Aug. 27, 2024

While patients can resume their previous endeavors following an ostomy, more than half develop a parastomal hernia within three years, according to a 2018 Hernia publication. This hernia involves an enlarged abdominal wall defect associated with the conduit construction that allows the patient to excrete waste. This stoma complication is unrelated to the surgical technique employed, says Robert R. Cima, M.D., a colorectal surgeon at Mayo Clinic in Minnesota who performs this repair and publishes on parastomal hernia treatment.

A quality-of-life issue

As parastomal hernias expand, they can threaten quality of life.

"With the expanding hernia, patients become worried about potential problems, such as appliance seal issues and resulting leaks causing stool or urine seepage at inappropriate times," Dr. Cima says. "Then they may withdraw from activities they enjoy, which can interfere with relationships."

Issues patients encounter with a parastomal hernia may include:

• Protrusion.
• Physical symptoms.
• Intestinal obstruction.
• Leakage.
• Self-esteem or relationship challenges.

Thus, a parastomal hernia can transform what was a relatively normal postostomy lifestyle into a reclusive one as the hernia becomes more problematic, says Dr. Cima.

Innovative parastomal hernia repair at Mayo Clinic

At Mayo Clinic, most patients with parastomal hernias are candidates for robotic surgical hernia repair. This less-invasive procedure improves outcomes, shortens hospital stays and promotes faster recovery compared with traditional open repair.

Mayo Clinic uses the modified Sugarbaker technique for parastomal hernia repairs, which is regarded by some experts, including Dr. Cima, as the gold standard for minimizing recurrence.

"Robotic parastomal hernia repair has transformed the practice for me," says Dr. Cima. "The 3D camera provides unparalleled visualizations and precision, allowing me to see anatomical details that are challenging to perceive in an open procedure."

During robotic parastomal hernia repair, the surgeon performs adhesiolysis; hernia content reduction; stomal revision, if required; enlarged stomal trephine narrowing; and bowel stomal limb lateralization.

The modified Sugarbaker technique involves installing a permanent, wide-pore, pliable mesh sheet inside the abdomen to prevent defects that may enable hernial recurrence. This mesh acts as a barrier, preventing the bowel from protruding through the abdominal wall.

According to Dr. Cima, benefits following parastomal hernia repair using this technique include:

• Improved collection pouch function. Parastomal hernia repair significantly improves functionality with low recurrence rates. A 2024 publication in Updates in Surgery by Dr. Cima and colleagues reports a low recurrence rate of 5.8% at a typical 10-month follow-up. In a recent review of his team's robotic parastomal hernia repair experience, recurrence rates were less than 10% within two years postsurgically.
• Good postsurgical aesthetics. With robotic repair, postsurgical cosmesis impresses patients, especially with only four half-inch (1.27 cm) incisions and no substantial scars. The hernia repair effectively restores the patient's anatomy, eliminating the hernial bulge and enhancing cosmetic health.
• Improved function. The repair offers significant functional benefits, such as allowing a police officer or an athlete in baseball or track to wear a belt properly. It also smooths the abdomen for patients to wear pants or belts.
• Return to usual activities. Postsurgery, patients can go back to their typical activities unrestricted by their previous stomal challenges.

Why refer patients to Mayo Clinic for this surgery

While parastomal hernias are reparable, the repair requires specific training and experience to make it durable without compromising stomal function. Dr. Cima and colleagues in colorectal surgery at Mayo Clinic have this background. He suggests the following additional benefits of referral to Mayo Clinic for physicians and their patients:

High-volume center

A key benefit of a center such as Mayo Clinic for patients with parastomal hernias is the sheer volume of cases managed annually.

"It's important for physicians to seek care for patients requiring parastomal hernia repair at a high-volume hospital such as Mayo Clinic," says Dr. Cima. "In this setting, the surgery will be performed expertly with minimal complications, plus lower recurrence and revision rates. Our capability means it will be an efficient surgery and that we can ensure patients' safety during a complex procedure."

Collaborative approach to partnership with patients and their healthcare professionals

Dr. Cima emphasizes the importance of partnering with patients and their local healthcare professionals. He and his team ensure all patients' questions are answered and have hundreds of stoma supplies available. They are happy to work with patients, at times taking multiple days to ensure the right appliance and fit for their lifestyles.

Support for local healthcare professionals

Healthcare professionals often refer patients to Mayo Clinic due to a lack of local services and supplies.

Dr. Cima states, "That's where we can help out. Our goal is caring for patients sent to us and ensuring we build good relationships with their local healthcare professionals to address any postoperative issues. We're always available to referring healthcare professionals for consult."

Convenient care for traveling patients

For patients who come to Mayo Clinic from a distance for parastomal hernia repair, a significant portion of care can be done at home, which is more convenient. Dr. Cima and team guide local healthcare professionals on necessary tests and steps to take. If surgery is not preferred, Mayo Clinic's parastomal nurses can discuss nonsurgical options via video chat. The team also is available for remote communication with patients.

For a small number of patients referred to Mayo Clinic with stomal issues, Dr. Cima and his team determine that the existing stoma is unnecessary. In such cases, they collaborate closely with the patient to facilitate its removal.

Treatment beyond just the hernia

The Mayo Clinic team also helps patients with parastomal hernia through management of more than just the hernia, including any relevant part of the patient's health and lifestyle. Dr. Cima says the team is deeply committed to helping patients optimize every facet of their lives while living with their stomas.

For more information

Antoniou SA, et al. European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia. 2018;22:183.

Ferrari D, et al. Robotic modified Sugarbaker technique for parastomal hernia repair: a standardized approach. Updates in Surgery. 2024;76:1115.

Refer a patient to Mayo Clinic.