V-032 INTRAOPERATIVE BLEEDING AFTER SUGARBAKER REPARATION: HOW CAN I SOLVE IT ??

Abstract

Abstract Aims The parastomal hernia represents a controversial item in the wall surgery field, due to the frequency of occurrence in ostomized patients. Sugarbaker Technique constitutes the gold standard for the reparation of this type of hernia. We present the case of a 66-year-old man with a paraostomal hernia. Material We opted for a laparoscopic approach to solve a type III incisional hernia. We found a 6×5cm parastomal hernia, and we performed reduction of the hernial content and section of adhesions, placing a 16×15cm Dynamesh protesis around the defect as the Sugarbaker Technique describes, fixed with Tackers and Cianocrilate. At the end of the intervention, an active bleeding was seen in the hernial wall defect, which does not stop with compression nor with the application of hemostatics. We opened the mesh by cutting it in the middle, exploring the hernia cavity and verifying an active bleeding from an arterial vessel; which was controlled by electrocoagulation. A new Dynamesh protesis was placed on top of the previous one, using the same technique. We ended the intervention. Results The patient was discharged at the second day of the intervention without any complications. Follow-up at the first month, sixth months and one year after the intervention does not evidence any signs of recurrence. Conclusions We have not found any case in the literature of intraoperative bleeding using Sugarbaker technique prior to the ending of the intervention. We think that the described technique can be a useful way to solve this complication when it occurs.