Parastomal hernia: Quality of life

The recent article¹ outlined the techniques used in contemporary management of parastomal hernia. Reported outcomes are centred around surgical site complications and recurrence. There is, however, a huge burden placed upon the patient who ultimately has to manage the physical as well as psychological stresses associated with a parastomal hernia. There is growing interest in developing optimal management strategies that take into account patient reported outcomes, that do not simply focus on clinical determinants such as successful operative repair.

Patients with parastomal hernia have worse physical functioning, experience more pain and have lower general health as well as experiencing feelings of negative body image, compared to patients without parastomal hernia^2,3. Body image encompasses perceptions, emotions and attitudes a person holds with regards to their own body³. Interventions can be designed to improve perceptions of body image, as well as levels of physical activity.

The Hernia Active Living Trial (HALT) aims to evaluate the effect of increased physical activity on the risk of parastomal hernia development³. Increased levels of physical activity may contribute towards improving overall perceptions of body image and also quality of life.

There is also a need to assess the direct impact of surgical intervention on quality of life, as well as overall patient satisfaction.

The PROPHER (Patient-Reported Outcomes after Parastomal HErnia tReatment) study is currently underway and aims to quantify patient reported quality of life outcomes after parastomal hernia treatment⁴. PROPHER has the opportunity to better understand patient satisfaction after treatment, and associations between operative technique and quality of life outcomes.

Parastomal hernias continue to be a common problem. Increased understanding of their impact on quality of life and body image is an important next step. Holistic approaches to counselling and management of these patients may have less long term impact on psychological stressors, even if patients ultimately live with a parastomal hernia.