2016 Volume 7 Issue 1 Pages 21-25
A 69-year-old man presented to us with a large peristomal bulge. He had undergone laparoscopic abdominoperineal resection with D3 dissection and sigmoid colostomy for lower rectal cancer and 14 months later began to notice a bulge in the stoma area. Because of an absence of specific symptoms, continued follow-up was decided upon. However, within 9 months, the bulge had grown so large that it had become difficult for the patient to secure the stoma bag in place, so surgery was performed. Abdominal computed tomography revealed the sigmoid colostomy as well as a hernial sac into which intra-abdominal fatty tissue had prolapsed. The sac was cranial to the lifted bowel. Laparoscopic repair was performed. Exploration of the abdominal cavity showed adherence of the greater omentum, sigmoid mesocolon, and fatty appendages to the abdominal wall around the lifted bowel. Upon adhesiolysis, a 3×3-cm hernial orifice cranial to the lifted sigmoid colon was seen. The orifice was closed with three sutures of 2–0 absorbable material and repaired with two different Parietex Parastomal meshes (keyhole style and central band style meshes). The two meshes were fixed so that they overlapped each other. Three cicatricial hernias observed along the midline of the lower abdomen were simultaneously repaired. The operation time was 170 minutes, and the blood loss volume was small. The postoperative course was uneventful. The patient began oral intake on postoperative day 1 and was discharged on postoperative day 4. One year and 6 months have passed since the surgery, and there is no evidence of recurrence. The laparoscopic two-mesh repair is described in detail along with a review of the literature.
