Hi folks, I don't know if this is any use to you guys/girls or should be in the innovations section, but it is something to consider when thinking about peristomal repair. I was asked this exact same question not that long ago and I decided to research the subject, so I am going to post this in the exact same way I answered the question originally. I hope you don't mind as it's easier just to copy and paste it here.
The vast majority of people who develop peristomal hernias learn to live with them, as they cause little or no problem. However, if you are having substantial difficulties with the stoma due to the bulge or have developed pain or episodes of obstruction due to the hernia, an operation to repair the hernia is possible. Unfortunately, this is no small undertaking.
There are a variety of methods and techniques to attempt to repair these hernias. The simplest method is to make an incision in the vicinity of the stoma, push the contents of the hernia sac back into the abdomen, and close the muscle layer with some stitches.
Unfortunately, this simple technique has a very high rate of recurrence of the hernia and is rarely used because of the long-term failure rate.
Another "local repair" is to make a similar incision around the stoma and place a piece of synthetic mesh to close the defect.
This technique has a lower recurrence rate but has a greater rate of wound problems. The mesh products that are now available have revolutionized the ability of surgeons to repair many types of hernias. However, placement of this type of "foreign body" always places you at some risk of infection.
Utilizing mesh around a stoma is always somewhat worrisome due to the higher risk of contamination of the mesh with bacteria from the stoma at the time of its insertion.
A further concern is the possibility of placing the mesh too tightly around the bowel as it exits the abdomen. If it is placed too tightly, it may inhibit the emptying of the bowel content through the stoma postoperatively. Also, if it lies up against the mesh it may, with time, slowly erode into the bowel wall, necessitating removal of the mesh.
Alternatively, placing the mesh too loosely may result in not closing the entire hernia defect around the stoma and allow another hernia to occur.
Many peristomal hernia repairs require that the abdomen be reopened, usually through the same incision that was used to create the original stoma. From inside the abdomen, a piece of mesh can be placed around the stoma to repair the hernia. This still carries all the possible risks of mesh placement.
However, the risk of contaminating the mesh with bacteria from the stoma is felt to be less and the ability to better judge mesh position make this a better option than the local repairs.
Lastly, in some cases it is necessary to completely take down the stoma, repair the abdominal wall, and create a new stoma in an entirely different location. This is most often the preferred option if there are other problems with the original ostomy, such as a poor location, narrowing of the stoma opening, or retraction of the stoma below the skin level.
In these situations, you are far better off with a completely new ostomy than trying to salvage a stoma that was giving you problems even before the development of the hernia.
In summary,
repairing a peristomal hernia is certainly possible, but often requires major abdominal surgery with all its possible complications.
Therefore, it is not recommended that every peristomal bulge be repaired. Rather, if adjustments to your stoma appliance can be made such that a reliable seal can be maintained and the hernia remains asymptomatic, there is no need for surgery.
Hope this helps in making the decision as to whether or not you actually need a peristomal repair done.
