Simultaneous stoma closure and type IV parastomal hernia repair after botulinum toxin and progressive pneumoperitoneum

Author:

Correia Penélope1ORCID,Pereira Ana Marta1,Matos Maria Leonor1,Rodrigues Catarina Santos2,Guimarães Marta1,Nora Mário1

Affiliation:

1. Centro Hospitalar de Entre o Douro e Vouga General Surgery Department, , Santa Maria da Feira 4520-211, Portugal

2. Hospital da Horta General Surgery Department, , Horta 9900-038, Faial, Azores, Portugal

Abstract

Abstract Surgery is the only treatment for parastomal hernia (PH). When possible, stoma closure is the best way to manage this type of hernia, however, whether to perform it in a single approach with abdominal wall reconstruction (AWR) is still debatable. A 58-year-old woman with a type IV PH with loss of domain was submitted to preoperative optimization [botulinum toxin type A and progressive pneumoperitoneum (PPP)], followed by simultaneous stoma closure and AWR. Hospital discharge was on the eighth day with no complications. Six months later, no clinical evidence of recurrence or other complication was observed. Large PHs are technically challenging. Stoma closure and simultaneous AWR increase surgical risk. Preoperative optimization with a combination of adjuvants (including PPP) is feasible in PH and may overcome technical complexity, even though patient selection remains the key when choosing a PH repair with synchronous stoma closure.

Publisher

Oxford University Press (OUP)

Subject

Surgery

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