma displacement repair. The latter completely covers the original defect and repairs, and the recurrence rate is low. However, additional operations such as free intra-abdominal bowel are required. In the future, the stoma that has been repositioned may still have a hernia next to the stoma. Therefore, it is clinically to repair in situ.

At present, most of the surgery uses patch to strengthen the repair. According to the location of the patch, it can be divided into three categories: extrafascial repair (Onlay), rectus abdominis sheath preperitoneal repair and intraperitoneal repair. The first two can only be performed with open surgery. Intraperitoneal repair can be performed by open, laparoscopic or hybrid methods. According to the relationship between the patch and the stoma bowel after placement, it can be divided into two types: Keyhole and Sugarbaker. The Keyhole method usually uses a special patch with a sleeve to surround the stoma bowel. The Sugarbaker method covers the stoma with the patch to make the stoma bowel close to the side abdominal wall. Which method is usually used depends on the condition of the abdomen and the stoma.

In recent years, with the extensive development of laparoscopic technology, the proportion of parastoma repair under laparoscopy has also increased. It has become the current repair due to its advantages such as less trauma, rapid recovery, and fewer complications such as infection. Ideal surgical method for parastoma.

Prevention of parastomas

The main reason for the occurrence of parastomas is the stoma itself. The existence of the stoma prevents the surgeon from fundamentally eliminating the abdominal wall defect, but through some measures we can still reduce the incidence of parastomas as much as possible. We can take different preventive measures according to the specific situation of the patient. For example, for obese patients, weight control may be required appropriately. For patients with increased intra-abdominal pressure, relevant diseases should be actively treated before and after surgery, such as avoiding lung infection and severe cough. For patients with malnutrition, strengthen before and after surgery. Nutritional support; good bowel preparation and rational use of antibiotics to prevent infection during the perioperative period. For the surgeon, controlling the size and tightness of the stoma, and careful operation can also help reduce the incidence of parastomas.