Invited comment to: European Hernia Society guidelines on prevention and treatment of parastomal hernias
The prevalence of parastomal herniation is well documented as being a major post-operative complication for individuals undergoing stoma formation. For the individual with a stoma, they encounter many physical and psychological challenges and management issues as a consequence of having and living with a parastomal hernia.
The Association of Stoma Care Nurses UK (ASCN UK), in their plight to improve patient outcomes, have recently undertaken significant investigation into parastomal hernia prevention and management. Clinical guidelines have been produced and disseminated nationally (ASCN UK 2015) to promote consistency of evidenced-based advice and practice. We are also looking into the effectiveness and plethora of support garments currently available in the UK, which not only is questioned due to the lack of evidence in justification for use and compliance, but also from the cost implications for the health service.
This EHS review is very much welcomed by the ASCN, as greater understanding and evidence into preventative measures are paramount in reducing the incidence in parastomal hernias.
As a stoma patient, it is reassuring to see the guidelines. Ostomates are aware that parastomal hernias are very common and would welcome a standard approach to prevention and treatment. The lack of evidence currently available does need to be addressed with further clinical trials, but the key points noted are of relevance to the patient, particularly the option of preventative measures such as prophylactic mesh. This could have a great impact on the patient if it reduces the risk of hernia. Hernias affect quality of life and many ostomates ‘live in fear’ of developing one, so any option to minimise this risk would be a positive step. Open discussion with the treating physician is vital. As a patient, I believe that we must make informed decisions about our healthcare alongside the medical team. Discussion should include the various options, evidence for and risks associated with it to ensure the correct decision for the individual. It is impossible to say how all patients will perceive the key recommendations as one will favour watchful waiting when another will insist they need surgery. The guidelines address this by providing a reference tool, which can be shared with the patient, so they are on board with the preferred clinical path. An informed patient will be far more likely to comply with all areas of treatment and play their part in working towards a successful outcome.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.