Repair of Giant Parastomal Hernia with Loss of Domain by Total Colectomy: A Case Report

TL;DR

A 50-year-old man with a large parastomal hernia underwent successful surgery using bowel resection to reduce hernia volume and improve quality of life.

Contribution

Bowel resection as a novel approach for repairing giant parastomal hernias with loss of domain.

Findings

Total colectomy and stoma reconstruction reduced hernia volume and improved stoma management.

Fascia lata graft successfully closed the hernia orifice without postoperative complications.

Six months post-surgery, the patient had a small hernia and improved quality of life.

Abstract

Parastomal hernias with loss of domain are those in which it is difficult to return the hernia contents to the abdominal cavity and close the hernia orifice using standard mesh repair methods. We encountered a case in which abdominal wall closure was achieved safely by reducing the hernia content through bowel resection.

The patient, a 50-year-old man, had a history of ulcerative colitis with a complex anal fistula, resulting in construction of a stoma with double orifices using the sigmoid colon. He presented requesting surgery because his parastomal hernia had increased greatly in size, and stoma management became difficult. Abdominal CT showed a large hernia with an incisional hernia volume to peritoneal volume ratio >80%. Total colectomy was performed, and a stoma was reconstructed at another site. The hernia orifice was closed using a fascia lata graft. No postoperative abdominal compartment syndrome was observed. Six months later, abdominal CT showed a small hernia of the abdominal wall; however, the stoma was easily managed, and the patient’s quality of life improved.

Bowel resection for volume reduction may be an effective option for the repair of incisional hernias with loss of domain.

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