Reinforcement of a permanent stoma with a synthetic or biological mesh to prevent a parastomal hernia

Evidence-based recommendations on reinforcement of a permanent stoma with a synthetic or biological mesh to prevent a parastomal hernia. This involves inserting a piece of mesh to strengthen the abdominal wall.

# Recommendations
The evidence on the safety of reinforcement of a permanent stoma with a synthetic or biological mesh to prevent a parastomal hernia shows there are serious but well-recognised complications. The evidence on efficacy is limited in quantity and quality. Therefore, this procedure should not be used unless special arrangements are in place for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.
Clinicians wishing to do reinforcement of a permanent stoma with a synthetic or biological mesh to prevent a parastomal hernia should:
Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the procedure's safety and efficacy, as well as any uncertainties about these. Provide them with clear written information to support shared decision making. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having the procedure. NICE has identified relevant audit criteria and has developed an audit tool (which is for use at local discretion).
All adverse events involving the medical devices (including the synthetic or biological mesh) used in this procedure should be reported to the Medicines and Healthcare products Regulatory Agency.
Further research could be in the form of randomised controlled trials, observational studies and analysis of registry data. It should report details of patient selection, the type of synthetic or biological mesh used, mesh-associated complications and long-term outcomes (at least 3 years). In participating centres, clinicians should encourage patients to take part in the National Institute for Health Research CIPHER study.# The condition, current treatments and procedure

# The condition
Stomas are created surgically to divert the contents of the urinary or digestive tract through an opening in the abdominal wall. A parastomal hernia allows protrusion of abdominal contents through the abdominal-wall defect created by the stoma. They are relatively common, usually developing gradually and increasing in size over time. A parastomal hernia may remain asymptomatic, but can cause problems such as unacceptable physical appearance, poorly fitting stoma device, bowel obstruction, and bowel ischaemia and strangulation.

# Current treatments
A parastomal hernia can be repaired surgically, using an open or laparoscopic approach. Surgical repair is associated with its own morbidity and there is a high risk of recurrence.

# The procedure
This procedure is done using general anaesthesia, at the same time as the creation of the stoma. A space is formed between the rectus abdominus muscle and the rectus sheath of the abdominal wall, and a piece of synthetic or biological mesh is inserted into the space. The bowel or ureter is passed through the mesh and then through the abdominal wall. The mesh and the bowel or ureter are stitched to the abdominal wall. The aim is to strengthen the abdominal wall and prevent parastomal herniation.