The topic at hand is about deciding whether to undergo surgery or manage conservatively for a parastomal hernia. Pete, who has a hernia on his old incision line, is considering his options. While it doesn't cause him much pain or trouble, it is cosmetically bothersome. His doctor suggested a surgical repair using a mesh patch, but Pete is unsure and is looking for advice from others who have been in similar situations.

Here are some insights and advice shared by others:

1. **Overall Outcomes & Decision-Making**
- Some people have had successful mesh repairs with minimal issues, but others have experienced early recurrence or mesh tearing. Surgeons often mention a long-term success rate of about 50%.
- Many have been advised to leave an asymptomatic hernia alone, with surgery usually recommended only for pain, obstruction, appliance problems, or significant cosmetic concerns.
- If an ileostomy reversal is planned, it might be best to wait, as the defect will be closed during that procedure.

2. **Surgical Techniques & Considerations**
- Simple suture repair is rarely recommended due to a high recurrence rate.
- Local mesh repair can reduce recurrence but may increase risks like wound infection, mesh contamination, or erosion into the bowel.
- An intra-abdominal (open) approach offers better mesh placement and slightly lowers contamination risk.
- Re-siting the stoma along with abdominal wall reconstruction is preferred if there are issues with the stoma's placement, retraction, or narrowing.
- Choosing a surgeon experienced in laparoscopic or "keyhole" hernia repair can help reduce infection risk.

3. **Non-Surgical Management & Prevention**
- Hernia support belts or braces, like the Nu-Hope hernia belt, can help reduce the bulge, support the abdominal wall, and improve appliance adherence. In the UK, these supports are available for free through the NHS, though they may not be the most fashionable.
- Improvised support, such as using modified support tights, can be a cost-effective alternative.
- Wearing a support belt during activities that strain the abdominal muscles and minimizing intra-abdominal pressure (like avoiding heavy lifting or forceful coughing) can help, though it won't eliminate the risk entirely.

4. **Factors Influencing Surgical Candidacy**
- Factors such as general health, abdominal fat, scar tissue, previous surgeries, and the ability to follow postoperative activity restrictions can affect the success of a repair.
- Consulting a surgeon who specializes in complex or parastomal hernia repairs is highly recommended before making a decision.