Parastomal hernias and why they should be avoided

Parastomal hernias, and why they should be avoided. Purpose Prevention and the musculoskeletal consequences of parastomal hernias (PH) are unknown. Two investigations were carried out: (i) musculoskeletal consequences in having a hernia (low back pain (LBP), musculoskeletal function and disability related to LBP), and (ii) an advice/exercise programme to reduce the incidence of PH in the first year post-operatively. Methods Two studies investigated PH. Study 1 was a province-wide postal questionnaire survey of people with a stoma (ileostomy/colostomy) (n = 1322). A range of outcomes related to exercise, LBP, and disability were analysed in relation to symmetry of the abdomen. Study 2 (n = 543) compared the incidence of PH in a convenience sample of two groups: ostomates who took part in a prevention programme (different year groups) and a control group. Data over 6 years were analysed to determine the effect of the intervention. Results Study 1: People with asymmetric abdomens (n = 274) had statistically significant poorer outcomes (Mann-Whitney U test) for disability associated with LBP (p < .001), deterioration in posture (p = .040), muscle strength (p < .000) and the ability to carry out every day activities (p< 0.05). Study 2: overall incidence of PH in control group was 28% and in the intervention groups: 14%, 17%, 15% and 13% (p ≤ 0.05) for the different year groups. Conclusions PH is associated with significant co-morbidities. An advice and exercise programme can help reduce but not abolish the incidence of PH. It is likely that surgical technique plays a vital role in minimising PH development. Objective Understand that parastomal hernias have significant co-morbidities that affect quality of life. Can surgeons play a role in minimising the incidence of parastomal hernia development?