27 August 2024
While patients can return to their previous activities after an ostomy, more than half develop a parastomal hernia within three years, according to a 2018 hernia publication. This hernia is an enlarged abdominal wall defect related to the construction of the conduit that allows the patient to expel waste. This stoma complication has nothing to do with the surgical technique used, says Dr. Robert R. Cima, a colorectal surgeon at the Mayo Clinic in Minnesota who performs this repair and has published on the treatment of parastomal hernias.
A question of quality of life
If parastomal hernias spread, they can endanger quality of life.
“As a hernia expands, patients worry about potential problems, such as problems with the seal of the device and resulting leaks that lead to stool or urine leakage at inconvenient times,” says Dr. Cima. “They may then withdraw from activities they enjoy, which can affect their relationships.”
Problems that patients with a parastomal hernia may experience include:
- Projection.
- Physical symptoms.
- intestinal obstruction.
- Leakage.
- Problems with self-esteem or in relationships.
A parastomal hernia can cause a relatively normal post-ostomy lifestyle to turn into a reclusive one as the hernia becomes more and more problematic, says Dr. Cima.
Innovative parastomal hernia repair at the Mayo Clinic
Robot-assisted surgery to repair parastomal hernias
Robot-assisted surgery to repair parastomal hernias requires only four half-inch (1.27 cm) incisions and leaves no significant scarring.
At Mayo Clinic, most patients with parastomal hernias are candidates for robotic-assisted hernia repair. This less invasive procedure improves outcomes, shortens hospital stays, and promotes faster recovery compared to traditional open surgery.
The Mayo Clinic uses the modified Sugarbaker technique to repair parastomal hernias, which is considered by some experts, including Dr. Cima, to be the gold standard for minimizing recurrence.
“Robotic-assisted parastomal hernia repair has been a game changer in my practice,” says Dr. Cima. “The 3D camera provides unprecedented visualization and precision, allowing me to see anatomical details that are difficult to perceive in an open procedure.”
During robot-assisted parastomal hernia repair, the surgeon performs adhesiolysis, reduction of the hernia contents, stoma revision if necessary, narrowing of the enlarged stoma trephine, and lateralization of the stoma limb of the intestine.
The modified Sugarbaker technique involves installing a permanent, wide-pore, flexible mesh in the abdomen to prevent defects that may encourage hernia recurrence. This mesh acts as a barrier and prevents the intestine from penetrating the abdominal wall.
According to Dr. Cima, the advantages of parastomal hernia repair using this technique are:
- Improved collection bag function. Parastomal hernia repair significantly improves functionality and has a low recurrence rate. A 2024 publication by Dr. Cima and colleagues in Updates in Surgery reports a low recurrence rate of 5.8% at a typical 10-month follow-up. In a recent review of his team’s experience with robotic-assisted parastomal hernia repair, the recurrence rate within two years after surgery was less than 10%.
- Good postoperative aesthetics. With robotic-assisted repair, post-operative cosmesis impresses patients, especially since there are only four half-inch (1.27 cm) incisions and no significant scarring. Hernia repair effectively restores the patient’s anatomy, eliminates the hernia bulge, and improves cosmetic health.
- Improved functionality. The repair provides significant functional benefits, such as allowing a police officer or baseball or track and field athlete to wear a belt properly. It also smooths out the abdominal area so patients can wear pants or belts.
- Return to your usual activities. After surgery, patients can return to their normal activities without any limitations caused by their previous stoma problems.
“Our aim is to take care of the patients who are referred to us and to ensure that we build good relationships with their local health professionals to manage any post-operative issues. We are always available to provide advice to referring health professionals.”
Why patients should be referred to Mayo Clinic for this surgery
While parastomal hernias are repairable, the repair requires special training and experience to make them permanent without compromising stoma function. Dr. Cima and his colleagues in colorectal surgery at Mayo Clinic have this background. He suggests these additional benefits of a referral to Mayo Clinic for physicians and their patients:
Large-volume center
A major advantage of a center like the Mayo Clinic for patients with parastomal hernias is the enormous number of cases treated there each year.
“It is important that physicians treat patients who require parastomal hernia repair at a high-volume hospital such as Mayo Clinic,” says Dr. Cima. “In this setting, the surgery is expertly performed with minimal complications, and recurrence and revision rates are lower. Our capabilities mean it will be an efficient operation and that we can ensure patient safety during a complex procedure.”
Collaborative approach to partnering with patients and their healthcare professionals
Dr. Cima emphasizes the importance of working with patients and their local health professionals. He and his team make sure all patient questions are answered and have hundreds of ostomy supplies in stock. They enjoy working with patients and sometimes take several days to find the right device that fits their lifestyle.
Support for local health workers
Due to a lack of local services and care, patients are often referred to Mayo Clinic by healthcare professionals.
Dr. Cima explains: “This is where we can help. Our aim is to take care of the patients who are referred to us and to ensure that we build good relationships with their local health professionals to manage any post-operative issues. We are always available to provide advice to referring health professionals.”
Convenient care for traveling patients
Patients who come to Mayo Clinic from afar for treatment of a parastomal hernia can complete much of the treatment more comfortably at home. Dr. Cima and his team direct local health care professionals to the necessary tests and steps. If surgery is not desired, Mayo Clinic parastomal nurses can discuss nonsurgical options via video chat. The team is also available to communicate with patients remotely.
In a small number of patients referred to Mayo Clinic with stoma problems, Dr. Cima and his team determine that the existing stoma is unnecessary. In such cases, they work closely with the patient to facilitate removal.
Treatment beyond the inguinal hernia
The team at Mayo Clinic also helps patients with parastomal hernias by treating not only the hernia, but also all relevant aspects of the patient’s health and lifestyle. Dr. Cima says the team is committed to helping patients optimize every aspect of their lives with their stomas.
More information
Antoniou SA, et al. Guidelines of the European Hernia Society for the prevention and treatment of parastomal hernias. Hernia. 2018;22:183.
Ferrari D, et al. Robot-assisted modified Sugarbaker technique for parastomal hernia repair: a standardized approach. Updates in Surgery. 2024;76:1115.
Refer a patient to the Mayo Clinic.
