International journal of surgery case reports · 2020
Roux-en-Y gastric bypass and parastomal hernia repair: case report of concurrent operation in comorbid patient.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Khitaryan Alexander, Miziev Ismail, Mezhunts Arut, Veliev Camil, Zavgorodnyaya Raisa, Orekhov Alexey, Kislyakov Vasily, Golovina Anastasiya
Аннотация
INTRODUCTION: The treatment of parastomal hernias remains one of the most relevant issues in coloproctology and general surgery due to its high recurrence rate of 5 to 50%. An increase in the number of overweight people has led to the fact that at least 25% of patients with parastomal hernias are obese and have severe concurrent disorders.
PRESENTATION OF CASE: A 69-years old woman with 12 × 15 cm parastomal hernia, grade 3 obesity and type 2 diabetes mellitus underwent concurrent laparoscopic IPOM hernia repair and Roux-en-Y gastric bypass. The patient was discharged on the 5th postoperative day. After 12 months the patient lost 42 kg, BMI = 28.3 kg/m2, had a complete remission of diabetes, and no signs of parastomal hernia.
DISCUSSION: Symptomatic parastomal hernias, accompanied by pain, episodes of incarceration, impaired evacuation of intestinal contents through the ostomy, and dermatitis require surgical intervention. The combination of bariatric surgery and simultaneous hernioplasty is a standard intervention approved in the respective guidelines. At the same time, in the case of parastomal hernias after colorectal operations, the risk of encountering a serious adhesion process can complicate laparoscopic surgery. In obese patients with type 2 diabetes mellitus, it is recommended to perform one of the bypass interventions.
CONCLUSION: Concurrent bariatric surgery and hernia repair allow the patient to lose more than 70% of excess body weight, reduce the risk of hernia recurrence, and significantly reduce comorbidity. This surgical approach is safe in thoroughly selected patients, who might greatly benefit from it.
PRESENTATION OF CASE: A 69-years old woman with 12 × 15 cm parastomal hernia, grade 3 obesity and type 2 diabetes mellitus underwent concurrent laparoscopic IPOM hernia repair and Roux-en-Y gastric bypass. The patient was discharged on the 5th postoperative day. After 12 months the patient lost 42 kg, BMI = 28.3 kg/m2, had a complete remission of diabetes, and no signs of parastomal hernia.
DISCUSSION: Symptomatic parastomal hernias, accompanied by pain, episodes of incarceration, impaired evacuation of intestinal contents through the ostomy, and dermatitis require surgical intervention. The combination of bariatric surgery and simultaneous hernioplasty is a standard intervention approved in the respective guidelines. At the same time, in the case of parastomal hernias after colorectal operations, the risk of encountering a serious adhesion process can complicate laparoscopic surgery. In obese patients with type 2 diabetes mellitus, it is recommended to perform one of the bypass interventions.
CONCLUSION: Concurrent bariatric surgery and hernia repair allow the patient to lose more than 70% of excess body weight, reduce the risk of hernia recurrence, and significantly reduce comorbidity. This surgical approach is safe in thoroughly selected patients, who might greatly benefit from it.