Parastomal Hernia: A Growing Problem with New Solutions

Aquina, Christopher T.; Iannuzzi, James C.; Probst, Christian; Kelly, Kristin N.; Noyes, Katia; Fleming, Fergal J.; Monson, J. R. T.

doi:10.1159/000369279

Cited by 111 publications

(150 citation statements)

References 89 publications

(113 reference statements)

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“…This discrepancy is presumably because of the lack of a consistent deinition of PSH, variations in clinical or radiological diagnostic methods (which have yet to be standardized), variations in followup time, and small or heterogeneous patient groups [4,6,[9][10][11]. The use of imaging methods, such as ultrasonography (US) or computed tomography (CT), may have contributed to the high PSH rates reported during the last years because they can detect smaller hernias that are not apparent at clinical examination [2,4,6]. Cingi et al [12] reported a PSH incidence of 52% at physical examination, while it was up to 78% with the addition of CT scan.…”

Section: Incidence and Risk Factorsmentioning

confidence: 99%

“…Ostomy creation is usually associated with potential weakness of the abdominal wall, and parastomal hernia (PSH) is a common complication of permanent stoma formation [1,2]. PSH is a type of incisional hernia located near an intestinal stoma (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

“…PSH is a type of incisional hernia located near an intestinal stoma (Figure 1). Although PSH is rare (ranges from 0 to 3%) in the early postoperative period, it occurs most commonly within the irst 2 years after surgery, with a prevalence of 30-50%, and the risk persists for more than 20 years [2][3][4]. Ostomy creation and one of its major complications, PSH may negatively afect an individual's physical function and quality of life (QoL) [5].…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, high recurrence rates have been reported after repair [1,3,7]. Presently, the prevention of PSH development is clearly considered the best management approach for this diicult and problematic entity [1][2][3][4]8]. In this chapter, an overview of parastomal hernia will be presented, and its clinical features, incidence and risk factors, preventive strategies, and surgical management techniques will be discussed.…”

Section: Introductionmentioning

confidence: 99%

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Parastomal Hernia

Çelik¹,

Kocaay²,

Akyol³

2017

Hernia

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Parastomal hernia (PSH) is a type of incisional hernia deined as a protrusion of abdominal contents through a weakness in the abdominal wall. PSH is the most common and signiicant complication following enterostomy construction, with an incidence of 30-50%. The risk is higher in colostomies than in ileostomies. Diagnosis of PSH is based on clinical examination or imaging. Most patients with PSH are usually asymptomatic. On the other hand, PSHs may afect an individual's physical function and decrease their quality of life. Surgical repair is indicated in 10-30% of patients with PSH. For repair, no single technique is superior to another. Therefore, several surgical methods have been developed and atempted, including primary repair, stoma relocation, and repair with diferent types of mesh either via the open or laparoscopic approach. However, high recurrence rates have been reported after repair. Because this is a diicult and problematic entity, the prevention of PSH occurrence is clearly the most appropriate management approach.

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Section: Incidence and Risk Factorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Parastomal Hernia

Çelik¹,

Kocaay²,

Akyol³

2017

Hernia

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“…The prevalence of parastomal herniation is consistently documented as a common complication for individuals undergoing stoma formation (1,2,3,4) . This can result in distressing physical, psychological and management challenges for the individual with a stoma.…”

Section: Ns4mentioning

confidence: 99%

Nurses' Symposium

2017

Colorectal Disease

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Aims and objectives: A formalised systematic nurse led clinical treatment pathway has been developed and implemented to enhance an area of suboptimal service delivery for patients who develop LARS. The successful outcome of having a designated nurse led clinic has enabled comprehensive robust management of this patient group thus aligning care standards to support the transition into Survivorship (DOH, 2010, DOH et al 2013. This in turn addresses the long term effects of cancer treatments so that patients quality of life can be optimised. Method: A work based MSc project was undertaken by the lead author and a planned change management model developed by Kotter (1996) was emulated to platform the change into practice. A review of the literature was undertaken to locate all available published evidence on LARS so that the clinical treatment pathway reflected best evidence based practice. A gap analysis in the published literature on formalised assessment for patients who develop LARS allowed the author's original ideas to be explored and implemented. Standard patient satisfaction questionnaires were used to evaluate the patient experience in the clinics. Results: The development of a structured clinical treatment pathway used in conjunction with a validated LARS scoring tool has enabled early identification of patients who develop symptoms of LARS. This has prompted early assessment and intervention so that patients who have this bowel dysfunction as a consequence of cancer treatments can be supported to manage their symptoms and adapt to a new normal following rectal cancer surgery. NS3No abstract available. NS4Parastomal Hernia: providing evidence for consistency in care and management W. Osborne Association of Stoma Care Nurses, UKThe prevalence of parastomal herniation is consistently documented as a common complication for individuals undergoing stoma formation (1,2,3,4) . This can result in distressing physical, psychological and management challenges for the individual with a stoma.For Stoma Care Nurses (SCN), despite the plethora of compounding issues encountered daily with their patients; there is a huge disparity in the provision of information in relation to prevention and management of parastomal hernias (5) . A project group of specialist nurses undertook a significant investigation into parastomal hernia prevention and management. Their intention was to review current literature, align and develop evidenced based guidelines and ultimately identify practice that would reduce the development of hernia's. Following a comprehensive literature review, master classes, involvement of colorectal surgeons, patients and physiotherapists: clinical guidelines were produced and disseminated nationally in 2016 (6) . The extensively peer reviewed guidelines include succinct advice for pre, post and long term follow up care. Information includes core exercises, underwear advice, quality of life assessment and referral criteria to compliment the guidelines.Further work by the project group is being undertaken into...

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Population-based study of outcomes following an initial acute diverticular abscess

Aquina

Becerra

et al. 2018

British Journal of Surgery

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Background: Studies examining long-term outcomes following resolution of an acute diverticular abscess have been limited to single-institution chart reviews. This observational cohort study compared outcomes between elective colectomy and non-operative management following admission for an initial acute diverticular abscess. Methods: The Statewide Planning and Research Cooperative System was queried for unscheduled admissions for an initial acute diverticular abscess in 2002-2010. Bivariable and propensity-matched multivariable analyses compared stoma rates and use of healthcare in patients who had an elective resection and those receiving non-operative management. Diverticulitis recurrence rates were analysed for non-operative management.Results: Among 10 342 patients with an initial acute diverticular abscess, one-third (3270) underwent surgical intervention within 30 days despite initial non-operative management. Of the remaining 7072 patients, 1660 had an elective colectomy within 6 months. Of 5412 patients receiving non-operative management, 1340 (24⋅8 per cent) had recurrence of diverticulitis within 5 years (median 278 (i.q.r. 93⋅5-707) days to recurrence). Elective colectomy was associated with higher stoma rates (10⋅0 per cent, compared with 5⋅7 per cent for non-operative observation, P < 0⋅001; odds ratio 1⋅88, 95 per cent c.i. 1⋅50 to 2⋅36), as well as more inpatient hospital days for diverticulitis-related admissions (mean 8⋅0 versus 4⋅6 days respectively, P < 0⋅001; incidence rate ratio (IRR) 2⋅16, 95 per cent c.i. 1⋅89 to 2⋅47) and higher mean diverticulitis-related cost (€70 107 versus €24 490, P < 0⋅001; IRR 3⋅11, 2⋅42 to 4⋅01).Conclusion: Observation without elective colectomy following resolution of an initial diverticular abscess is a reasonable option with lower healthcare costs than operation.

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Parastomal Hernia: A Growing Problem with New Solutions

Cited by 111 publications

References 89 publications

Parastomal Hernia

Parastomal Hernia

Nurses' Symposium

Population-based study of outcomes following an initial acute diverticular abscess

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