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| Coquitlam Connection |
| Paraostomy Hernia |
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| Why are wise men and wise guys opposites? |
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| Excerpted from presentation by Paul H. Sugarbaker, M.D. A hernia is the abnormal protrusion of an organ or tissue through an opening. Hernias that are associated with colostomies, ileostomies, urostomies, or jejunostomies are all classified as paraostomy hernias. A parostomy hernia occurs most frequently in patients who have inadequate wound healing between the ostomy tunnel and the organ that extends through the abdominal wall. Any decrease in scar formation in the early postoperative periods will increase the incidence of paraostomy hernia. Poor nutrition, progressive cancer and poor surgical technique that fails to bring together completely bowel and abdominal wall are all prominent causative factors. Other postoperative problems that would tend to separate these tissues will also lead to increased incidence of paraostomy hernias. Coughing, sneezing, and accumulation of fluid in the abdominal cavity are associated causative factors The improper location of an ostomy through a tendon area of the abdomen rather than through a muscular area (such as the lateral [outer] edge of the rectus abdominus muscle) will also increase the incidence of paraostomy hernia formation. Hernias that occur around an ostomy cause an unstable base for the appliance. Coughing, sneezing, exercise and other activities that cause any increase in intrabdominal pressure will often dislodge the ostomy pouch. It is imperative that the incidence of hernia from an ostomy be kept at a minimum. Paraostomal hernia is the most frequent late complication of any ostomy. It occurs in from 10% to 25% of patients. A hernia as a result of ostomy construction is more common after an ileal conduit than after ileostomy or colostomy. Hernias almost universally occur at the lateral aspect of the site of the ostomy. A separation between the segment of the intestine and the outer part of the ostomy tunnel permits part of the peritoneum or the small intestine to move into a subcutaneous pocket (under the skin]. With time, this space enlarges and a hernia progressively increasing in size is formed. With a sliding ostomy hernia there is a movement of the same segment of intestine that terminates in the ostomy into a subcutaneous pocket. There are two causes for sliding hernia. First, the segment of intestine used to construct the ostomy was not sutured to the lateral wall of the abdomen. Second, and most important, a separation occurs between a segment of the intestine and the stomal tunnel. The intestine leading to the ostomy slides into this space and creates a subcutaneous pocket. In the type of hernia, the ring of peritoneum, muscle and fibrous tissue that occurs at the abdominal entrance of the hernia is quite narrow. Consequently these hernias are at risk for incarceration [unnatural confinement of a part]. The hernias form laterally in a majority of patients because it is impossible using previously described techniques to accurately place sutures to bring together the seromuscular layers of the intestine and the lateral aspect of the tunnel. This surgical technique demonstrates a new method of suturing the remote surface of the intestine to the lateral aspect of the tunnel so that this separation, lateral to the ostomy, does not occur. Hernias, therefore, are prevented. via Metro Maryland, Tacoma (WA) Newsletter, Anchorage (AK) North Wind News, & S. Brevard (FL) Ostomy Newsletter Feb 2002 |