Prevention and treatment of parastomal hernia: a position statement on behalf of the Association of Coloproctology of Great Britain and Ireland

,

doi:10.1111/codi.14249

Cited by 36 publications

(35 citation statements)

References 101 publications

(125 reference statements)

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“…Currently there is a lack of high-quality evidence to guide treatment decisions. Surgeons do not know the best way to repair a PSH, nor do they know whether watchful waiting is safe or whether it can result in more complications [2]. Additionally, recurrence risks from PSH repair are high [3,4].…”

Section: Introductionmentioning

confidence: 99%

Assessment of the quality of online patient information resources for patients considering parastomal hernia treatment

Blackwell,

Clifford,

Pinkney

et al. 2024

Colorectal Disease

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AimThe aim was to examine the quality of online patient information resources for patients considering parastomal hernia treatment.MethodsA Google search was conducted using lay search terms for patient facing sources on parastomal hernia. The quality of the content was assessed using the validated DISCERN instrument. Readability of written content was established using the Flesch–Kincaid score. Sources were also assessed against the essential content and process standards from the National Institute for Health and Care Excellence (NICE) framework for shared decision making support tools. Content analysis was also undertaken to explore what the sources covered and to identify any commonalities across the content.ResultsFourteen sources were identified and assessed using the identified tools. The mean Flesch–Kincaid reading ease score was 43.61, suggesting that the information was difficult to read. The overall quality of the identified sources was low based on the pooled analysis of the DISCERN and Flesch–Kincaid scores, and when assessed against the criteria in the NICE standards framework for shared decision making tools. Content analysis identified eight categories encompassing 59 codes, which highlighted considerable variation between sources.ConclusionsThe current information available to patients considering parastomal hernia treatment is of low quality and often does not contain enough information on treatment options for patients to be able to make an informed decision about the best treatment for them. There is a need for high‐quality information, ideally co‐produced with patients, to provide patients with the necessary information to allow them to make informed decisions about their treatment options when faced with a symptomatic parastomal hernia.

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Section: Introductionmentioning

confidence: 99%

Assessment of the quality of online patient information resources for patients considering parastomal hernia treatment

Blackwell,

Clifford,

Pinkney

et al. 2024

Colorectal Disease

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“…Given the risks of further surgery and high risk of recurrence after repair, it is important that people with parastomal bulging are given effective support, help and guidance to self-manage parastomal bulging without surgical intervention. Current guidelines only offer surgery as an option for parastomal bulging treatment and offer advice on prevention [ 13 ]. Alternative self-management options are not part of current advice or guidelines in the United Kingdom.…”

Section: Introductionmentioning

confidence: 99%

Lived Experience of Parastomal Bulging: A Mixed Methods Study

Munro,

Hubbard,

Goodman

et al. 2024

J. Abdom. Wall Surg.

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Aim:This United Kingdom study aimed to explore people’s experiences of living with, and self-managing parastomal bulging.Methods:Seventeen people were interviewed and 61 people completed an online survey.Results:Parastomal bulging has a detrimental impact on quality of life including a negative impact on stoma function, daily activities, body image, physical intimacy, and socialising; access to specialist information and support for addressing the problem of bulging was inequitable; support garments were the most common self-management intervention; there was confusion about what exercise would be beneficial or how being active would help in terms of parastomal bulging self-management; peer support is no substitute for high quality specialist support.Conclusion:People need equitable access to information and support to self-manage and treat parastomal bulging. Research about other types of self-management interventions, for example, exercise is required so that people do not have to rely solely on support garments to self-manage parastomal bulging.

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“…However, only 24% of patients with an ostomy remain asymptomatic in the long term [5]. Subsequently, the Association of Coloproctology of Great Britain and Ireland identified that the prevention and treatment of PSHs are the second most important non-cancer-related issues due to high recurrence rates after hernia repair [6]. Although prophylactic mesh for PSH prevention has been advocated [7][8][9] a recent randomized controlled trial has shown that reinforcing meshes to prevent PSH formation cannot be recommended [10].…”

Section: Introductionmentioning

confidence: 99%

High recurrence rate after posterior component separation and keyhole mesh reconstruction for complex parastomal hernia: A case series study

et al. 2021

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Aim: This study aimed to describe the results of complex parastomal hernia repair after posterior component separation and keyhole reconstruction. Method:We conducted a retrospective review of a prospectively sustained database in one single complex abdominal wall referral centre. We analysed the data of patients who underwent the posterior component separation technique using modified transversus abdominis release for complex parastomal hernia and retromuscular keyhole mesh repair from February 2014 to January 2017. Demographic data, hernia characteristics, operative details and outcomes were analysed. The primary outcome measured was the recurrence rate during the follow-up.Results: Twenty patients were included in this study. Among the patients who underwent surgery for parastomal hernia, 17 patients had a colostomy (85%) and three patients had a ureteroileostomy after the Bricker procedure (15%). The mean body mass index was 33.2 kg/m 2 (range 25-47). Twelve patients had an expected associated risk according to the Carolinas equation for determining associated risk classification of >60%. Sixty per cent of our patients had contaminated or dirty/infected wounds. The overall complication rate was 60%. Surgical site infection was observed in 25% of the cases. The mortality rate in our study group was 5% (n = 1). We found clinical or radiological evidence of parastomal hernia recurrence in nine out of 20 (45%) patients during follow-up. No hernia recurrence was detected in the concomitant incisional hernias. Conclusions:Although posterior component separation in the form of modified transversus abdominis muscle release allows abdominal wall reconstruction, keyhole mesh configuration at the stoma site does not offer satisfactory results in terms of long-term recurrence rate at the parastomal defect.

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Prevention and treatment of parastomal hernia: a position statement on behalf of the Association of Coloproctology of Great Britain and Ireland

Cited by 36 publications

References 101 publications

Assessment of the quality of online patient information resources for patients considering parastomal hernia treatment

Assessment of the quality of online patient information resources for patients considering parastomal hernia treatment

Lived Experience of Parastomal Bulging: A Mixed Methods Study

High recurrence rate after posterior component separation and keyhole mesh reconstruction for complex parastomal hernia: A case series study

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