# Non-Operative Considerations in Relation to Parastomal Hernia

## TL;DR

This review discusses non-surgical approaches for managing parastomal hernias, emphasizing conservative care and the need for more targeted research.

## Contribution

The paper synthesizes current evidence on non-operative strategies for parastomal hernia and highlights research gaps.

## Key findings

- Conservative management is widely accepted for asymptomatic patients with comparable outcomes to surgery.
- Abdominal binders and core training show promise but lack high-quality evidence specific to parastomal hernias.
- Stoma care and psychosocial support are critical but underrepresented in guidelines.

## Abstract

Parastomal hernia (PSH) is a frequent and challenging complication following stoma formation. While operative repair remains an important option in selected cases, non-operative strategies are essential, particularly for asymptomatic patients or those with significant comorbidities. This narrative review aims to synthesize current evidence on conservative management of PSH and on selected perioperative supportive measures, outlining core components, limitations, and research priorities.

A narrative review of the literature was conducted focusing on non-operative strategies in PSH, including watchful waiting, core training, abdominal support garments, stoma care, and psychosocial considerations. Relevant publications were identified through searches in PubMed and Google Scholar (2011–2025) and supplemented by expert consultation.

In patients with minimal symptoms, conservative approach is widely accepted, given that recurrence rates have been reported to be comparable between elective and emergency repairs. Physical activity and patient education are underexplored yet promising components in enhancing function and improving quality of life. The role of abdominal binders remains empirically supported but lacks high-quality, PSH-specific evidence. Stoma care optimization - and psychosocial support are critical to improving quality of life but remain underrepresented in clinical guidelines. Most available data are extrapolated from ventral and incisional hernia literature, underscoring the need for targeted PSH research.

Non-operative management remains a cornerstone of PSH care, requiring an individualized, multidisciplinary approach. Non-operative strategies should emphasize structured follow-up, abdominal support, guided core training, appliance adaptation, and psychosocial wellbeing. Dedicated prospective studies are urgently needed to define evidence-based protocols specific to PSH.