A stoma is an artificial opening in the body that is surgically created permanently or temporarily in order to maintain bodily functions. A stoma is therefore an artificially created opening of a hollow organ to the body surface. An artificial bowel outlet is therefore referred to as a stoma.
The parastomal hernia particularly often affects the so-called enterostomy, i.e. the artificial bowel outlet. This is particularly susceptible to incisional hernias as it originates from strong structures that are also exposed to great stress. The internal abdominal pressure (for example during bowel movements) and the abdominal wall act on the stoma.
In the case of a parastomal hernia, there is a prolapse underneath the skin of the so-called stoma loop of the bowel. Additional prolapse of other parts of the bowel or parts of the greater omentum into the subcutaneous fatty tissue may also occur. The parastomal hernia is regarded as a special form of incisional hernia.
It is currently assumed that up to 50 to 80 percent of patients with an artificial anus also develop a parastomal hernia. Accordingly, incisional hernia is a common complication following abdominal surgery.
The symptoms of a parastomal hernia appear as defects in the abdominal wall and a protrusion next to the artificial anus. When the pressure inside the abdominal cavity increases, the bulge through the hernia sac becomes clearly visible. This is the case, for example, when coughing or pressing the abdomen.
However, the symptoms can vary greatly and range from complete freedom from symptoms to restricted movement and pain.
These arise in particular with circulatory disorders if parts of the intestine are trapped in the hernial orifice. Complete blockage of the intestine can be life-threatening. Immediate surgery is then required to relieve the pain and restore blood flow to the intestine.
Illustration of a hernia with trapped parts of the intestine © blueringmedia | AdobeStock
A parastomal hernia mainly occurs after a surgical procedure. The tissue and the scar of the stoma opening have not yet grown together and strengthened sufficiently.
The parastomal hernia is caused by
are favored.
generally favor complications after an artificial bowel outlet.
The general risk factors that lead to the development of a parastomal hernia include, for example
All of these factors weaken the tissue. As a result, it is possible that a scar does not heal properly after a surgical procedure and the stoma is not properly secured in the abdominal wall.
Even today, the causes of parastomal hernias are still thought to be a technical error on the part of the surgeon. However, the development of the parastomal hernia shows that the surgical technique does not play a role as the cause of the parastomal hernia. This has also been proven in clinical studies.
When a new stoma is created, a new hernia also occurs in most cases. This proves that the surgical technique does not appear to play a role in the development of parastomal hernia.
In most cases, a parastomal hernia can be detected by a clinical examination from the outside. A thorough palpation may reveal the contents of the hernia sac.
However, in order to be able to make a reliable and accurate diagnosis, imaging procedures such as ultrasound or MRI should follow. This can also increase the rate of detected small hernias.
An ultrasound examination helps to diagnose a parastomal hernia © Alexander Raths | AdobeStock
Large parastomal hernias in particular require surgery. In these cases, the hernial orifice and the hernial sac are correspondingly large and can also contain a correspondingly large amount of intestine. The operation should
A very large hernia sac often makes the surgical conditions more difficult. The anatomical function of the abdominal wall must be restored. This is difficult because the artificial outlet interrupts the supporting function of the abdominal wall and represents a weak point.
In the treatment of parastomal hernias, the use of a plastic mesh to reinforce the hernial orifice has proven successful. This is the most reliable way to reduce the recurrence rate. There are various mesh materials that are used for the different surgical procedures.
In open surgery, lightweight polypropylene meshes with large meshes are used. These are in direct contact with loops of the bowel. They are very firm and can therefore cause irritation and fistulas.
In addition, the meshes must be more flexible and finer-meshed when used with laparoscopic techniques.
The use of mesh reinforces the abdominal wall © gritsalak | AdobeStock
Each mesh has different properties that behave differently in the body. Accordingly, the mesh must be selected appropriately for each surgical technique for a parastomal hernia.
The high recurrence rates in particular are the reason why the so-called fascial suture is no longer used for a parastomal hernia. The creation of a new stoma at a different location is also no longer preferred, as a new parastomal hernia is then to be expected. This is because the basic requirements of the tissue and the patient are unchanged.
In principle, the probability of developing a new parastomal hernia is very high, even after the parastomal hernia has been repaired. In the case of open surgery, a recurrence rate of up to 50 percent is assumed. The surgical field is exposed to a high risk of infection. This risk is lower with minimally invasive procedures, but these procedures do not always have optimal results.
In general, the patient himself cannot prevent a parastomal hernia, especially if it is caused by a necessary surgical procedure.
If a patient has a high risk of developing a parastomal hernia, a plastic mesh can be surgically inserted to prevent and secure the abdominal wall. In this way, the patient's abdominal wall is reinforced. The new weak point in the abdominal wall, which has arisen due to the creation of the artificial bowel outlet, is bypassed in the best possible way.
The Leading Medicine Guide's quality assurance is ensured by the following acceptance prerequisites.
