44346 Revision of colostomy; with repair of paracolostomy hernia (separate procedure)

Name of the Procedure:

Revision of Colostomy with Repair of Paracolostomy Hernia
Common name(s): Colostomy revision, Paracolostomy hernia repair
Technical term: Colostomy revision with hernia repair

Summary

Colostomy revision with repair of paracolostomy hernia is a surgical procedure aimed at correcting issues with a patient's existing colostomy and addressing any hernias that have developed around the stoma site. A colostomy is an opening created in the abdomen to divert the colon's contents. Over time, herniation near the stoma can occur, necessitating surgical intervention to restore function and comfort.

Purpose

This procedure addresses complications arising from a prior colostomy, such as a paracolostomy hernia. The goal is to repair the hernia, preventing further discomfort or complications, and to revise the colostomy to ensure it functions properly.

Indications

• Presence of a paracolostomy hernia, indicated by a bulge or lump near the stoma site.
• Stoma prolapse or retraction.
• Skin irritation or infection around the stoma.
• Leakage or malfunctioning of the existing colostomy.

Preparation

• Fasting for 8-12 hours prior to the procedure.
• Adjustments to current medications, as advised by the physician.
• Preoperative diagnostic tests, such as imaging studies (CT scans or ultrasounds) and blood tests.
• Bowel preparation might be required, including enemas or oral laxatives.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A surgical incision is made near the colostomy site.
3. Hernia Repair: The hernia is identified, and any protruding bowel is repositioned. The weakened area is reinforced, often using a mesh.
4. Colostomy Revision: The existing stoma may be relocated or reshaped, and the bowel is reattached at the new or revised site.
5. Closure: The surgical site is closed with sutures or staples, and a new stoma appliance is fitted.

Duration

The procedure typically takes 2-4 hours to complete, depending on the complexity.

Setting

This surgery is usually performed in a hospital's surgical suite.

Personnel

• Colorectal surgeon or general surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Adhesion or scar tissue development
• Recurrence of the hernia
• Bowel obstruction
• Anesthetic complications

Benefits

• Relief from pain and discomfort associated with the hernia.
• Improved stoma function and digestive health.
• Reduction in complications such as skin irritation and infection.

Recovery

• Hospital stay may last several days post-procedure.
• Pain management with prescribed medications.
• Instructions on stoma care and wound care.
• Gradual return to normal activities, typically within 4-6 weeks.
• Follow-up appointments to monitor healing and stoma function.

Alternatives

• Non-surgical management of the hernia, such as using a hernia belt or support garment.
• Alternative surgical techniques, like laparoscopic repair.
• Stoma relocation to an entirely new site on the abdomen.

Patient Experience

• The patient will be under general anesthesia and unaware during the procedure.
• Postoperative pain and discomfort are common, managed with medications.
• Fatigue and limited activity during the initial recovery phase.
• Emotional and physical support for adjusting to the revised stoma is crucial.