Authors (including presenting author) :
Ng KK(1), Ngan HL (1)
Affiliation :
(1) Stoma and Wound care team, United Christian Hospital
Keyword 1: :
Parastomal herniation
Keyword 2: :
Multidisplinary approach
Keyword 3: :
Core muscle exercise
Keyword 4: :
Abdominal binder
Introduction :
Parastomal hernia (PSH) remains a prevalent complication following stoma surgery, significantly impacting patient Quality of Life (QoL) through pain, protrusion, and appliance leakage issues. This clinical project conducted at United Christian Hospital evaluated the efficacy, safety profile, and patient compliance of two distinct PSH prevention protocols. The study was developed in collaboration with the Department of Surgery, stoma care team, physiotherapy department, and occupational therapy services to address the multifactorial nature of PSH development.
Objectives :
The primary aim was to compare adherence rates, safety outcomes, and Stoma-QoL impacts between two intervention arms among colorectal surgery patients: Group A (n=23) receiving core muscle strengthening exercises plus mandatory abdominal binder versus Group B (n=22) receiving core exercises alone. Secondary objectives included identifying compliance barriers and informing future integrated prevention strategies.
Methodology :
Between October 2024 and December 2025, 45 patients undergoing elective colorectal surgery with stoma formation were prospectively recruited. The study compared two intervention arms: Group A (n=23), who received core muscle exercises combined with a mandatory abdominal binder, and Group B (n=22), who received core exercises alone. Follow-up extended to one year or until stoma closure.
Result & Outcome :
Compliance emerged as the critical differentiator. Group A achieved a 100% initial uptake rate with 78.2% maintaining good adherence, although 21.7% exhibited protocol deviations (e.g., wearing the binder while sitting). In contrast, Group B suffered a significant "compliance gap," with a 31.8% default rate, leaving high-risk patients unprotected.
Safety profiles revealed a clear trade-off. Group A reported device-related complications in 17.4% of patients (skin damage) and one case of mucosal necrosis due to compression. Group B had zero device-related adverse events but remained vulnerable to herniation due to low engagement. Outcomes & Implications
Stoma-QoL analysis indicated that binders provide a "security effect," stabilizing early postoperative QoL and reducing movement anxiety. The exercise-only group showed greater score volatility, though adherent patients demonstrated significant recovery potential. Notably, sharp QoL declines were linked more to systemic factors (e.g., chemotherapy) than the intervention itself. Conclusion
The data suggests that neither strategy is sufficient in isolation. While binders ensure compliance and immediate stability, they carry tissue viability risks. Exercise offers physiological restoration but fails due to attrition. An integrated, risk-adapted model is recommended: utilizing binders as a mandatory short-term "safety bridge" for healing, while systematically transitioning to progressive core strengthening for long-term functional protection.
