From the Guidelines
A parastomal hernia occurs due to the creation of a defect in the abdominal wall during stoma formation, which can enlarge over time as a result of intra-abdominal pressure, with risk factors including obesity, smoking, steroid use, and transverse colostomies. This complication is common, occurring in up to 50% of ostomates within 5 years 1. The underlying cause of parastomal hernia is the weakened abdominal wall around the stoma, which can be exacerbated by various factors. Key risk factors for hernia formation include:
- Obesity
- Smoking
- Steroid use
- Transverse colostomies To minimize the risk of hernia formation, stomas should be placed through the rectus muscle, and the use of the transverse colon should be avoided when possible 1. The natural tendency of tissues to follow the path of least resistance contributes to the formation of the hernia, as abdominal contents push through the surgically created defect. Prevention strategies and proper management are crucial to reduce the risk of parastomal hernia and its complications.
From the Research
Causes of Parastomal Hernia
- Mechanical factors, such as the relationship between the stoma and peritoneum, stoma location, and aperture size, may contribute to the development of parastomal hernia 2
- Intrinsic defects in collagen metabolism and wound repair may also play a role in the occurrence of parastomal hernia 3
- The type of stoma, such as end colostomy, loop colostomy, or loop ileostomy, can affect the risk of parastomal hernia, with end colostomy carrying the highest risk 3
- Patient-related factors, including operation time and individual conditions, may also influence the development of parastomal hernia 2
Risk Factors
- The selection of intestine for stoma formation may be a risk factor for parastomal hernia 2
- The size of the trephine used in stoma formation can also affect the risk of parastomal hernia, with very large or very small sizes increasing the risk of complications 4
- Obesity, with a mean body mass index of 30 kg/m2, may be a risk factor for parastomal hernia, as seen in a case series of robotic parastomal hernia repair 5
Prevention and Repair
- Prophylactic mesh and perioperative care may help prevent parastomal hernias 2
- The use of a biologic mesh with the keyhole technique can avoid the risk of erosion into the bowel segment 5
- The Stapled Mesh stomA Reinforcement Technique (SMART) can be used to place a prophylactic onlay mesh in the trephine during permanent stoma formation to prevent parastomal hernia 4
- Laparoscopic repair using mesh can be an effective treatment for parastomal hernia, with a low recurrence rate 6, 3