Here is the complete op report if you could plese review.
Procedure performed: Exploratory laparotomy, SB resection, take down and reposition of ileostomy, repair of incisional/parastomal hernia and right subclavian triple lumen catheter.
The patien had prior colectomy and terminal ileostomy. He had several prior parastomal hernia repairs. A transverse incision was made overlying the parastomal hernia. The gentleman is morbidly obese and the incision was about 12 inches in a transverse manner, dissected down through the copious subcutaneous tissue, down to the parastomal/incisional hernia. The incision was made about 5 cm below the actual ostomy site and about 2 cm above the previous transverse incision for repair. Once the stomal hernia was entered, several feet of SB loops were noted to be in the hernia. The hernia was huge. The hernia sac was dissected and removed. The bowel loops I attempted to extricate out of the abd into the hernia sac, but only the more proximal dilated obstructed bowel would come through and it became more and more ischemic as it was pinched at the neck. As such, the parastomal incisional hernia fascia was incised medially and opened, cutting across previous mesh. Finally I was able to indentify the point of obstruction and adhesions causing the relative internal hernia and twist. As such, following this we were able to run the bowel and the terminal foot of SB was fairly ischemic and this was excised with the GIA. The remainder of the SB was replaced back into the abd. A new site was chosen and created inferior to the incision with an ellipse of skin for the ostomy and a cruciate incision in the rectus and the new neoterminal ileum was brought through there with Babcock. The stomal incisional hernia was then closed.
