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A giant parastomal hernia in a high risk patient: preparation to make surgery worthwhile.
- Source :
-
Acta chirurgica Belgica [Acta Chir Belg] 2023 Jun; Vol. 123 (3), pp. 309-312. Date of Electronic Publication: 2021 Oct 08. - Publication Year :
- 2023
-
Abstract
- Background: Parastomal hernia (PH) is a frequent and well-known complication of stoma placement. Most PHs are asymptomatic and those who are not are usually well tolerated by patients. Thus, watchful waiting is a common practice. Nevertheless, this management policy is associated with a risk of complications and with an inevitable risk of hernia enlargement, complicating its subsequent surgery. Moreover, PH can affect body image and alter the quality of life.<br />Methods: We herein present a complex case of a 67-year-old man with multiple comorbidities, who presented with an uncommon, below knee, giant PH, which was managed in a two-steps surgery by a multidisciplinary team comprising a senior digestive surgeon, experienced in abdominal wall repair, cardiologist, pulmonologist, anesthesiologist, psychiatrist, dietitian and physiotherapist.<br />Result: Treatment started with 8 months hygienic measures comprising smoking cessation, strict control of diabetes and hypertension, a strict diet, and a physical fitness and pulmonary rehabilitation program. Two steps surgery started by colostomy transposition along with pre-peritoneal mesh repair to the right side and the second step consisted of a prophylactic PH repair using a Key-hole preperitoneal polypropelene mesh.<br />Conclusion: PH is a common and sometimes inevitable complication of stoma creation. The success achieved by operating a heavily morbid patient, is only possible through the combined efforts of the multidisciplinary team and a preoperative rigorous management.
Details
- Language :
- English
- ISSN :
- 0001-5458
- Volume :
- 123
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Acta chirurgica Belgica
- Publication Type :
- Academic Journal
- Accession number :
- 34583625
- Full Text :
- https://doi.org/10.1080/00015458.2021.1987616