Oc-085 Approach and Surgical Repair of Recurrent Complex Parastomal Hernia in an Advanced Abdominal Wall Unit

Abstract

Aim We present a case of a recurrent parastomal hernia with enterocutaneous fistula and subcutaneous abscesses and their management. Material & Methods 79-year-old patient with history of pT4b low rectal cancer treated with an abdominoperineal resection with adjuvant chemo-radiotherapy in 2000. Parastomal hernia repair was performed in 2016 with PTFEe mesh according to the Sugarbaker technique and closing midline with double-sided inlay mesh. A plastic peritonitis was found at this moment In July 2021 presented episodes of fever with spontaneous parastomal purulent drainage, deciding initially conservative treatment. Due to persistence of soft tissue infection local surgical drainage was performed in September 2021, removing previous parastomal PTFEe mesh. The patient presented multiple infectious relapses from January to March 2022, debridement was carried out combined with negative pressure therapy. During follow-up intestinal fluid was seen through the negative therapy what put on show an enterocutaneous fistula. Finally, we decided radical surgery in May 2022 performing an in-block resection of end colostomy, 30 cm of ileum and abdominal wall area affected of chronic infection and previous meshes. A 20×20cm defect was left. Reconstruction with double-sided inlay mesh and new colostomy in the right iliac fossa was performed. Skin closure required cutaneous plastia. Conclusions The use of suitable prosthetic material for the repair of parastomal hernia doesn't exclude the developing of severe complications. An early and decisive surgical approach is recommended in cases of chronic prosthetic material infection to avoid redundant and non-cost-effective treatments.