EP480 - Botulinum Toxin Injection and Progressive Pneumoperitoneum Followed by Single-Stage Stoma Closure and Repair of Parastomal Hernia: A Case Report

Sunday, May 11, 2025

2:35 PM – 2:40 PM PT

Location: Monitor 2, Sails Pavilion, Upper Level

ePoster Presenter(s)

Ma. Ina Felicia B. Gutierrez

Fellow in Training
Quirino Memorial Medical Center
Makati City, National Capital Region, Philippines

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

MD

Mohammad Sadeq Disomangcop, n/a

Fellow in Training
Quirino Memorial Medical Center
Marawi City, Lanao del Sur, Philippines

Disclosure information not submitted.
JR

Jose Fernando Ricardo, n/a

Fellow in Training
Quirino Memorial Medical Center
Tuguegarao, Cagayan, Philippines

Disclosure information not submitted.
KY

Kenneth Yabut, n/a

Fellowship Training Officer
Quirino Memorial Medical Center
Quezon City, National Capital Region, Philippines

Disclosure information not submitted.
RA

Ryan Rainiel Abary, n/a

Chief of Section in Colorectal Surgery
Quirino Memorial Medical Center
Quezon City, National Capital Region, Philippines

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Ma. Ina Felicia B. Gutierrez, n/a: This individual has no financial relationships with ineligible companies.

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Purpose/Background: Large parastomal hernias with loss of domain are a significant surgical challenge, and stoma closure with abdominal wall repair is an option to its management. Preoperative optimization techniques such as botulinum toxin injection and progressive pneumoperitoneum have shown promise in facilitating repair of complex abdominal wall hernias, however, these are not routinely done.

Methods/Interventions: We present the case of a 42-year-old Filipino male with a large parastomal hernia (European Hernia Society Type 3) that developed 4 years after laparoscopic right hemicolectomy with ileocolostomy for gastrointestinal tuberculosis. CT scan revealed a parastomal hernia with loss of domain equal to 19.14% at the right anterolateral abdomen, with an abdominal wall defect measuring 7.1 x 6.7cm. The patient underwent botulinum toxin A injection on bilateral trilaminar muscles, followed by progressive pneumoperitoneum after three weeks. Subsequently, single-stage stoma closure and mesh hernia repair was performed.

Results/Outcomes: The patient tolerated the procedure well and was discharged after 4 days without complications.

Conclusion/Discussion: This case demonstrates the successful use of preoperative optimization techniques followed by a single-stage approach for stoma closure and parastomal hernia repair. This technique may help overcome technical complexities associated with large parastomal hernias, potentially reducing postoperative complications and improving outcomes. Further studies are needed to establish the long-term efficacy and safety of this approach in managing complex parastomal hernias.