A new anterior approach to parastomal hernia repair (PHR) with linear stapler suture: A case report.

INTRODUCTION: Parastomal hernia is a type of incisional hernia occurring in abdominal integuments in the vicinity of a stoma. The best surgical approach for PSH remains controversial. Most studies report short follow-up time after surgery and a low number of cases to allow conclusions. Actually, we don't have a relevant recommendation about an optimal surgical technique or the most effective mesh for PSH repair. PRESENTATION OF THE CASE: Once packaged the latero-lateral mechanical anastomosis to restore the continuity of the intestinal tract of the patient, an adequate disinfection of trough of the stoma was done. The lateral and medial margins of the defect are then transposed towards each other and kept side by side with a gripper; a 60 mm tristaple linear stapler was placed, incorporating both edges and the charge is fired to obtain a perfect synthesis of the retromuscular plane. DISCUSSION: In the literature has been described several surgical techniques for its repair: suture repair, relocation, mesh-based technique with open or laparoscopic approach. Both, the simple corrective surgery of Thorlakson in 1965 and the use of the peritoneomuscular flap for closing the defect, suggested by Bewes, led to high incidence of recurrence. An important reduction in the rate of parastomal hernia derives also from the mesh reinforcement of the stoma trephine. CONCLUSION: The authors suggest that this technique should be help the surgeons to repair parastomal hernia in patients with multiple risk factors to develop a recurrence of parastomal hernia.

An unusual case of bowel obstruction in emergency surgery: The heterotopic mesenteric ossification.

The heterotopic mesenteric ossification, also known as myositis ossificans, is a rare form of heterotopic ossification, a metaplastic phenomenon where new bone is formed in the mesenteric base, generally after abdominal trauma (surgical or other). The pathophysiology of heterotopic mesenteric ossification is unknown; clinical presentation is not specific, with vague abdominal symptoms, uncertain radiological findings, and often regular laboratory exams. No consensus exists on the best possible approach, although it might well be both medical and surgical. We reviewed the clinical history of a 28-year-old man with a recent motor vehicle accident who was admitted to our surgical unit with symptoms consistent with a small bowel obstruction; after surgery, a diagnosis of myositis ossificans was surprisingly made.