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Parastomal hernia repair
A parastomal hernia is a bulge beside a stoma where bowel pushes through the weakened muscle around it. It is common, especially with a colostomy. Many are managed with a support belt and a well-fitted appliance. Surgery, usually a mesh repair by keyhole or open technique, is advised for pain, leaking bags, obstruction or a hernia that keeps growing.
Symptoms
- A swelling around the stoma, larger when standing or coughing.
- Bags that no longer seal well, leaks and sore skin.
- A dragging discomfort or ache.
- Changes in stoma output or difficulty irrigating.
Seek urgent help if
the swelling becomes painful and hard, you are vomiting, the stoma turns dark or purple, or the stoma stops working. These can mean the bowel is trapped (strangulated) and needs emergency surgery.
Non-surgical management
Many parastomal hernias cause few symptoms. A stoma nurse can supply a support belt or garment, refit the appliance (convex or flexible bases often seal better over a bulge) and advise on lifting and core exercises. This is often all that is needed.
When surgery helps
- Persistent leaks or skin problems despite appliance changes.
- Pain or a hernia that is steadily enlarging.
- Episodes of obstruction.
- When the stoma can be reversed, which removes the cause entirely.
Repair techniques
| Technique | Notes |
|---|---|
| Keyhole (laparoscopic) mesh repair | Mesh placed inside the abdomen to cover the defect, for example the Sugarbaker technique. Lower wound complication rates. |
| Robotic-assisted repair | Allows mesh placement in deeper layers of the abdominal wall in selected patients. |
| Open repair | Through a local or midline incision; useful for large or complex hernias. |
| Stoma relocation | Moving the stoma to a new site; the new site can also herniate. |
| Stoma reversal | The best solution when reconnection is possible. |
Simple stitching of the defect without mesh has high recurrence rates and is rarely used. Even with mesh, parastomal hernias recur more often than other hernias, so technique and experience matter. See is hernia mesh safe?.
Can parastomal hernias be prevented?
Placing a prophylactic mesh when a permanent stoma is made has been studied in several trials with mixed results; a large Scandinavian trial found no clear benefit, and practice varies. Maintaining a healthy weight, avoiding heavy straining early on and using a support garment when lifting are sensible measures.
Experience across hernia and bowel surgery
Parastomal hernia sits between hernia and colorectal surgery. Mr Papettas has performed more than 1,000 hernia repairs by open, keyhole and robotic-assisted techniques, including complex and recurrent abdominal wall hernias, alongside his colorectal practice, so he can also advise whether stoma reversal is an option.
Common questions
Does a parastomal hernia always need surgery?
No. Many are managed with a support belt and appliance changes. Surgery is for pain, leaks, obstruction or a growing hernia.
Is parastomal hernia repair done by keyhole?
Often, yes. Keyhole mesh repair is commonly used; open and robotic-assisted approaches suit certain hernias.
Will the hernia come back?
Recurrence is more common than with other hernias, even after mesh repair, which is why technique and surgeon experience matter. Reversing the stoma, where possible, removes the problem.
What are the danger signs?
Severe pain at the hernia, vomiting, a stoma turning dark, or the stoma stopping working. Seek emergency care.
This guide is general information, not personal medical advice. If you have severe abdominal pain, heavy bleeding, a high temperature or vomiting, call 111, or 999 in an emergency.