November's Paper of the Month is an investigation of patients' experiences of being prepared for the development of a parastomal bulge in relation to a stoma.
Understanding patients' perspectives when unprepared for the emergence of a parastomal bulge - a qualitative study
Marianne Krogsgaard, Pia Dreyer, Thordis Thomsen
Colorectal Dis. 2023;25:2198-2205
What is known about the subject?
A parastomal bulge or hernia is a common complication after stoma surgery, with the reported incidence of parastomal bulging around 40-50% after two years. Currently there is much that is unknown regarding treatment for parastomal bulging. Treatment options, both surgical and non-surgical have a low evidence base. Surgical treatment is technically challenging with significant morbidity and recurrence. There is also no firm evidence that common conservative management treatment options are effective, for example the wearing of support garments. The numbers of patients who have surgical repair of their parastomal bulge is low, with the majority either undergoing conservative management, or being left to manage their condition on their own.
There is currently little information about the patients’ perspective on the information that they were provided with on parastomal bulging.
What the study adds?
This study is part of a wider qualitative study that aimed to establish patients’ perspectives on living with a parastomal bulge [1]. This paper focuses on patients’ experiences of being prepared for the development of a parastomal bulge. 26 patients were recruited from five hospitals in the Capital Region of Denmark and participated in five focus group interviews. Two groups were comprised of patients referred for surgical repair of their parastomal bulge (n=9) and three groups comprised patients who were undergoing non-surgical treatment (n=11).
Three themes were identified from the interviews: ‘The unforeseen bulge gives rise to increasing concern and a search for an explanation’. Patients searched for explanations in their own life and suspected that their behaviour or previous illness induced the bulge; ‘Missing or confusing information leads to counterproductive behaviour’. Patients lacked information on the prevention and treatment of parastomal bulging which led to disappointment with healthcare professionals; and ‘Weighing the pros and cons of life with the bulge against the gamble of surgical repair’. Some patients came to terms with their situation, but for others a deadlocked situation arose when surgical repair was not an option.
Implications for colorectal practice
This study highlights the need for patients undergoing stoma formation to be adequately counselled with regards the incidence of parastomal bulging. It found that patients feel unprepared for the development of a parastomal bulge, and that this can have a negative impact on their emotional and psychological wellbeing. Given the high incidence of parastomal bulging, and the lack of clear evidence for prevention and treatment, clinicians should ensure that their patients are provided with the necessary information so that they can make informed decisions about their personal risk factors, and treatment choices.
References
- Krogsgaard M, Thomsen T, Vinther A, Gogenur I, Kaldan G, Danielsen AK. Living with a parastomal bulge - patients' Experiences of symptoms. J Clin Nurs. 2017;26:5072-81.