The aim of the study was to improve an efficient and effective prescribtion process in case of parastomal hernia. Therefore we have developed a set of decision making rules for enterostomal therapists.

Methods:literature search, 2 questionnaire patients with parastomal hernia and stomatherapists, expertgroups.

Main outcome and recommendations Parastomal hernia primarely occurs shortly after stoma surgery: 60% of all hernia cases was diagnosed within the first postoperative year. Age and BMI are the main predictors of parastomal hernia. No other factors were found. A stoma patient at the age of 65 years or older appears to have a far greater risk (6.3 times higher) in developing parastomal hernia then a stoma patient at the age of 45 or younger. Compared to a BMI-score of less then 25, a BMI above 30 leads 2.5 times more often to parastomal hernia. We expect that the number of patients with parastomal hernia will rise dramatically in the years to come due to the higher number of stoma patients (increase of cancer of the colon and bladder), aging of the general population and the increase of obesitas. Formally, Dutch stoma nurses are not qualified to diagnose parastomal hernia; only a surgeon is fully qualified to do so. Stoma nurses can and do however ask a surgeon to make a formal diagnosis on bases of stoma nurses observations. Our study showed that there are no clear rules how to perform the diagnosis. Therefore we have developed a decision tree model to support this process. If applied in the proper way, the protocol prevents unnecessary use of expensive devices for parastomal hernia. It is not only a tool for stoma therapists, but also health care insurance companies should be given information on this subject.