Colostomy and parastomal hernia repair

A colostomy is the extraction of a large part of the large intestine (colon) through an orifice in the abdominal wall so that the faecal material exits the body and collects in a bag. It can be permanent or temporary. A paracolostomy hernia involves creating an orifice in the abdominal wall through which the colon passes, meaning that, over time, it grows and allows not only the colon (for which it was created) but other intra-abdominal structures to pass through (herniation). It is considered that this is inevitable if a colostomy is worn for enough time.

Paracolostomy hernia symptoms

Symptoms of a paracolostomy hernia are the same as a hernia located in any other place: appearance of a lump, pain, possible hernial strangulation and particularly in this type of hernias, problems in the usage of the colostomy, as the hernia may affect the colostomy exit point.

Treatment 

In temporary colostomies the ideal situation would be to remove the colostomy, rebuild (splice) the colon to re-establish normal intestinal transit and close the abdominal wall hernia, reinforcing it with a mesh.

In cases where it is permanent, the orifice cannot be closed (only the hernia) as the colon must go through, which maintains the risk of a new hernia in the future.

The technique which has the best results is placing a mesh which covers the hernia from inside the abdomen using a laparoscopy (Sugarbaker laparoscopy technique) with small incisions and without creating a new incision that might break causing an internal hernia.

This procedure has numerous advantages: it does not involve creating a new large incision, the exit of the colostomy is not affected (less risk of infection in the mesh) and the mesh is placed inside the abdomen, which is where the hernia starts.

Placing this mesh should last permanently, which is why this (Sugarbaker) technique is indicated in cases of permanent colostomy.