Stomal or para-stomal hernias as they are probably better described occur through the opening in the abdominal wall used to create a stoma either ileostomy or colostomy.

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Who commonly presents with it?

In some cases we simply don’t know but we are aware of certain risk factors. Stomal hernias are more common after emergency abdominal surgery. Other factors that can lead to hernias include:

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• Excessive coughing or straining after an operation

• Increasing age

• Steroids

• Obesity

• Smoking

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How does it present?

Stomal hernias are very similar to a type of incisional hernia. Because a hole is created in the abdominal wall to form the stoma there is a potential weak spot for a hernia to develop. They can occur soon after an operation or may develop months or years later. Stomal hernias are quite common and when small may go unnoticed. Stomal hernias left untreated can get larger with time.

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What can be done?

In some cases you simply can’t prevent a Stomal hernia, but you can reduce the risk or help prevent an existing hernia getting larger by:

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• avoiding heavy lifting wherever possible

• using your legs and not your back to lift heavy objects if you need to

• avoiding constipating or straining during bowel movements

• maintaining a healthy weight

• stopping smoking

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A different sort of stoma bag with convexity can help with small hernias, as can a simple elasticated stoma belt. A colorectal nurse specialist should be able to advise you on this. A hernia belt may be beneficial for some patients with a hernia who do not want an operation. These can provide additional support to the abdominal wall. The belt is worn over the hernia site to prevent it coming out. These belts are usually made-to-measure by a specialised appliance fitter. More modern elasticated support garments may provide an alternative for those who wish to avoid surgery or wear a belt but there isn’t any good evidence that they will prevent hernias enlarging.

 

A hernia repair is usually advised if a hernia becomes symptomatic i.e. starts enlarging causing discomfort, or generally interfering with the activities of daily living or starts causing problems with bag fitting. Stomal hernias can vary in size from very small to very large and no single operation is suitable for all types of hernia. Your surgeon will discuss which are the best options open to you.

 

The operations can be done as open or as keyhole procedures, again not all stomal hernias are suitable for a keyhole repair. Hernias are repaired using sutures or a combination of sutures and a mesh reinforcement. Generally sutured repairs are only suitable for smaller hernias and large hernias nearly always need a mesh reinforcement as well. The principle of the repair is to place the hernia back in the abdomen and to narrow the opening in the abdominal wall to prevent it recurring.

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It is important to make the opening tight enough to prevent that but not to make it so tight that it interferes with stoma function. Sometimes when a stomal hernia is vey large or has been repaired previously the surgeon may advise moving it to a different site on your abdomen, usually on the opposite side. All para-stomal hernia repairs are carried out under a general anaesthetic.

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How long will your recovery take?

Patients are encouraged stay active following surgery. Walking regularly is the most useful exercise after the operation. Following the operation you should avoid heavy lifting for 4-6 weeks. After about 4 weeks you should be able to increase your exercise activities. Starting with gentle rhythmic exercises such as cycling or cross-training and gradually building up to your normal exercise regimen. Provided there are no wound problems swimming can also be good at this stage.

 

You should be able to return to work within one or two weeks but if your job involves any strenuous activities you may need to be off work for longer or carry out only light duties.

 

It is difficult to be specific about driving as this will be dependant on the site and size of the hernia repaired. After repair of a small hernia some patients can usually drive again after one to two weeks but this may be four weeks or more for larger hernias. Your surgeon will give you specific instructions regarding this.

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What are the main risks of surgery?

Your surgeon will advise on any specific complications and risks. For all types of surgery there is always a risk of wound infection and a 1-2% risk of recurrence of the hernia.