Hernia Support Garments for Parastomal Hernia Following Ostomy Procedure

Abstract

What Is the Issue? Parastomal hernia is a common complication that can occur following ostomy surgery. They can have a negative impact on a person’s quality of life, affecting them both physically and psychologically. One intervention that may be used to help prevent or manage parastomal hernias are hernia support garments. To help inform decisions about the most appropriate use for hernia support garments, it is important to understand the current best practices as well as potential benefits and harms of using these garments. What Did We Do? We searched for clinical and cost-effectiveness literature comparing hernia support garments to alternative hernia prevention or management strategies or no intervention. We also searched for evidence-based guidelines that provide recommendations about the use of hernia support garments for the prevention or management of parastomal hernias. An information specialist searched for peer-reviewed and grey literature sources published between January 1, 2013, and November 1, 2023. We engaged with an individual who has lived experience of an ostomy and parastomal hernia and who wears a hernia belt regularly. He shared his thoughts on the physical and psychological benefits, impact on quality of life, and challenges of using a hernia belt. This gave CADTH a more nuanced understanding of the literature. What Did We Find? We did not find any studies directly evaluating the clinical or cost-effectiveness of hernia support garments versus alternative hernia prevention or management interventions or no treatment that met the inclusion criteria for this review. Three evidence-based guidelines made recommendations related to using hernia support garments to prevent and manage parastomal hernia. One guideline recommends that individuals with an ostomy should be assessed to determine the type and level of support required to prevent or manage hernia. Another guideline recommends that health providers provide postoperative education on using support garments. The third guideline recommends that stoma care nurses provide lifestyle advice about support garments to individuals with a stoma. This guideline also recommends that these nurses should be available to advise on non-operative management options for parastomal hernias more generally. What Does This Mean? Decision-makers might wish to consider ways to ensure that individuals who have had or are scheduled to have an ostomy surgery have timely access to parastomal hernia risk assessment, education, and advice on the use of hernia support garments from nurses specialized in wound, ostomy, and continence care. They may also want to consider out-of-pocket costs that may be a barrier to this care.