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One of the ugly truths that may not be mentioned when a patient first learns they will need to have a colostomy, is that at some point down the line a stoma revision may need to be performed as well. It is not something every patient will have to undergo but various stoma or colostomy related problems may occur that may prompt your surgeon to advise a stoma revision. The key to a healthy life after colostomy surgery is to have a healthy stoma that does not interfere with the workings of the patients of an ostomy.
Revising the stoma site may involve; making the stoma larger or smaller, strengthening the stoma with mesh in cases of hernia or injury, redoing the attachment of the stoma to the outside of the abdomen, or widening the the site to help with blood flow or pinching problems, just to name a few. It may be unpleasant, worrisome and downright scary to have to undergo another surgery, but a properly functioning stoma and stoma site is the cornerstone of safe, hassle-free colostomy care. More than likely the patient will have to be put under general anesthesia, with local anesthesia being an option for usually only the smallest of simplest revisions. After surgery an average stay of four days may be needed.
A hernia is when a rip/tear in muscle tissue that causes a portion of the abdomen (particularly, the intestine) to bulge through. This causes pain when standing up, moving the abdomen, or any kind of tension on the abdomen including coughing, sneezing, laughing, bending over, picking up objects, etc.
Coughing, sneezing, heavy lifting and being overweight all put pressure on the abdominal wall and stoma. Over time, muscles can weaken to the point a stoma begins to protrude and push out due to the pressure of the guts behind it. There are many possible origins for parastomal hernia to develop. Some are related to surgery and a poorly placed stoma or a developing infection around the border. Other causes are related to an individuals health, such as being overweight, heavy lifting, or any kind of physical strain, or a combination of these factors.
Having a stoma can develop into an ostomy specific type of hernia called a parastomal hernia. Since a stoma passes through the abdomen, it can compromise the strength of the muscular abdomen wall. These weakened muscles can come away from the stoma, weakening its integrity and causing the intestine to bulge. A stoma hernia is typically not painful, but can be very comfortable and unnerving, not to mention more difficult to manage and care for. As the stoma grows, it can become more difficult to attach ostomy wafers and pouches.
Surgery is the most common repair for any type of large hernia. Typically, if the hernia is not recurring, doctors will recommend a hernia and appliance changes before recommending surgery. A hernia belt is designed for individuals with small hernias or those where surgery can be risky or further compromise one's healthy. A henia belt is a firm wide belt that helps support the stoma and muscle tissue around it externally. As for surgery, doctor opinions vary based on their preferences for proper care and an individual's needs. There are two options for the surgeon.
To repair the muscle tissue around the stoma (either with stitching or mesh).
Create a new opening in a health spot and close off the old one.
In some cases, option 1 isn't applicable; either henia is too large or the surgery is too risky. Some surgeons will choose to re-locate the stoma first and install mesh of the problem persists. However, today, often a mesh is implanted instead of stitches. This is the ideal method of repairing a hernia. A mesh laid across the herniated muscle tissue, helping to hold the muscle together and increasing its strength and integrity. The mesh also speeds recovery times over the methods and reinforces the tissues; patients can be mobile again with a matter of days.
In the 1990's, the United Ostomy Association found that a hernia is one of the most common complications of ostomy patients. Ostomy hernias happen to about 30% of all stomas. It's more common with Colostomy than Ileostomy and Urostomy.
Patients often shutter when they hear that they may need to have another surgery. This is usually replaced with relief once successful stoma revision surgery is performed. Stoma problems can be rather distressing for patients so correcting a malfunctioning stoma can be quite rewarding. A healthy, properly functioning stoma is crucial to overall well-being of colostomy patients. Stoma revision may be necessary course of action for some patients after their initial course of action for some patients after their initial colostomy surgery, but fixing a problematic stoma will ensure colostomy supplies will fit and function as intended which in turn will help the patient live a more worry free and healthier life going forward.
Malformed Stoma: A stoma that has settled into an odd shape can make it hard for colostomy appliances to enact a snug fit. If this happens possible leakage and or stoma irritation might occur.
Hernia: The most common type of complication seen by colostomy patients, a hernia may cause some pain and bulging at the stoma site. Non-severe cases may need stoma revision whereas more severe cases may involve stoma relocation, creating a new stoma on a different site on the abdomen.
Ulcers, bleeding, excessive skin irritation including fistulas:Continual skin problems at the stoma site may require stoma revision surgery to fix any causes leakage and skin issues occurring around the stoma.
Stoma prolapse or retracted stoma: These two types of stoma problems deal with a stoma either protrudes too much from the abdomen or one that does not protrude enough. This can lead to problems with stoma appliances being able to fit properly and cause leakages. A stoma revision may be recommended in these instances.
Blockages: Any type of blockage, especially where are multiple instances, stoma revision may be needed. Obstructions can be serious, so revision or relocation surgery may be advised should a patient develop a problem with constant blockages.
Reference: Colostomy Care.Org, http://www.colostomycare.org/stoma-revision/
Reference: Ostomy Guide, http://www.ostomyguide.com/what-is-a-parastomal-ostomy-hernia