Integrated Laparoscopic Management of Parastomal and Midline Incisional Double Hernias: A Staged Approach Including Hartmann's Reversal and Hernia Repair

TL;DR

A staged laparoscopic approach successfully managed a patient's combined parastomal and midline hernias after a Hartmann's procedure.

Contribution

A novel staged laparoscopic surgical strategy for treating combined parastomal and midline incisional hernias with an end colostomy.

Findings

Laparoscopic Hartmann’s reversal and parastomal hernia repair were successfully performed in the first stage.

Midline incisional hernia was repaired using the IPOM plus method ten months later with no recurrence observed.

The staged laparoscopic approach proved effective for managing complex double hernias with an end colostomy.

Abstract

Parastomal hernia (PH) following Hartmann’s procedure is a common late-term complication and is often combined with an incisional hernia (IH). The surgical treatment for double hernias with an end colostomy is complex and challenging. We present a 54-year-old woman with an end colostomy and combined hernias (PH and midline IH) after an emergency Hartmann’s procedure for diverticular perforation of the sigmoid colon underwent staged surgery. First, laparoscopic Hartmann’s reversal (LHR) and PH repair with primary suture were performed. Ten months later, "intraperitoneal onlay mesh repair (IPOM) plus" methods were implemented for IH repair. Both surgeries were successfully conducted using a laparoscopic approach, and no evidence of hernia recurrence has been observed in the 12 months after the second surgery. This case report provides valuable insights into the surgical strategy for double hernias with an end colostomy.

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