Parastomal Hernia Repair

What is a parastomal hernia?

When your stoma was created, a small hole was made through the muscle of your abdominal wall to bring the bowel to the surface of your skin. Over time, that opening can gradually widen — and when it does, a loop of bowel or some fatty tissue can push through it, creating a bulge or lump around your stoma bag. That is a parastomal hernia.

You are far from alone in this. Parastomal hernias develop in up to half of all people with a permanent colostomy, and in about 20–30% of those with an ileostomy. The longer the stoma has been in place, the more common they become. The reassuring news is that many parastomal hernias cause minimal trouble and do not need surgery — a good support garment and some adjustments to your stoma bag fitting can make a real difference.

Who needs surgery?

Surgery is recommended when the hernia is causing real problems. Here are the situations that would make Mr Nguyen suggest an operation:

• Obstruction — the bowel inside the hernia gets kinked or blocked, causing cramping, bloating, nausea, or an inability to pass wind or output through your stoma. This is an urgent situation and needs prompt attention.
• Strangulation — in rare cases, the blood supply to the bowel inside the hernia can be cut off. This is a surgical emergency. If your hernia suddenly becomes very painful, hard, or discoloured, call 000 or go straight to emergency.
• Appliance problems — if the bulge is stopping your stoma bag from sitting flat and sealing properly, causing repeated leaks and skin soreness, surgery may be the most practical solution.
• Significant pain or discomfort — if the hernia is aching or limiting what you can do day to day
• Impact on your confidence or quality of life — if the bulge is affecting how you feel in your body and you have already tried non-surgical options

If none of those apply to you, conservative management — a well-fitted hernia garment or stoma belt, and help from a stomal therapy nurse with your appliance — is the right first step, and it works well for many people.

Surgical options

It is important to be honest with you: parastomal hernia repair has one of the higher recurrence rates of any hernia surgery — with modern mesh techniques, around 30–50 in every 100 hernias return over five years, though older stitching-alone techniques had even higher rates. This is why surgery is generally saved for people who are truly struggling with their hernia. Mr Nguyen will explain the numbers for your particular situation at your consultation, and together you will decide whether the benefits outweigh the risks.

If surgery is the right choice for you, there are a few different ways it can be done:

Stoma relocation

Your stoma is closed at its current site and rebuilt through a fresh, unscarred part of the abdominal wall. The original weak spot is repaired at the same time. This avoids having to operate through old scar tissue, which is often tricky. The downside is that the new site can develop its own hernia over time too. This approach tends to suit younger, fitter patients with particular types of hernia.

Open mesh repair

A mesh is placed around your stoma through an open incision to reinforce the weak area. The two most common open techniques are the Sugarbaker repair — where the mesh lies flat over the defect with the bowel looped through a slit at the side — and the keystone repair, where the mesh has a central opening that the stoma passes through. Both are a significant improvement on stitching alone when it comes to keeping the hernia from returning.

Laparoscopic (keyhole) mesh repair

Instead of a large cut, Mr Nguyen places the mesh inside the abdomen through three or four small incisions, using a camera and fine instruments. The mesh (called an IPOM — intraperitoneal onlay mesh) sits on the inside of the abdominal wall around the stoma. This approach means less wound infection risk and a faster recovery. It is Mr Nguyen's preferred approach for most patients who are suitable for it.

Robotic repair

For hernias that are complex, large, or have come back after a previous repair, robotic-assisted surgery gives Mr Nguyen a magnified 3D view and finer instrument control — especially useful when there is a lot of scar tissue from prior operations. The small incisions and recovery time are similar to standard keyhole surgery.

Before the operation

• A clinical examination and CT scan to map out the hernia — its size, what is inside it, and how the anatomy looks — so Mr Nguyen can plan carefully before going into theatre
• A review by a stomal therapy nurse, who will assess your stoma and help optimise your appliance fitting before and after the operation
• If the plan is to move your stoma, the nurse will mark the best new site on your skin before surgery
• Mr Nguyen will help you optimise your health beforehand — including nutrition, weight, and any other medical conditions — so your body is in the best shape to heal
• Bowel preparation (a special cleansing diet or drink the day before) may be needed if the stoma is being relocated — Mr Nguyen's rooms will advise you specifically

What to expect on the day

• You will be given a general anaesthetic — you will be completely asleep. The operation typically takes between 1.5 and 3 hours depending on how complex your hernia is.
• For the keyhole approach, Mr Nguyen makes 3–4 small cuts. For the open approach, there will be a larger incision near or around your stoma — he will explain which applies to you beforehand.
• A small drain tube may be placed near the mesh to prevent fluid build-up; if so, it is removed within 24–48 hours.
• You will receive pain relief through a drip and antibiotics to protect against infection, and will be cared for on the surgical ward.
• Your stoma will continue to work normally throughout — the stomal therapy nurse will visit you on the first day after surgery to check the appliance fit and make sure everything looks right.

Recovery

In hospital (2–4 days): Your pain will be managed well with medication — you should feel comfortable, not suffering. Your diet will progress from liquids to normal food over a day or two. You will be ready to go home once you are comfortable, eating and drinking, and your stoma is working normally.

• Weeks 1–2: Rest at home and take it easy. Do not lift anything heavy. Your wound will be reviewed at 1–2 weeks — and the stomal therapy nurse will also see you to refit your appliance as swelling around the stoma settles.
• Weeks 4–6: You can gradually return to light activities including driving. Start wearing a supportive stoma belt or hernia garment — your stomal therapy nurse will help you find the right fit. Wearing it consistently is one of the most effective things you can do to protect the repair long-term.
• Weeks 6–8: You can return to most everyday activities. Avoid lifting anything heavier than 10 kg for at least 3 months — the repair is still consolidating.
• Long-term: Continuing to wear a support garment, reaching and maintaining a healthy weight, avoiding chronic straining (treating constipation early), and doing gentle core-strengthening exercises with a physiotherapist all reduce the chance of the hernia coming back.
• A follow-up with Mr Nguyen is arranged within 2–6 weeks of your operation (timing depends on the type of repair). This visit is provided at no charge.

Risks and complications

We believe you deserve a clear and honest picture of the risks, so you can make a decision you feel good about:

• Hernia recurrence — this is the main risk to know about. Even with the best keyhole mesh technique, around 30–50% of parastomal hernias return over five years. This is higher than most other hernia types, which is exactly why Mr Nguyen reserves surgery for people who are genuinely struggling. Recurrence rates are lower with keyhole mesh than with stitching alone, but remain real.
• Wound infection — stoma sites carry more bacteria than usual, which means wound infection occurs in about 5–15 in every 100 cases. Mr Nguyen uses antibiotics and specific techniques to reduce this risk.
• Mesh infection — uncommon but serious; if the mesh gets infected, it may need to be removed and the repair redone
• Stoma complications — the stoma itself can occasionally retract (sink inward), prolapse (push outward), lose blood supply, or become temporarily obstructed during or after the repair. This is monitored closely in the first days after surgery.
• Bowel injury — particularly if you have had multiple previous operations and there is scar tissue (adhesions) inside; Mr Nguyen works carefully to avoid this
• Blood clots (DVT/PE) and bleeding — general surgical risks that are managed with blood thinners and compression stockings from the day of surgery

Frequently asked questions

Patient guides on this topic

We have written plain-language articles to help you and your family understand what a parastomal hernia is, what your options are, and what recovery looks like — in language that is easy to read when you are anxious or overwhelmed.