Khitaryan Alexander, Miziev Ismail, Mezhunts Arut, Veliev Camil, Zavgorodnyaya Raisa, Orekhov Alexey, Kislyakov Vasily, Golovina Anastasiya
Private Healthcare Institution Clinical Hospital "RGD-Medicine", Varfolomeeva Street 92, Rostov-on-Don, Russian Federation; FSBEI HE Rostov State Medical University of the Ministry of Health of the Russian Federation, Nakhichevansky Lane 19, Rostov-on-Don, Russian Federation.
FSBEI HE Kabardino-Balkarian State University named after Berbekov H.M., Chernyshevskiy Street 173, Nalchik, Russian Federation.
Int J Surg Case Rep. 2020;71:360-363. doi: 10.1016/j.ijscr.2020.05.024. Epub 2020 May 21.
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.
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 5 postoperative day. After 12 months the patient lost 42 kg, BMI = 28.3 kg/m, had a complete remission of diabetes, and no signs of parastomal hernia.
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.
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.
由于造口旁疝的复发率高达5%至50%，其治疗仍是结直肠外科和普通外科中最受关注的问题之一。超重人群数量的增加导致至少25%的造口旁疝患者肥胖且伴有严重的并发疾病。
一名69岁女性，患有12×15厘米的造口旁疝、3级肥胖和2型糖尿病，同时接受了腹腔镜腹腔内补片修补术（IPOM）疝修补术和Roux-en-Y胃旁路手术。患者术后第5天出院。12个月后，患者体重减轻了42千克，体重指数（BMI）=28.3千克/平方米，糖尿病完全缓解，且无造口旁疝迹象。
有症状的造口旁疝，伴有疼痛、嵌顿发作、通过造口的肠内容物排空障碍和皮炎，需要手术干预。减肥手术与同时进行的疝修补术相结合是各自指南中批准的标准干预措施。同时，在结直肠手术后发生造口旁疝的情况下，遇到严重粘连过程的风险可能会使腹腔镜手术复杂化。对于患有2型糖尿病的肥胖患者，建议进行其中一种旁路干预。
同时进行减肥手术和疝修补术可使患者减轻超过70%的多余体重，降低疝复发风险，并显著降低合并症。这种手术方法在经过严格挑选的患者中是安全的，他们可能会从中受益匪浅。
