Authors (including presenting author) :
Ngan HL (1), Ng KK (2)
Affiliation :
(1) (2)Stoma & Wound Care, Nursing Services Division, United Christian Hospital
Introduction :
Parastomal hernia (PSH) is a common complication following stoma formation, with reported global incidence rates ranging from 5% to 50%. The incidence of PSH in Hong Kong is poorly documented, and there is a lack of management guidelines.
Objectives :
The objectives of this clinical quality improvement (CQI) initiative were to evaluate the incidence of PSH in a local hospital, describe the implementation of preventive strategies for PSH and highlight areas for improvement.
Methodology :
A total of 385 patients who underwent surgical stoma formation at the United Christian Hospital between January 2021 to December 2023 were included in the study. Data collected included patient demographics, type of surgery (emergency or elective), type of stoma, preoperative stoma siting, and timing of PSH development. Additionally, any management interventions implemented to address PSH, such as the use of abdominal binders or convex pouches, were also recorded.
Result & Outcome :
The results of the CQI initiative revealed that 9.87% (N=39) of patients developed PSH. Most patients who developed PSH were male (67%) with a mean age of 72 years old (range: 60 to 94). Loop colostomies were the most common stoma type (44%), followed by end stoma (36%), double barrel stoma (15%) and urostomies (5%). Emergency surgeries accounted for 67% of cases, while 33% were elective. The timing for patients developed PSH ranged from 3 to 40 months post-operation. Most patients (69%) developed PSH within one year, 20% between one to two years, 5% between two to three years, 3% after three years and 3% could not be traced regarding the timing of PSH onset. 75% of patients with PSH were referred to Occupational Therapy for abdominal binders, and 23% required a change to a convex pouch due to leakage issues. Despite implementing preventive measures, a significant proportion of patients still developed PSH. This suggests that the current preventive measures may not be effective in reducing the incidence of PSH. The implementation of a multifaceted program involving physiotherapy to educate patients on core muscle training and early referral to Occupational Therapy for abdominal binders, and ongoing support through regular follow-up patient in the stoma nurse clinic for patient health education and patient empowerment may be necessary to reduce the incidence of PSH. Further research is needed to evaluate the effectiveness of this approach and to develop evidence-based guidelines for the prevention and management of PSH.
