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Parastomal hernia is the most common late complication after stoma creation. In fact, given enough time, almost all stomas will develop some degree of herniation through the abdominal wall opening. In addition to the prevalent nature of parastomal hernias, attempts at repair are often followed by very high recurrence rates approaching 60%–70% in some series. Given this extraordinary risk of failure, the mere presence of a parastomal hernia should not be considered an indication for repair. Therefore, the initial approach should always include commonsense measures such as weight reduction and smoking cessation. A trial of a commercially available ostomy hernia belt, custom-fitted girdles, and other external support accessories is strongly encouraged. A consultation with a trained enterostomal therapy nurse plays an invaluable role during a trial of these nonoperative measures. Parastomal hernia repairs should only be offered to patients exhibiting significant pain or recurrent bowel obstructions and those who have failed a trial of external support devices. Another common indication for stoma repair is difficulty with maintaining a seal around the stoma and other pouching problems caused by the deformed abdominal wall. Of course, like a hernia at any other location, an incarcerated parastomal hernia constitutes an absolute indication for surgical intervention.

A number of techniques have been described for parastomal hernia repair. The multitude of surgical options serves as a testament to the fact that there is no optimal repair. These techniques include primary tissue repair, translocation of the stoma to the contralateral side, and mesh repairs using either a keyhole or a Sugarbaker method. Primary repairs are associated with an unacceptably high incidence of early recurrence and have been mostly abandoned. Translocation to the contralateral side is an attractive option because of its technical simplicity. However, translocation is inevitably followed by the development of hernia at the new stoma site, leaving the patient with significant abdominal wall scarring and a potential for bilateral stoma-site hernias. More recent literature suggests that the Sugarbaker technique is associated with the least incidence of recurrence, and that procedure has now emerged as the preferred technique for parastomal hernia repair. A discussion covering the entire landscape of parastomal hernia repair techniques is beyond the scope of this chapter; therefore, we have limited the operative description to the Sugarbaker technique.


Two critical elements in the preoperative period are smoking cessation and weight loss in obese patients. These two factors can considerably worsen the already dismal outcomes of parastomal hernia repair and should be addressed prior to proceeding to the operating room. The preoperative preparation includes computed tomography (CT) imaging to delineate the size and nature of the hernia. CT scans also help to differentiate true parastomal hernias from subcutaneous bowel prolapse. This distinction is critical because both have similar appearances on physical examination but call for considerable adjustment of the surgical technique, as discussed in the ensuing sections. Patients with residual colon ...

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