Reinforcement of a permanent stoma with a synthetic or biological mesh to prevent a parastomal hernia

2.1 Stomas are created surgically to divert the contents of the urinary or digestive tract through an opening in the abdominal wall. A parastomal hernia allows protrusion of abdominal contents through the abdominal-wall defect created by the stoma. They are relatively common, usually developing gradually and increasing in size over time. A parastomal hernia may remain asymptomatic, but can cause problems such as unacceptable physical appearance, poorly fitting stoma device, bowel obstruction, and bowel ischaemia and strangulation.

2.2 A parastomal hernia can be repaired surgically, using an open or laparoscopic approach. Surgical repair is associated with its own morbidity and there is a high risk of recurrence.

2.3 This procedure is done using general anaesthesia, at the same time as the creation of the stoma. A space is formed between the rectus abdominus muscle and the rectus sheath of the abdominal wall, and a piece of synthetic or biological mesh is inserted into the space. The bowel or ureter is passed through the mesh and then through the abdominal wall. The mesh and the bowel or ureter are stitched to the abdominal wall. The aim is to strengthen the abdominal wall and prevent parastomal herniation.