Symptom load and individual symptoms before and after repair of parastomal hernia: a prospective single centre study

Abstract

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.

Living with a parastomal bulge ‐ patients’ experiences of symptoms

“…Purposeful sampling ensured variation in experienced symptoms (Polit & Beck, ). We recruited patients referred to repair of parastomal bulging as they were assessed to have symptomatic bulging (Krogsgaard et al., ). Furthermore, we included patients receiving nonsurgical treatment who reported less symptomatic or even symptomless bulging (Moreno‐Matias et al., ).…”

“…• Establishing a patient perspective in parastomal bulging is important to improve clinical outcome. KROGSGAARD ET AL. | 5073 appliance leakage (Cowin & Redmond, 2012;Krogsgaard et al, 2017;Ripoche, Basurko, Fabbro-Perray, & Prudhomme, 2011), skin problems (Cowin & Redmond, 2012;Krogsgaard et al, 2017;Ripoche et al, 2011;Rubin & Bailey, 1993;Wara & Andersen, 2011), pain Ripoche et al, 2011;Rubin & Bailey, 1993;Wara & Andersen, 2011), difficulty with ostomy appliance (Cowin & Redmond, 2012;Krogsgaard et al, 2017;Ripoche et al, 2011;Rubin & Bailey, 1993;Wara & Andersen, 2011), a bearing-down sensation at the site of the stoma (Cowin & Redmond, 2012;Krogsgaard et al, 2017), limitation of activity Rubin & Bailey, 1993), difficulty with clothing and cosmetic complaints Ripoche et al, 2011). While each of the latter six symptoms was reported in more than 50% of patients referred to surgical treatment , a French survey found that 24% of patients had no "particular problems" (Ripoche et al, 2011).…”

Quality of life after end colostomy without mesh and with prophylactic synthetic mesh in sublay position: one-year results of the STOMAMESH trial

“…In the generic C-30, patients with a PSH reported a greater problem with constipation. Pain is a major symptom of PSH [10], and one could speculate that opioid treatment with secondary constipation played a part in this difference. Previous results published by our research group showed that stoma patients with a PSH or bulge reported inferior scores in several symptom and functional scales [3].…”

“…Previous studies have described problems such as social restriction, difficulty in stoma dressing, appliance leakage, pain, limitations of activity, cosmetic problems, and difficulties with clothing [10][11][12]. If a PSH or bulge is present, the patient's quality of life is reduced even more [3].…”

Long distance to hospital is not a risk factor for non-reversal of a defunctioning stoma

“…When reversed, these effects seem to be reduced and the global quality of life (QoL) seems to improve [16]. Patients with a permanent stoma have generally been found to have a lower QoL but also problems with pain, skin excoriation, and leakage [17,18]. Failure to reverse a defunctioning ileostomy after rectal cancer surgery is counter to the fundamental purpose of preserving the sphincter at the index operation.…”