DEAR MAYO CLINIC: My friend had a stoma created after years of managing Crohn's disease. She recently had surgery to repair a hernia. What is a stoma, and are these types of hernias common? What is the typical treatment?

ANSWER: Occasionally, the surgical treatment of Crohn's disease, ulcerative colitis and other gastrointestinal, gynecologic, or urologic conditions, both cancerous or benign, may require reconstruction or removal of the bladder, colon, or rectum. Surgeons may use other parts of the intestine to replace the function of these organs to facilitate the removal of urine or stool from the body. When this is done, the surgeon constructs a stoma, a small opening in the abdomen used to remove this body waste into a collection bag.

When the stoma is connected to the urinary system, it is known as an urostomy. If the stoma is releasing stool, it can be an ileostomy constructed from the small intestine or a colostomy made from the colon, also known as the large intestine. Stomas may be temporary or permanent depending upon why they were constructed. If they are temporary, another operation is required to reverse them.

While adjusting to your stoma may take some time, you can lead a completely normal life with a stoma — there are really no limitations on activities.

Because a hole in the abdominal wall is required to construct a stoma, that hole can enlarge over time and become a hernia. An abdominal wall hernia is a condition where some abdominal tissue or part of an abdominal organ, most commonly the intestines, protrudes through the abdominal wall. From the outside, this may result in a noticeable bulge. Hernias may cause no symptoms or become quite symptomatic as they enlarge. Discomfort or pain with activity is the most common symptom of an abdominal wall hernia. Occasionally, hernias containing a portion of the intestine may result in an intestinal obstruction which can be life-threatening and require emergency surgery.

A hernia associated with a stoma is known as a parastomal hernia. Like other abdominal wall hernias, parastomal hernias result in a noticeable bulge and can have similar symptoms. However, parastomal hernias can be very problematic for patients because the bulging around the stoma frequently interferes with the function of the appliance that collects the waste material. If the appliance seal fails, then waste material will leak out onto the skin. Parastomal hernia repair not only improves the function of the collection pouch, but it also improves the appearance of the abdominal wall.

Most patients who have a parastomal hernia may be candidates for robotic surgery to repair the hernia. Robotic repair typically results in improved outcomes with a shorter hospital stay and quicker recovery than open repairs. Robotic surgery can lead to lower rates of complications.

Parastomal hernias can be repaired, but it requires a higher level of surgical training and experience to perform a long-lasting repair of the abdominal wall without compromising the function of the stoma. It's important for patients to seek out care at a high-volume hospital, like Mayo Clinic, to lower the recurrence rate of future hernias. — Dr. Robert Cima, Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota

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The post Mayo Clinic Q and A: Treatment for a parastomal hernia appeared first on Mayo Clinic News Network.

The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery focuses on the science of best practice. Best practice in health care, that is.

Across the center, researchers work together with the medical practice to find ways to improve health, and the ways people (patients, caregivers, providers) experience health care. This includes identifying what adds value to care experiences, and where we can find cost savings. Health care delivery research encompasses diverse areas, such as human-centered design, data collection and analysis, systems and physical engineering, qualitative research, and much more.

So much research is going on at Mayo Clinic that it’s hard to get our arms around it, and even just within the center, it can be a challenge. But we want to share what we can. We’ve all heard the statistic that it takes 17 years for a practice changing research finding to actually change practice. While that may not always be the case, we figured we’d do our part to spread the news, and maybe shave off a few days here and there.

Here’s a couple of our latest for:

People with herniated disks

Researchers from our Knowledge Synthesis group partnered with others from the Neuro-Informatics Laboratory to dig through all the publications available discussing extraforaminal disk herniation. This particular type of herniation is difficult to diagnose – and treat – because of where it occurs. However, they account for as many as 11 percent of all disk hernias.

The question of how best to treat this condition came from two areas in Mayo Clinic:

• Department of Neurologic Surgery, which provided content expertise about the target condition and type of surgery; and
• Division of Preventive, Occupational and Aerospace Medicine, which provided methodological and analytical expertise.

Together they made up the rest of the research team.

One might assume there would be a commonly understood best practice for how to treat them. But as the research team says in its paper, “Despite the heterogeneity of spinal procedures, there is a paucity of literature comparing the outcomes from different surgical approaches.”

When they completed their search for relevant studies, they found 41 studies with 1,810 patients. Of these, about two-thirds had received open surgery, and the remaining third minimally invasive surgery. Volume does not indicate best practice though.

The team found that compared to open surgery; minimally invasive procedures resulted in lower estimated blood loss, shorter operative times, shorter hospital stays, and faster return-to-work times. They also found that tubular microscopic procedures for extraforaminal disk herniation have the lowest reoperation rate of all minimally invasive surgery types.

Sounds like a cost saving, value adding, experience enhancing finding to me!

Women with breast cancer

Surgical Outcomes

is another area we constantly are seeking best (and better) practices. Recently a research team with members from the center and a number of areas across Mayo Clinic including: Surgery, Diagnostic Radiology, Anatomic Pathology, Mayo Clinic School of Medicine,  and Health Sciences Research, published a paper describing a new nomogram they developed.

First you may be wondering, what the heck is a nomogram?

Basically it’s a set of lines that each have a scale marked off—in this case lines representing different characteristics of a type of non-invasive breast cancer (ductal carcinoma in situ)—and arranged in a way that connecting a straight line between two known characteristics will allow you to determine a third one.

The team’s nomogram is able to predict which women will actually be found to have invasive breast cancer (a more serious form of the disease) when they go in to have the ductal carcinoma in situ (DCIS) removed.

Doctors can help their patients make more informed decisions before surgery using this new nomogram.

If a woman having a lumpectomy for DCIS is found to have invasive disease, she often will have to come back for a second surgery. However, with this new tool, if the lines predict the woman will have invasive breast cancer, she may wish to have a different surgery up front. She also can go into surgery agreeing to a more aggressive surgery at the time if invasive cancer is seen by the surgeon.

One of the team members we’re especially proud of is Brittany Murphy, M.D. She just completed her time as a Surgical Outcomes Research Fellow in the center, and is well on her way to a great career as a breast surgeon and health care delivery researcher.

The nomogram is likely to be a welcome addition to her and other breast surgeons’ toolkits, and a boon for patients.

About 800 words is all there’s time for today, but check out our website and stay tuned for other updates from the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

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• Subscribe to this blog
• Check out Discovery’s Edge, Mayo’s online research magazine
• Visit the Mayo Clinic Research website

The post What the heck is a nomogram? And other medical research questions answered. appeared first on Mayo Clinic News Network.

Miss the show?  Here's the podcast: Mayo Clinic Radio PODCAST April 4 2015

Myth or Matter-of-Fact: Most hernia repair surgeries are performed on men ages 40 to 60 years.

To listen to the program at 9 a.m. Saturday, April 4, click here.

Follow #MayoClinicRadio and tweet your questions.

Mayo Clinic Radio is available on iHeartRadio.

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

To find and listen to archived shows, click here.

The post Mayo Clinic Radio: Hernias/Handbook for Happiness/Cochlear Implants appeared first on Mayo Clinic News Network.

Salt Lake City — Think having a hernia repaired is going to be a walk in the park — or that you’ll be ready to take a walk in the park within hours afterward? It may be time for a reality check, a Mayo Clinic study suggests. Researchers found that though patients tend to expect to return to normal activities swiftly after laparoscopic ventral hernia repair, many of those studied were still experiencing pain and fatigue several days later. People under 60 and women in particular seemed to have more prolonged recoveries.

Journalists: Soundbites with Dr. Bingener-Casey are available in the downloads.

The findings were presented at the Society of American Gastrointestinal and Endoscopic Surgeons annual meeting April 2-5 in Salt Lake City.

Physicians may need to work with patients to set more realistic expectations about recovery and help them better cope with pain and fatigue after the procedure, says senior author Juliane Bingener-Casey, M.D., a gastroenterologic surgeon at Mayo Clinic in Rochester, Minn.

“It may be that people expect, when they’ve seen their neighbors after laparoscopic gall bladder surgery and they’re back taking a walk the next day, that they’ll be able to do the same thing with laparoscopic ventral hernia repair,” Dr. Bingener-Casey says. “They will probably find out that it takes several days before they start moving the way they usually do.”

Laparoscopic ventral hernia repair is an outpatient surgery performed when a gap forms between muscles in the abdomen, allowing organs or other soft tissues to push through that weakened area and potentially causing obstructions and pain. It is one of the more common surgeries in the United States: Roughly 90,000 ventral hernia repairs are performed in the U.S. each year, the researchers note. Anyone can develop a ventral hernia, though people who have had surgery with an incision, have lung disease, are obese or have weakened immune systems are at higher risk, Dr. Bingener-Casey says.

Researchers studied the quality of life reported by 18 patients over their first seven days after surgery, considered the worst part of the recovery period. They found that the mean levels of patient-reported fatigue and pain didn’t recede to their pre-surgery levels until seven days after the procedure. Women and people under 60 tended to report poorer physical well-being in the days after surgery than men and patients over 60.

“It’s worse than expected for the patients probably. So I think it’s important for patients to have a realistic expectation, so they’re not surprised and disappointed,” Dr. Bingener-Casey says. “For the surgeons, it’s important to look at what we can do to improve recovery. Is it the pain control, is there other help we can provide to get through the pain or through the fatigue for the time after surgery?”

Further research is planned to determine whether an individualized approach to patient recovery after the surgery helps people get back to normal more quickly.

Dr. Bingener-Casey’s research is supported by National Institutes of Health grant DK93553.

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About Mayo Clinic
Recognizing 150 years of serving humanity in 2014, Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit 150years.mayoclinic.org, MayoClinic.org or https://newsnetwork.mayoclinic.org/.

MEDIA CONTACT: Sharon Theimer, Mayo Clinic Public Affairs, 507-284-5005, Email: newsbureau@mayo.edu

The post Recovering From Abdominal Hernia Repair Often Takes Longer Than Patients Expect appeared first on Mayo Clinic News Network.