This topic is about managing colostomy irrigation when you have a peristomal hernia. A person has developed a significant hernia around their stoma and is considering whether to continue with colostomy irrigation or opt for surgical repair. They are seeking advice and practical experiences to help make this decision.

Here are some helpful insights and advice:

1. The person feels somewhat reassured that irrigation isn't completely off the table, but they are looking for techniques to avoid immediate surgery.

2. They are undergoing targeted chemotherapy and want to be cautious about hernia repair. They have heard negative things about synthetic mesh repairs and are curious if biologic mesh might be a better option.

3. They recently learned how to irrigate, but the hernia now blocks the cone, so they need methods to overcome this obstruction.

4. They are interested in seeing photos or getting clearer descriptions of homemade devices that help maintain a seal during irrigation.

Advice and insights from others include:

- General Reference: Check out Section 15 of the "Irrigation – FAQ" PDF from the United Ostomy Associations of America. It confirms that irrigation can be done with a hernia, though individual technique adjustments are often needed.

- Successful irrigation with a hernia is possible, but results may be less predictable. Many have irrigated for years despite large hernias, emphasizing patience and trial-and-error.

- Technique Tips:
- Gently insert a lubricated finger into the stoma for a minute or two to help the herniated ring recede, allowing the cone to slide in.
- Use a gentle pressurized water flow to help the cone pass the obstruction. Some have adapted a 3-liter garden spray bottle to work with the Coloplast irrigation valve and cone. Commercial pressurized irrigation systems are also available.

- Managing Leaks:
- A perfect flange-to-skin seal is crucial to prevent leaks. If the sleeve adhesive lifts, high-pressure effluent can spray.
- A homemade backup involves using a small plastic base-plate cut from a skirting board with a plastic waste-pipe bend glued in the center. After water infusion, place this inside the irrigation sleeve and secure it with waist belts or strings to press the sleeve against the abdomen and divert output downward.

- Hernia Repair Considerations:
- Repairs often fail unless heavy lifting is avoided afterward. Be prepared for lifestyle changes and extended recovery time.
- Get several surgical opinions, as surgeon experience is important. One person mentioned being satisfied with their surgeon in Nashville.
- Biologic mesh, such as porcine or pig-skin mesh, was chosen by another member, who was told it offers better long-term success than synthetic grafts. They report good results so far.

- Post-Repair Irrigation Outcomes:
- Initial post-op swelling can make pouch adhesion difficult, but the area usually flattens over time. Once healed, irrigation at the new stoma site can work as well as or better than before.

Products mentioned include the Coloplast irrigation cone and valve, and a 3-liter garden spray pressure bottle adapted for use.