218. Side Hernias: Flank & Parastomal Hernias

Um, okay, so one of the questions proposed is the issue of peristomal hernias.

Um, we know that about a quarter to a third of peristomal hernia of, of stomas, so ileostomy, colostomy, urostomy probably, um, result in hernias.

Mm-hmm.

Um, you wanna just let me know exactly, like, things have changed.

It used to be that you would just switch it around, and then there was, like, we went back and forth about using mesh the first time to prevent hernias.

Um, now we're kind of looks like we're being a bit more conservative, like only repair the ones that really bother people and don't address every single hernia.

So what has been your experience with peristomal hernias, which is hernias after you perform, like, a colostomy or ileostomy or urostomy?

Yeah.

I- the peristomal hernias are a losing game.

Like, that's the, the really tough thing about them.

I actually, I just had a CAT scan of a patient come through today.

She's a, a lady I did a big abdominal reconstruction on with- because she had a, it was all a peristomal hernia, but loss of domain, like, everything out in the hernia from this-

Yeah

... stoma.

And she had had rectal cancer, so it's an end colostomy, so it can't be-

Permanent

... reversed, right? It's permanent.

Okay.

And, um, she lost weight, and we got her optimized, and I did this beautiful abdominal reconstruction, but she has her stoma.

And what I tell patients when I, "When you make a stoma, you make her- make a hernia," because the definition of a hernia is bowel poking out through a hole in the abdominal wall, right?

Yeah.

And that's, that's exactly what a stoma is.

So we're basically making a purposeful hernia when we're making a s- a stoma.

And so it's ba- it's kind of a losing game.

And we've-