Aim The symptom load and individual symptoms before and after repair of parastomal hernia were investigated.Method Stoma-related symptoms were prospectively recorded before repair of a parastomal hernia and at 10 days and 6 months postoperatively: leakage, skin problems, difficulty with the appliance, limitation of activity, difficulty with clothing, cosmetic complaints, social restriction, erratic action of the stoma, a bearingdown sensation at the site of the stoma and pain. Episodes of intermittent bowel obstruction and difficulty with irrigation were also recorded. Patients were seen at 1, 2 and 3 years and were examined for recurrent parastomal herniation.Results Of 131 consecutive patients referred to a specialized centre for treatment of parastomal bulging, 61 underwent parastomal hernia repair. Forty-eight patients were treated with the Sugarbaker technique. Six different symptoms were present in more than half the patients before surgery. The overall symptom load decreased significantly from a median of 4 [interquartile range (IQR) 2.5-6] preoperatively to 2 (IQR 1-3) on postoperative day 10 and 1 (IQR 0-2) at 6 months, P < 0.001. The number of symptoms decreased in 93% of patients; in 5% there was no change and in 2% symptoms increased. Skin problems and leakage were the only symptoms that were not significantly reduced. The overall recurrence rate of herniation was 5/48 (10%) at a median of 12 (IQR 6-24) months. ConclusionThe preoperative symptom load was high and this fell after repair in over 90% of patients. Recurrence occurred in 10% of patients within 2 years of repair. The study emphasizes the importance of detailed knowledge of the symptoms of parastomal hernia when addressing and managing patients' problems and complaints.Keywords Parastomal hernia, repair, Sugarbaker technique, symptoms, symptom load, stomaWhat does this paper add to the literature? There is little information on the effect of repair of parastomal hernia on symptoms. This prospective study demonstrated that the symptom load of parastomal herniation before surgery was high, with six different symptoms present in more than half of the patients. Six months after surgery, all symptoms except for leakage and skin problems were reduced.

Aim To investigate patients’ experiences of the assessment of support garments in relation to a parastomal bulge. Methods We conducted a qualitative study with semi-structured interviews preceded by field observations. The 11 in-dept interviews were analysed using interpretative phenomenological analysis. Results In the assessment process patients lacked information from professionals on the advantages, disadvantages as well as criteria for choosing between garments. Garments had to fit patients’ needs and personal preferences; being comfortable, flexible and user-friendly. The garment created new possibilities and challenges; well-assessed garments reduced symptoms while poorly assessed worsened or induced symptoms and ended up unworn. When comorbidities were not accounted for, garments were unmanageable to patients. Patients needed guidance on how to apply and use the garment. Lack of hands-on-guidance left patients confused and helpless with unworn garments. Re-assessment of a garment before it could be worn was time consuming, stressful and required patients’ physical and mental resources. Conclusion Exploring patients’ expectations, symptoms, needs and comorbidity was vital for patients’ subsequent use and benefit of garments. Tailor-made information, hands-on-guidance and professional assistance are important in the assessment process. Interventions to support a patient centred, individual and systematic approach is warranted.

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Aim To investigate patients’ experiences of the assessment of support garments in relation to a parastomal bulge. Material and Methods A qualitative study with 11 in-depth semi-structured interviews. A preceding systematic literature review and a small field study conducted before the study informed the main topics in the interview guide. Results Garments had to fit patients’ needs and personal preferences; being comfortable, flexible and user-friendly. When comorbidities, e.g., incontinence, poor balance, arthritis and visual impairment were not accounted for, garments were unmanageable to patients. Patients needed guidance on how to apply and use the garment. Lack of hands-on guidance left patients confused and helpless with unworn garments. Re-assessment of a garment necessitated several visits to the manufacturer, was time-consuming and stressful for patients and required patients’ physical and mental resources. The garment created new possibilities and challenges; well-assessed garments reduced symptoms from the parastomal bulge while poorly assessed worsened or induced new symptoms and ended up unworn. Conclusion Exploring patients’ expectations, symptoms, needs and comorbidity were vital for patients’ subsequent use and benefit of garments. Tailor-made information, guidance and professional assistance are important in the assessment process. Interventions to support a patient-centred, individual and systematic approach are warranted.