INTRODUCTION

Rolstad and Boarini (1996) cited by Bland et al (2015) ² define parastomal hernia as “a bulging of the stomach skin, indicating the passage of one or more bowel cycles through a fascia flaw around the stoma and subcutaneous tissue”. According to these authors, parastomal hernia represents the most common complication associated with the creatoin of intestinal stomas.

Abdominal surgery and the creation of a stoma cause trauma to the anterior abdominal muscles. The Association of Stoma Care Nurses of the United Kingdom (ASCN-UK) in 2016 ¹, recommended that all people with an ostomy be subjected to an appropriate abdominal exercise program after surgery, to strengthen the abdominal muscles and the floor pelvic in order to reduce the risk of developing hernias.

The present work has as objectives:

METHOD

It is a simple review of the existing literature on the topic, using Boolean research, due to the difficulty in finding literature on the subject, based on the keywords: parastomal hernia, guidelines, person with ostomy, published between January 2009 and October 2017.

RESULTS

Despite technological and scientific advances in the surgical area, postoperative complications continue to exist and constitute one of the main barriers to the adaptation of the person to the new transition processes that surgeries implie.

In the area of ​​stomatherapy, complications can occur in the first days after surgery (early or immediate complications) or a few weeks/months later (late complications). Therefore, the recognition of the signs and symptoms of complications, as well as the implementation of interventions as early as possible, are essential to ensure a more effective adaptation of the person to the ostomy with a consequent improvement in their quality of life.

According to a study carried out on patients at a University Hospital in Switzerland by Carlsson et al (2016) ³, parastomal hernia was the most common surgical complication (20%), and significantly more in women (69%) and in emergency surgeries, occurring in patients with colostomy and ostomy ≤ 5 mm.

In a study carried out at the Centro Hospitalar e Universitário de Coimbra by Melo et al (2014) ⁴, the incidence of parastomal hernia was 40.6% and other complications 6.25% (infection of the surgical wound, stoma stenosis, or others).

According to the data previously presented, parastomal hernias appear as the main late complication after the construction of an ostomy. According to Devlin (1983) cited by Târcoveanu et al (2014) ⁵, there are 4 types of parastomal hernia: interstitial, in which one or more cycles of the herniated intestine occur next to the stoma, penetrating between the intermuscular planes; subcutaneous, the most common, appears in the same way as the previous one but affects the subcutaneous tissue; intraestomal (usually occurs in ileostomy) that occurs along the intestine towards the stoma; peristomal where the stoma is prolapsed and cycles of the herniated intestine appear through the stoma.

According to ASCN-UK (2016) ¹, paraestomal hernias have a multifactorial etiology. However, there are some risk factors that healthcare professionals should be aware of:

According to Meleis et al. (2000) ⁶, “all transitions trigger change and to understand it, is essential to identify the effects and their meanings. These must be explored according to their nature, temporality, severity and personal, family and social expectations. The change may be related to critical events or imbalances that lead to changes in ideals, perceptions, identities, relationships and routines”.

The teaching-learning process of the person with ostomy must start in the preoperative period, with the purpose of achieving a faster adaptation to the changes that might be necessary in their lifestyle, without forgetting the help in raising their health status and supporting the transition conditions.

Therefore, and taking into account the main risk factors for the development of previously identified parastomal hernias, there are several Nursing interventions that can be implemented at the level of teaching/instruction/training of the person with ostomy, with a view to their recovery as early as possible.

DISCUSSION

Health education is a teach/instruct/train process that nurses do with users, with the aim of providing them with strategies that can help to minimize the impact that the transition processes have on their daily lives, contributing to their recovery and well-being, trying to identify the value they attach to the situation and the response patterns for assessing their involvement.

With the accomplishment of this work was verified the existence of little literature and research studies on this theme. Thus, it becomes pertinent to implement training and research in this area, given the increased incidence of people with ostomy in younger and more active age groups.

According to the literature review previously carried out, performing exercises to strengthen the abdominal muscles before surgery is one of the most important interventions to reduce the risk of developing parastomal hernia. These must be started after an evaluation by the multidisciplinary team and carried out daily. In the first 6 weeks, the exercises should be smooth and maintained according to the person's physical capacity.

Thus, in collaboration with the specialist nurses in rehabilitation and taking into account the recommendations of the international experts obtained through the consulted literature, it was possible for us to develop some practical exercises for later teaching to the person with an ostomy, in order to reduce the incidence of parastomal hernias in the institution where we develop our professional activity.

CONCLUSION

Parastomal hernia continues to be a concern for healthcare professionals and the person with an ostomy. The weakening of the abdominal muscles increases the risk of hernia formation; therefore strengthening it with a specific exercise program seems to be the best option.

The non-invasive prevention program includes reducing maneuvers that increase abdominal pressure during the first three months of the immediate postoperative period. Subsequently, abdominal exercises should be performed to strengthen the abdominal muscles and the use of clothing and/or devices which help to homogenize abdominal pressure.

If the person with an ostomy is cognitively capable, teach/instruct/train exercises should be carried out regularly to strengthen and maintain the strength of the abdominal muscles. The exercises are easy, comfortable and without added costs, without the need for additional support (straps or underwear for support).

These exercises, in addition to reducing the risk of parastomal hernia, optimize biomechanical and postural problems, balance and coordination; increase the capacity to support intra-abdominal pressure, well-being and confidence.

Given the lack of bibliography and research in this area, studies that support the implementation of this specific care in consultation, directed to the person with ostomy, are emerging.