Complex Incisional Hernia and Stoma Reversal: Synchronous or Two-Stage Approach

Abstract Background Parastomal hernia (PH) is a common complication post stoma creation, often coexisting with incisional hernias. Stoma closure is the primary treatment for PH, with options including simultaneous repair (stoma closure and abdominal wall reconstruction – AWR) or a deferred two-stage approach. The optimal approach remains undetermined. The study aimed to assess outcomes following AWR and stoma closure in both simultaneous and deferred approaches, focusing on complications and hernia recurrence. Method Four cases were presented, with two undergoing one-stage treatment and the others with a deferred approach. Results In the one-stage approach, patients aged 58 and 78 with a history of Hartman's operation developed Type IV PH. Both received botulinum toxin type A (BTA), and one had progressive pneumoperitoneum. The deferred approach involved patients aged 45 and 46. One, with a colostomy post-traumatic severe pancreatitis, developed an incisional midline complex hernia. The other had an ileostomy post-intestinal occlusion for endometriosis. Both received BTA, and AWR was deferred due to intraoperative technical difficulties. Negative pressure therapy with mesh-mediated traction served as a bridging technique for one patient. Both were reoperated after 6 days, with one using intraoperative dynamic fascial traction. No short-term complications or recurrence were observed. Conclusion The decision to simultaneously treat the abdominal wall with stoma closure should consider the patient's functional capacity. Surgeons should prioritize patient selection, preoperative preparation, and maintain a low threshold to defer AWR, thereby avoiding complications associated with extensive operations.