Non-Operative Considerations in Relation to Parastomal Hernia

Purpose: Parastomal hernia (PSH) is a frequent and challenging complication followingstoma formation. While operative repair remains an important option in selected cases,non-operative strategies are essential, particularly for asymptomatic patients or those withsignificant comorbidities. This narrative review aims to synthesize current evidence onconservative management of PSH and on selected perioperative supportive measures,outlining core components, limitations, and research priorities.
Methods: A narrative review of the literature was conducted focusing on non-operativestrategies in PSH, including watchful waiting, core training, abdominal support garments,stoma care, and psychosocial considerations. Relevant publications were identifiedthrough searches in PubMed and Google Scholar (2011–2025) and supplemented byexpert consultation.
Results: In patients with minimal symptoms, conservative approach is widely accepted,given that recurrence rates have been reported to be comparable between elective andemergency repairs. Physical activity and patient education are underexplored yetpromising components in enhancing function and improving quality of life. The role ofabdominal binders remains empirically supported but lacks high-quality, PSH-specificevidence. Stoma care optimization - and psychosocial support are critical to improvingquality of life but remain underrepresented in clinical guidelines. Most available data areextrapolated from ventral and incisional hernia literature, underscoring the need fortargeted PSH research.
Conclusion: Non-operative management remains a cornerstone of PSH care, requiringan individualized, multidisciplinary approach. Non-operative strategies should emphasizestructured follow-up, abdominal support, guided core training, appliance adaptation, andpsychosocial wellbeing. Dedicated prospective studies are urgently needed to defineevidence-based protocols specific to PSH.