The most common complication for colostomy patients is the occurrence of a parastomal hernia. Those that suffer serious cases of this will more than likely face another surgery involving parastomal hernia repair. Surgically repairing PSH is aimed at ensuring tissues and muscles of the abdomen fit closely and securely around the colon and stoma and that nothing protrudes from this area of weakness. It may involve relocating the stoma to a different section of the abdomen or the surgeon may decide to leave the stoma where it is and fix the problem area. There have been marked advances in both techniques and materials used in this area of corrective surgery that have lowered the recurrence of another hernia, particularly in the same site.
Surgery can be done in either of the two ways. The operating surgeon can either relocate the stoma; create another opening elsewhere on the abdomen and arrest the hernia or treat it without relocating. The later case, the stoma is not relocated but rather the surgeon works his way around it. Traditionally, when the stoma is not relocated, the surgeon opens the wall of the abdomen near the hernia and surrounding or near the stoma and then sutures the tissues and muscles in the area. This has given way to strengthening and supporting the site with mesh, which is discussed further down.
Relocating the Stoma
If the condition is critical or for some other important reason, the operating surgeon may suggest moving it to a new site. The surgeon creates a new stoma on a different area on the abdomen, the hernia is then repaired and the original site where the stoma was located repaired by stitches.
Another possible technique involves using a prosthetic mesh. The mesh basically reinforces the weak muscles and tissues that lead to hernia. In this technique, the stoma is not relocated. The operating surgeon inserts the prosthetic mesh into the area with hernia. The mesh afterwards is incorporated into the site by surrounding muscle and tissue fibers. This mesh reinforces the weak abdominal muscles and tissues and thereby arresting the hernia. Use of the prosthetic mesh is far better than sutures since the condition is less likely to recur. When stitches are used, they may drift from tissue and muscles resulting to a recurrence of the hernia. Use of a prosthetic mesh is a modern method that is slowly replacing the old method of using stitches.
Laparascopic Mesh Repair
This may be carried out in two ways; totally extra-peritoneal repair or trans-abdominal preperitoneal. The procedure involves making small incisions. This means that a patient experiences less bleeding, post operative infections and a faster recovery rates. There is less likelihood of chronic pain.
Intra-abdominal Repair With Mesh
This method also involves the use of a prosthetic mesh. The mesh may either be placed above the fascia or below it and the muscle tissues. Prior to this technique, the mesh would be inserted into the defect in the abdominal wall. However, this method has lost some favor due to higher failure rates. This technique has the advantage in that the surgeon does not make large intra-abdominal dissection. However, it has a higher risk of contamination. Insertion of the mesh below the fascia or what is known as the sublay technique and is generally better than the other methods since it is associated with low recurrence rates of the hernia.
Placement of the mesh requires that the hernia contents be reduced into the abdominal cavity first. The defect is then closed usually by securing the mesh under the defect. The mesh is placed in a way that it leaves a wide overlap onto the normal abdomen wall. The bowel loop is then pulled out through an opening in the mesh. The loop is then attached to anterior and lateral abdominal wall, followed by the piece of mesh.
Parastomal hernia can also be repaired by the use of biological tissue instead of using a prosthetic mesh. This options eliminates the use of synthetic materials which have their own disadvantages on the patient. More importantly, it avoids placing the materials near the stoma. Once the biological grafts are implanted in the area with hernia, they act as a cellular collagen scaffolds. Host cells move into these implants producing the required native tissue. However, the procedure may not be an option for some patients due to the high cost involved and tangible evidence on the success and the appropriateness of biological grafts is still being collected and researched.
Any bulge in the skin around the stoma should be reported to your doctor or nurse especially if accompanied by noticeable pain and drastic change in color of the stoma. Hernia management might be the preferred course if the hernia is small and no pain and discomfort is involved. However, over time they can be come more inconvenient, uncomfortable and can interfere with the proper fit of colostomy appliances. Parastomal hernia repair surgery is something that should be carefully discussed with your doctor to determine if and when it may be needed.
Since colostomy surgery makes incisions into the abdominal muscles and creates areas of weakness colostomy patients should maintain safe practices for hernia prevention. Avoid lifting heavy objects, especially in the weeks after the surgery. Use of stoma hernia belts is another precaution that can be exercised and can also be used in the maintenance of minor hernias. It’s always better and easier to try and prevent a problem rather than trying to fix one.