Parastomal Hernia Repair: Experiences, Techniques, and Outcomes?

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Beachboy
May 20, 2024 4:35 pm

I've been researching parastomal hernia repair and read many medical research studies about it.  

I have a colostomy with a mild parastomal hernia. Though I'm willing to live with it, it would be nice to get it fixed provided the damn thing doesn't reoccur. Of course, there's no guarantee, but some surgical repair techniques offer superior results.

Have many of you undergone surgical repair? If so, what was the technique used? Did you suffer postoperative complications? And most importantly, did the fix work?

In reading about this, one point medical researchers recently stated: ostomy placement for a colostomy makes a huge difference in future parastomal hernia formation. It has been noticed by medical researchers that the extraperitoneal route of stoma creation is superior to the intraperitoneal route. 

Of course, patients don't have input on this when undergoing emergency surgery, like in my case. But it might be worth discussing with your surgeon if colostomy ostomy surgery is recommended for you.

 

 

mild_mannered_super_hero
May 20, 2024 4:55 pm

Yes, I had a hernia repair back in '15. My surgeon recommended we move the old stoma and place it in the rectus muscle. I have had no problems since, but I had to retire as I was a mechanic and did too much heavy lifting. I would suggest that you get the repair but get a good colo/rectal surgeon. I had the pig skin mesh, and it worked great so far. I am a little more cautious about lifting stuff, but I lead a very active lifestyle. Can I ask why you don't irrigate? I had my stoma situated about flush with the skin at the surgeon's suggestion since I irrigate. Any questions, just shoot me a message.

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Beachboy
May 20, 2024 6:47 pm
Reply to mild_mannered_super_hero

Thanks for your reply and experience.

I don't irrigate because I'm too lazy. My colostomy doesn't cause me grief and output is normally thick, well-formed, and mostly predictable. Occasional bag emptying/changing and once a week wafer replacement is the extent of my dealing with it. I've resumed a full, active life. My Hollister bag holds a lot of poop, so I rarely encounter emergency bathroom events.

My stoma sticks out around 2 inches. About an inch too long. But... better more than less. My surgeon did an excellent job considering I underwent emergency surgery and he wasn't sure what he would find once he unzipped me.

What does bring me down is the parastomal hernia. Combined with my extra-long stoma... I appear deformed. I'm a little guy with this big-assed lump. My wife constantly points it out. Like I can really do something about it. I have a Nu-Hope support belt with prolapse strap, which transforms my big lump to a medium lump. But I can't wear it every day.

I was considering stoma revision to decrease stoma length. But kinda pointless without hernia repair.

Thus, I'm researching it. Just undecided, if at age 66, more major surgery is worth the risk to look somewhat slender again.

DexieB
May 20, 2024 6:50 pm

Hey Beachboy. I don't have my colostomy anymore, so I shouldn't be commenting... yet here I am, LOL. I hear you on the hernia - I was so glad to be rid of it. Unfortunately, I did end up getting a new one when I caught that virus and had a nasty cough days after my reversal. But it's in a different spot than my parastomal hernia was - I'm meeting with the surgeon in June.

I am the type of person who will read every piece of literature to try to come to an informed decision, but I end up dwelling on all the bad so much that I get overwhelmed and don't take action. Not saying you do this - but it's what I do. I've come to the conclusion that as with anything in life, things could go wrong - but they could also go right. And if it's something you really want, I hope you will pursue it with a good colorectal surgeon.

I will be watching this thread because I want to hear more about hernias in general - thanks for bringing this subject up. Good luck in whatever you decide to do! ;)

kittybou
May 20, 2024 7:03 pm
Reply to Beachboy

Hmmm, you're alive, healthy, and happy. I would not mess with that. But, that's me. I have an intense dislike of hospitals, getting expired date cottage cheese, and hospital food in general. So, nope vote from all of us, even baby Button said "Oh hell no" 😸

 
Living with Your Ostomy | Hollister
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Beachboy
May 20, 2024 7:15 pm

Hi Dexie,

I read a lot of clinical and medical research studies. There is an amazing amount of research about ostomy surgeries, complications, and parastomal hernia repair and prevention.

I learn something new every day. Like how ostomy placement and creation technique can affect patient outcomes. Like the extraperitoneal route is superior to the intraperitoneal when creating a colostomy. Hernia development occurs much less with the extraperitoneal method.

Also, all the different repair techniques. If I decide to get repaired, I want to choose what I feel is the best approach, provided my surgeon agrees and can perform that type of repair.

And it is possible... I'll just "throw up my hands" and decide to hell with it. Do I really need, at my age, to risk another major surgery? I've had so many over the decades... I've lost count.

I've just retired, so I have all this free time on my hands to look stuff up and overthink my ostomy. 😎

Beachboy
May 20, 2024 7:40 pm
Reply to kittybou

Hi Kittybou,

Thanks for your affirmative, rational reply. Yes, I'm amazed I've recovered so well. My wife continually reminds me to quit grouching about my ostomy. Even my cat glares at me from time to time. She's probably thinking... "Dan, nothing matters except kibble time."

Login to see image

Does anyone know how to rotate a picture inserted into a post? I tried rotating the image before inserting it... didn't work.

 

Yes... the last place you want to be sick is in the hospital. Kind of a mega germ warehouse.

Sometimes seeing my thoughts in writing helps to "chill me out." Always gotta remind myself: Self... you're 66, not 26. 🐣 not a spring chicken.

 

DexieB
May 20, 2024 7:53 pm
Reply to Beachboy

I always overthink things for fun, and also enjoy medical literature. Bad combination ;). But honestly, I completely understand where you are coming from. I am 5'2" and my husband would say my hernia/ostomy didn't bother him at all, but then make a comment like, "Wow - your hernia is getting bigger!" I know he was not intending to hurt me, he was just stating facts - but it always kind of hit me like a punch in the gut when he would comment on it. And I'm not a vain person in the least - but I didn't feel like myself anymore, so not gonna lie, I was happy to be rid of the hernia. Another reason I'm so upset that I have a new one - even though I knew it was a possibility - I was just hoping I could be "me" again, even if just for a while!

Question... if you have a stoma revision, couldn't they fix the hernia at the same time? My colorectal surgeon had no choice but to fix mine in order to do my reversal.

Well, the good news is you've got nothing but time now to reflect and also time to recover should you decide to fix it. Keep us posted!

kittybou
May 21, 2024 12:37 am
Reply to Beachboy

All cats sit like that. They ignore gravity. The picture is fine.

aTraveler
May 21, 2024 2:49 am

BB, you have studied the literature and you know it is possible to have it repaired and not develop a new one. You know things can go south and you develop a new one. The first thing you have to consider is how well your body heals. Since you have undergone many surgeries, you know how well your body heals. If your body has difficulty healing, then stop 🛑.

If you are satisfied with the pace of your body's healing, then it's time to talk to the surgeons. Since you have the time, talk to at least two. Find out from the surgeons what is the best way to repair your hernia. Has the surgeon performed many surgeries using the approach that's best for you? Have many of the patients remained hernia-free after the surgery? What is the likely recovery time? What are some of the complicating factors of the surgery and post-surgery recovery?

The most important thing is to develop a good rapport with the surgeon — you want someone with whom you can have honest conversations and who is willing to answer all your questions both pre and post-surgery.

By all means, don't limit yourself to just two if neither provides you a suitable comfort level. You owe it to your successful recovery to find a good surgeon that you can relate to.

toddB
May 21, 2024 12:26 pm

This is a really interesting thread to me. I also have a colostomy with intermittent parastomal hernia and bowel obstructions that result from it. I wear a Nu-Hope belt 24-7, but still occasionally get obstructions. I would love to find a good fix for this problem... I have found that daily Miralax helps, but what about surgical options to correct it? Thanks!

Beachboy
May 21, 2024 2:22 pm
Reply to aTraveler

Very good points. My two surgeons are excellent. I have a colorectal and a hernia expert surgeon. The hernia expert performed my life-saving surgery, resulting in a colostomy after removing 12 inches of damaged colon and three impacted hernia repair meshes. I've consulted with both of them about reversal, revision, and hernia repair.

Last year, I decided to keep the colostomy, no reversal.

If I went ahead with hernia repair/stoma revision: one would do the revision, the other the hernia repair. Both are experts in minimally invasive robotic surgical techniques. Both are willing to do it.

I have researched the hell out of this. Worldwide, surgeons and researchers publish their surgical results and study findings. What works, what does not.

So, I know a lot about peristomal hernias. And I have my own to look at every day. The bottom line: at age 66, do I risk elective major surgery to look somewhat better physically? My hernia doesn't cause any trouble with my stoma, so my hernia fix at this point would be purely cosmetic. My concern is if the hernia gets bigger and does begin causing trouble. I've seen pictures of huge hernias. Yikes.

So, I'm going to have a CT scan and compare it to last year's CT with my hernia surgeon. The drama in my head continues.

Beachboy
May 21, 2024 3:29 pm
Reply to toddB

Hello,

You have a real need for hernia repair.

The first step is finding and consulting with a hernia repair surgeon. My colorectal surgeon does not perform hernia repair, so I also have a hernia repair specialist surgeon.

There are many repair techniques and modifications. Some repairs use mesh material. Thus, there are many types of mesh and mesh material, some plastic, some derived from biological origin. Stitching the repair a certain way affects the outcome. How the intestine is brought through the abdominal wall makes a difference in the outcome. There's a lot to research and learn. Armed with understanding the process, different repair protocols, and mesh materials, you can make an informed decision. The most important criteria should be stoma function. Your hernia is causing blockages. It is possible a surgeon could get in there, move things around, and you would be fine without repairing the hernia. In this case, you would have revision surgery. This is something to discuss with your surgeon.

If, in your surgeon's opinion, revision will not work, then onward to hernia repair.

There are many types of repair. Selected discussion below from my research:

Novel approaches: Sandwich and Hybrid with 3D mesh demonstrate superior outcomes in terms of recurrence when compared to Keyhole and Sugarbaker techniques. Keyhole technique is associated with the highest recurrence rates and postoperative complications. Sandwich technique demonstrates the lowest recurrence rate but has a high rate of postoperative complications. The Hybrid technique has a recurrence rate of 4% and the lowest postoperative complication rate, around 6%. Keyhole technique exhibits the highest recurrence rate but has the shortest operation time. Sugarbaker technique has an acceptable recurrence rate of 9% and a moderately increased complication rate of 27%. Note: Fascial closure with interrupted sutures before mesh application is a modification that leads to lower recurrence rates in all repair techniques. Modification of the Keyhole technique involving fascial closure and stoma fixation in defect edges before applying mesh resulted in decreased reoccurrence.

So, some food for thought regarding hernia repair and surgical techniques. As you can see, surgical technique (sutures) plays a major role in hernia recurrence, no matter the hernia repair style used. Also, see my previous post on this thread regarding extraperitoneal vs. intraperitoneal stoma creation.

Write a list of topics for your consultation with your surgeon. Refer to your list so you don't get sidetracked and forget to discuss a concern you have. Many times I'm driving home from the doctor and it hits me... I forgot to ask about that!

Beachboy
May 21, 2024 3:37 pm
Reply to DexieB

Exactly the question I'm going to ask:

Can hernia repair accompany stoma revision?

My colorectal surgeon does revisions but not hernia repair. I have to ask my hernia surgeon if he does both. The plot thickens...

IGGIE
May 21, 2024 4:36 pm
Reply to Beachboy

G-Day BB, I had a parastomal hernia done 18 months ago and it's been great ever since. BB, if you have one, it will get bigger and it's an easier operation when it's small, so think about it. My surgeon didn't like using mesh; he said it can cause infections and it can move inside and do damage. Ask your guy how he does it and then get a second opinion. Regards, IGGIE

DexieB
May 21, 2024 4:43 pm
Reply to Beachboy

Ah, ok... makes sense. I hope the hernia surgeon can do both for you!

Hisbiscus
May 21, 2024 5:06 pm

Hi Beachboy,

I think you and I spoke here before about my repair. I had mine at the Cleveland Clinic Foundation. They have specialized general surgeons who do parastomal hernia repairs.

As I had mentioned before, I had no issues with the surgery or recovery. The downfall was a flat stoma.

Hisbiscus
May 21, 2024 5:44 pm

Came back to say, since I saw you're looking at studies. I was in the study for parastomal hernia repair at Cleveland Clinic. I was one of the Sugarbaker method subjects. Dr. Petro did mine. So if you look up parastomal hernia repair study Cleveland Clinic and the Dr.'s name you should find the study.

aTraveler
May 21, 2024 6:29 pm
Reply to toddB

Todd, your situation demands hernia repair. You are getting bowel blockages caused by the hernia. The hernia is going to grow over time, and you may start to get more frequent blockages. You could end up in the ER with emergency surgery. You have to be proactive and search out good surgeons you are comfortable talking to. Having to endure blockages for the rest of your life due to the hernia is a non-starter.

Hisbiscus
May 21, 2024 8:12 pm
Reply to aTraveler

So true because I was getting a whole lot of blockages, and then came the mild obstruction in which they had no choice but to fix it.

Hisbiscus
May 21, 2024 8:19 pm
Reply to Beachboy

If you find a general surgeon who specializes in parastomal hernias, they can do the stoma as well. Mine told me I could possibly wake up with a new stoma site, and they did all the markings beforehand, but he left the old one there because he said it looked perfect. I kind of wonder if the mesh is kind of like an extra layer, sort of like a barrier ring would be on a pouch wafer. I'm thinking this may be why my stoma went flat. Not sure, but just my thoughts.

DexieB
May 21, 2024 8:25 pm

All this hernia talk has prompted me to move my hernia consult appointment date up! Too bad it could only be moved up a week, so I will see the surgeon on June 20 instead of June 26. The past few days I feel like it's getting bigger, and it might be easier to repair when it's small. Not sure on that, but it's something I definitely plan to ask! I think it's an incisional or ventral hernia; it's right in the middle of my abdomen. No fun, and I don't plan to spend my remaining time on earth waiting for that thing to strangle off. Plus, I hate how it feels, so I'm probably going to fix it if I can (not sure if it's too soon after my reversal surgery).

onecoolnana12
May 26, 2024 6:21 pm

Hi Beachboy!

I had a loop colostomy and developed a hernia and dealt with it for too long. My hernia doctor sent me to another specialist 400 miles away, said he was the best, and when he fixes it, it won't come back. Haha, well, it never went away. He did laparoscopic surgery, and what a bad call. I kept telling them my hernia was still there, and I was told it was just swelling from the surgery, which was weeks later. After several months, I made an appointment with my hernia doctor who sent me to the other doctor, and luckily, when I got to my appointment, he wasn't there for whatever reason, and I saw one of my other doctors who I now know is like a jack of all surgeries. Boy, was that a blessing in disguise. He looked at it and said, why don't we make your loop into an end ostomy and fix the hernia at the same time? Before doing so, he would look to make sure there was no chance of reversal, but I'm not so sure I would have wanted it reversed after having it for 8 years. But it couldn't be, so that took care of that thought. My surgeon asked why the other doctor put so many clamps in me; I didn't even know he did. I got my ostomy moved above where the loop ostomy was and the hernia fixed, and that was the best thing ever. I had my new end ostomy since the end of 2022 and no hernia in sight. I was 66 at the time I did this, so don't let age determine what you want for yourself. If it bothers you, do it; if not, then let it be. Between the time of my initial surgery till then, I had 6 surgeries.

Best wishes on your decision.

tonybrown777
May 26, 2024 6:38 pm
Reply to Beachboy

Great look, good and put life at risk. Go for it, fellow, why not?

Daisydexter
May 27, 2024 2:28 am

If your hernia is mild, I would leave it alone. I had two hernia repairs that failed, and my only next option is relocation in which the hernia still might happen. My last hernia came back mild. I wear a hernia belt every day, no one can see it, and I think the risk of relocating my stoma to the other side of my abdomen, for me, isn't worth it. Good luck!

Bertha
Jun 04, 2024 9:35 am
Reply to Beachboy

tnmontan9721
Jun 30, 2024 5:26 pm

Beach Boy, I recently had an abdominal CT scan and the report just stated parastomal hernia but did not indicate the size of the hernia. I see in your post you stated you have a colostomy with a mild parastomal hernia. How did the doctor determine the size of your parastomal hernia?

Jayne
Jul 03, 2024 5:45 pm
Reply to Beachboy

Also, Dan, the actual technique used by the surgeon [per odds as to recurrence - there are two schools of thought] is relevant, as are the complexities of your adhesions.

You may message me if you wish.

Jayne

Jayne
Jul 03, 2024 5:57 pm
Reply to Beachboy

BB,

 

'Over-thinking' can be counterproductive, but good solid and meticulous research is valid. So too is a professional informed understanding that takes into account one's own actual situation. And on the day of intervention, the ability to think on the hoof [whilst having an agreed ground plan with often several best options calibrated] - as regards any repairs which become necessary at the time of being in theatre - i.e., any minute bowel perforations which are or may become apparent - [and not necessarily due to accident either... adhesions are difficult to separate - one's surgeon is human, after all - no matter how advanced the techniques may be] during open surgery.

 

Research away and find yourself an excellent surgeon with no pre-formed agenda or any invested conflict of interests.

 

There are some amazing surgeons and physicians with the vocation, experience, knowledge, and genuine care which is truly amazing... If you are fortunate to access such an individual - those of us who do, are well blessed. Their openness and frankness, caring of sharing the detail, inspires confidence whereby we may rest in the knowledge they will give of their best.

 

Good luck in your search...

Your heart and mind will inform you when the time is right.

 

BW

Jayne

Jayne
Jul 03, 2024 6:18 pm
Reply to aTraveler

Agree on all these points ATravellor has made - it's down to who and how, and then a truthful self-assessment and the timing if you decide to proceed.

Jayne