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Abstract: A 65-year-old female patient with a colostomy had a significant localized bulge around the stoma with dyspareunia and localized pain and a history of prior rectal cancer surgery. For patients with a postoperative colostomy after rectal cancer surgery, a parastomal hernia occurs in 50% of patients 2 years after surgery. The diagnosis of parastomal hernia was then clear through examination, and surgery was recommended. Laparoscopic stoma hernia repair was usually used to avoid complications, and a lap band was fitted for 2 months after surgery, and no discomfort occurred.
Basic information】Female, 65 years old
Type of disease】Parastomal hernia, postoperative rectal cancer
Hospital】Central University Hospital of Southeast University
Date of Consultation】March 2022
Treatment Plan】Laparoscopic parastomal hernia repair
Treatment Period】6 days of inpatient treatment and 6 months of outpatient follow-up
Results】The stoma bulge disappeared and the patient’s discomfort disappeared.
I. Initial consultation
The patient underwent laparoscopic radical rectal cancer surgery + sigmoid stoma (artificial anus) for rectal cancer 2 years ago, and recovered smoothly after surgery. On examination, it was found that the skin around the stoma was obviously bulging when the patient was standing and lying down, and the patient’s blood was drawn for routine blood tests and tumor indicators were normal.
II. Treatment history
Based on the fact that the patient had undergone rectal cancer surgery 2 years ago, combined with CT examination and the appearance of the stoma, the diagnosis of parastomal hernia was clear. Therefore, it was explained to the patient’s family that parastomal hernia is a common complication in patients with colostomy, with an incidence of more than 50%, and the incidence of parastomal hernia in patients with stoma is increasing with time, and if no surgical treatment is performed, there is a risk of increasing abdominal pain and If not treated surgically, there is a risk of worsening abdominal pain and complicating intestinal obstruction as the herniation of the intestine increases. The patient recalled occasional abdominal pain and paroxysmal exacerbations in recent months, which may be a sign of intestinal tube entrapment. The patient’s family had concerns, having just undergone a major surgery 2 years ago and now having to undergo surgery again, but decided to undergo surgery considering the risk of parastomal hernia obstruction. The treatment recommended for her was laparoscopic parastoma hernia repair (Sugarbaker procedure).
III. Treatment outcome
The patient underwent laparoscopic parastomal hernia repair. The laparoscopic procedure was performed under general anesthesia with three small 0.5cm-1cm incisions in the abdominal wall, and the stoma defect was covered and repaired using the tension-free parastomal hernia repair style (Sugarbaker), which took 1.5 hours to perform. The patient was advised to wear a lap band for 2 months after surgery and was followed up for 6 months with no significant discomfort. A repeat abdominopelvic CT showed no recurrence of the parastomal hernia.
IV. Precautions
While feeling relieved about the recovery of the patient’s symptoms, the following points need to be noted for the care of the stoma.
1. Observe the mucosal skin around the stoma for redness, swelling, bleeding, ulceration, and mucus.
2. Observe whether there is bulging, pain and hardening around the stoma.
3.Keep the skin around the stoma clean and try to gradually develop the habit of regular bowel movement.
4.Revisit regularly for tumor recurrence.
5.After the surgery of parastomal hernia, it is also necessary to review regularly.
V. Personal insight
Patients who have undergone colostomy after rectal cancer surgery have a high probability of having a parastomal hernia. Patients may have just undergone a major surgery to remove rectal tumor and then have a parastomal hernia, so they do have concerns about surgical treatment, which is understandable. Clinically, it has been observed that the incidence of parastomal hernia is high, with a high incidence of complications and the possibility of serious complications, such as intestinal obstruction and intestinal necrosis. Therefore, for symptomatic parastomal hernia, patients are advised to have timely surgery, so patients with colostomy need to pay attention to the occurrence and treatment of parastomal hernia.