Stoma Relocation Research Articles

Perioperative and extended outcomes of patients undergoing parastomal hernia repair following cystectomy and ileal conduit

PurposeTo report perioperative and long-term postoperative outcomes of cystectomy patients with ileal conduit (IC) urinary diversion undergoing parastomal hernia (PSH) repair.MethodWe reviewed patients who underwent cystectomy and IC diversion between 2003 and 2022 in our center. Baseline variables, including surgical approach of PSH repair and repair technique, were captured. Multivariable Cox regressionanalysis was performed to test for the associations between different variables and PSH recurrence.ResultsThirty-six patients with a median (IQR) age of 79 (73–82) years were included. The median time between cystectomy and PSH repair was 30 (14–49) months. Most PSH repairs (32/36, 89%) were performed electively, while 4 were due to small bowel obstruction. Hernia repairs were performed through open (n=25), robotic (10), and laparoscopic approaches (1). Surgical techniques included direct repair with mesh (20), direct repair without mesh (4), stoma relocation with mesh (5), and stomarelocation without mesh (7). The 90-day complication rate was 28%. In a median follow-up of 24 (7–47) months, 17 patients (47%) had a recurrence. The median time to recurrence was 9 (7–24) months. On multivariable analysis, 90-day complication following PSH repair was associated with an increased risk of recurrence.ConclusionsIn this report of one of the largest series of PSH repair in the Urology literature, 47% of patients had a recurrence following hernia repair with a median follow-up time of 2 years. There was no significant difference in recurrence rates when comparing repair technique or the use of open or minimally invasive approaches.

OC-013 MEDIUM-LONG TERM OUTCOMES OF RETROMUSCULAR PARASTOMAL HERNIA REPAIR WITH PAULI MODIFIED SUGAR BARKER PROCEDURE

Abstract Objective We aim to evaluate the outcomes and stoma complication in parastomal hernia repair (PHR) with Pauli procedure. Material and Methods 18 patients were recruited between 2015–2022 in 2 hospitals. Data were obtained from prospective clinical database. Surgical technique included: posterior component separation (TAR), bowel lateralization according to Pauli modified Sugarbaker and, if necessary, stoma relocation. Quantitative variables are shown as median [interquartile rank] and qualitative as percentage. Results 22.2% patients had recurrent PH with 2 [3] previous repair attempts. 22.2% underwent bilateral TAR and 11.1% required inlay mesh. Panniculectomy was performed in 17,8% of patients and stoma relocation in 44,4%; 17% required intestinal resection and 11,1% bowel suturing. Complications < 30days: 17% had surgical site infection (SSIs), 2 deep SSIs and one required surgical management. 22.2% had clinical seroma, one required percutaneous drainage and other surgical intervention. Postoperative complications were adynamic ileus (22,2%), bowel obstruction (5%) which was managed conservatively and anastomotic leakage (5%). No mortality was observed, and hospital-stay length was 8 [7.25] days. Complications > 30days: 5.5% chronic seroma (grade III), 5.5% PTE and 22.2% bowel obstruction of which one required adhesiolysis and another bowel resection. 27.8% had any stoma-related complication: partial ischemia (5.5%), retraction (11.1%), prolapse (5.5%) and obstruction (5.5%) managed conservatively. One patient required reoperation due to stoma perforation. We found 25% of clinical or radiological recurrence after 24 [20.1] months follow-up. Conclusion This technique provides acceptable recurrence rates of the PH, but is still high, with a non-negligible associated comorbidity.

Surgical treatment of stomal prolapse: A systematic review and meta-analysis of the literature.

This study aimed to assess success, recurrence, and overall complication rates among different surgical procedures for stomal prolapse. This study was a PRISMA-compliant systematic review. PubMed, Scopus, and Google Scholar were searched until March 2022. Studies that assessed surgical treatments of stomal prolapse in adults were included. The primary outcome was recurrence of stomal prolapse and the secondary outcome was 30-day complications. A random-effect meta-analysis was used to estimate the weighted mean rates of recurrence. Six studies published (111 patients; 103 males) were included. 52 (46.8%) patients had end colostomies, 35 (31.5%) had loop colostomies. Seven procedures were assessed and included local stoma reconstruction (40%), stapled local repair (27%), modified Altemeier technique (10%), mesh strip repair (9%), stoma relocation (6%) redo laparotomy repair (5%), and colectomy and end ileostomy (3%). The weighted mean recurrence rate after local stoma reconstruction was 37.2% (95% CI: -1.8 to 76.3), higher than that after the stapled local repair technique (14.9%; 95% CI: 1.7-28.2). The crude recurrence rate of the modified Altemeier technique was 20%, and of stoma relocation was 66.6%. No recurrence was detected after the mesh strip technique (n=10). The median follow-up ranged between 7 months and 2.5 years. Several surgical techniques are available to treat stomal prolapse. Local stoma reconstruction may be associated with high rates of recurrence while the stapled local repair and modified Altemeier procedure has relatively low recurrence. Further larger studies are needed to compare the efficacy of these techniques.

P-084 OPEN PARASTOMAL HERNIA REPAIR: STOMA RELOCATION WITH CST, MODIFIED RIVES SUBLAY MESH TECHNIQUE WITH CST OR MODIFIED SUGARBAKER INTRAPERITONEAL MESH TECHNIQUE WITH CST

Abstract Aim To presents results of various open surgical techniques for parastomal hernia repair. Material and Method Between January 2014 and January 2020, 22 patients with parastomal hernias were treated by three various operative techniques: a) stoma relocation using component separation techniques (CST); b) modified Rives sublay mesh technique with CST; c) modified Sugarbaker intraperitoneal composite mesh repair with or withouth CST. Stoma relocation and CST was performed in two patients, modified Rives sublay technique and CST in 15 patients and modified Sugarbaker technique with or without CST in five patients. Results Hernia recurrence was developed in one of two patients treated by stoma relocation and CST and in two of 15 patients treated by modified Rives sublay mesh technique and CST. In five patients treated by modified Sugarbaker technique no complications occured. Mean follow up was 28 months. Conclusion Modified Rives sublay technique with CST and modified Sugarbaker technique with or withouth CST provide good results in treatment of patients with parastomal hernia.

Mid-term Efficacy of Local Repair Using Modified Altemeier Technique for Stomal Prolapse: A Case Series.

Introduction: Stomal prolapse (SP) is characterized by full-thickness protrusion of the bowel through the stoma site. The surgical procedures for SP include local repair, abdominal wall fixation, and stoma relocation. However, previous reports were mostly case reports or case series with a small number of patients and lacked long-term results. A modified Altemeier technique (MAT) has been used for the local repair of SP in our institution, and this study aimed to evaluate its mid-term efficacy.Methods: We reviewed patients who underwent MAT for SP between August 2013 and December 2020. The variables included patient characteristics, type of stoma, indications of stoma creation, the time interval from stoma creation to prolapse, site of prolapse, reasons for SP surgery, perioperative variables, complications during SP surgery, and length of follow-up. Recurrence of SP was defined as the need for change in stoma care or re-protrusion of the stoma by more than 5 cm in length.Results: Ten patients were included in this study. The median age at the time of SP surgery was 71.5 years. The indications of stoma creation included unresectable or recurrent intra-abdominal malignancies in four patients, diverting ileostomy with rectal cancer surgery in two, transverse colon cancer in one, gastric and rectal cancer in one, rectovaginal fistula in one, and non-occlusive mesenteric ischemia in one. The median interval from stoma creation to prolapse was 2.5 months. Six patients underwent elective SP surgery, and four patients underwent emergency surgery for incarcerated prolapse. The median operative time was 75.5 min. Postoperative complications that included transient mucosal ischemia and subcutaneous abscess occurred in one patient. There were four recurrences (40%), and the median time interval from surgery to recurrence was 4.5 months. Two patients underwent repeated MAT, one of whom underwent stomal reversal with laparotomy for re-recurrence. The median follow-up duration was 19 months.Conclusion: MAT for SP is associated with a high recurrence rate in mid-term follow-up.

Long-term parastomal hernia occurrence rate following Stapled Mesh stomA Reinforcement Technique

PURPOSE: Our initial publication on Stapled Mesh stomA Reinforcement Technique (SMART) for the prevention of parastomal hernias (PSH) demonstrated promising results. The aim of this study is to evaluate the long-term PSH occurrence rate with SMART and its associated complications and to radiologically measure the progression of trephine diameters.MATERIALS AND METHODS: All SMART cases from November 2013 to July 2016 were reviewed. Demographics, peri-operative details, and long-term mesh-related complications were collected. Serial computed tomography (CT) scans during follow-up were used to identify PSH and measure the progression of axial and sagittal trephine diameters and trephine area.RESULTS: 15 patients (M:F = 10:5) underwent an elective stoma formation with SMART. Nine died during the study period. Two patients died before any CT scan with no clinical evidence of PSH. All except one of the remaining 13 patients developed radiological PSH. There were no long-term mesh-related complications. Only one patient required the relocation of stoma due to the incarceration of small bowel in the PSH in an emergency setting. The median follow-up was 28 months (3–77 months).CONCLUSION: Prophylactic mesh placement by SMART did not prevent the occurrence of PSH in the long-term despite only a minority of patients required surgical intervention for PSH.

Parastomal hernia repair with onlay mesh remains a safe and effective approach

BackgroundParastomal hernia (PSH) management poses difficulties due to significant rates of recurrence and morbidity after repair. This study aims to describe a practical approach for PSH, particularly with onlay mesh repair using a lateral peristomal incision.MethodsThis is a retrospective review of consecutive patients who underwent PSH repair between 2001 and 2018.ResultsSeventy-six consecutive PSH with a mean follow-up of 93.1 months were reviewed. Repair was carried out for end colostomy (40%), end ileostomy (25%), ileal conduit (21%), loop colostomy (6.5%) end-loop colostomy (5%) and loop ileostomy (2.5%). The repair was performed either with a lateral peristomal incision (59%) or a midline incision (41%). Polypropylene mesh (86%), biologic mesh (8%) and composite mesh (6%) were used. Stoma relocation was done in 9 patients (12%). Eight patients (11%) developed postoperative wound complications. Recurrence occurred in 16 patients (21%) with a mean time to recurrence at 29.4 months. No significant difference in wound complication and recurrence was observed based on the type of stoma, incision used, type of mesh used, and whether or not the stoma was repaired on the same site or relocated.ConclusionOnlay mesh repair of PSH remains a practical and safe approach and could be an advantageous technique for high-risk patients. It can be performed using a lateral peristomal incision with low morbidity and an acceptable recurrence rate. However, for patients with significant adhesions and very large PSH, a midline approach with stoma relocation may also be considered.

Laparoscopic parastomal hernia repair delays recurrence relative to open repair.

Mesh repair of parastomal hernia is widely accepted as superior to non-mesh repair, yet the most favorable surgical approach is a subject of continued debate. The aim of this study was to compare the clinical outcomes of open versus laparoscopic parastomal hernia repair. An IRB-approved retrospective review was conducted comparing laparoscopic (LPHR) or open (OPHR) parastomal hernia repair performed between 2009 and 2017 at our facilities. Patient demographics, preoperative characteristics, operative details, and clinical outcomes were compared by surgical approach. Subgroup analysis was performed by location of mesh placement. Repair longevity was measured using Kaplan-Meier method and Cox proportional hazards regression. Intention to treat analysis was used for this study based on initial approach to the repair. Sixty-two patients (average age of 61years) underwent repair (31 LPHR, 31 OPHR). Patient age, gender, BMI, ASA Class, and comorbidity status were similar between OPHR and LPHR. Stoma relocation was more common in OPHR (32% vs 7%, p = .022). Open sublay subgroup was similar to LPHR in terms of wound class and relocation. Open "Other" and Sublay subgroups resulted in more wound complications compared to LPHR (70% and 48% vs 27%, p = .036). Operative duration and hospital length of stay were less with LPHR (p < .001). After adjustment for prior hernia repair, risk of recurrence was higher for OPHR (p = .022) and Open Sublay and Other subgroups compared to LPHR (p = .005 and p = .027, respectively). Laparoscopic repair of parastomal hernias is associated with shorter operative duration, decreased length of stay, fewer short-term wound complications, and increased longevity of repair compared to open repairs. Direct comparison of repair longevity between LPHR and OPHR with mesh using Kaplan-Meier estimate is unique to this study. Further study is warranted to better understand methods of parastomal hernia repair associated with fewer complications and increased durability.

Preoperative imaging for colorectal cancer: surgeons' perspective

Preoperative radiological diagnostics in patients with colorectal cancer has several objectives. The diagnostic localization of the colonic tumor is essential for planning the resection. The radiologically suspected infiltration of neighboring structures may lead to the decision for neoadjuvant treatment. In patients with rectal carcinomas, the T and Nstages, the distance to the circumference resection margin (CRM), and the penetration of the tumor into the mesentery must be determined. This crucial to determine whether the patient should undergo neoadjuvant treatment. Prior to the planned relocation of an upstream stoma, radiological diagnostics may be added to clinical and endoscopic assessment but should not be routinely used.

Laparoscopic parastomal hernia repair: A modified technique of mesh placement in Sugarbaker procedure.

Introduction:Conventional surgery for parastomal hernia entails primary suture repair or stoma relocation. Laparoscopic surgery has advantages of less pain, faster post-operative recovery and better cosmesis. While the Sugarbaker technique has been valued for least recurrences, however, it exposes the stomal loop to the parietal surface of the mesh exposing it to complications. We report a modification of mesh placement after primary defect repair to improvise the safety of meshplasty and to minimise mesh erosions into the stomal loop of bowel.Patients and Methods:Patients with permanent stoma presenting with a parastomal bulge leading to difficulty with stoma care or abdominal distention or pain were included in the study. A pre-operative computed tomography scan was performed in all patients to rule out any recurrence of primary pathology for which stoma was created and to study the abdominal musculature and defects.Results:Of 14 patients, 12 patients had end-sigmoid stoma, one had end ileostomy following surgery for ulcerative colitis and one had urinary conduit. The size of the defect varied from 4.5 cm to 6 cm in diameter, and the average duration of surgery was 125 min. Pain assessed on VAS score was higher in the first 12 h, and all were started on orals on the next day, and average hospital stay was 4.2 days. The longest follow-up of 7 years and shortest of 15 months did not reveal any complications as recurrence, seroma, mesh infections or erosions into the stoma.Conclusion:Modified placement of composite mesh is safe and helps in minimising mesh-related complications of the Sugarbaker technique for parastomal hernias.

Reprint of: Parastomal hernia: Surgical management

Parastomal hernia is a common clinical problem that is difficult to manage. Although surgical repair is recommended for the majority of other incisional hernias to prevent the complications of incarceration, obstruction, or strangulation, most authors recommend nonoperative management of parastomal hernias. Surgical management is usually reserved for those patients whose parastomal hernia results in intractable difficulty maintaining an effective stoma appliance or who develop a severe complication. This article reviews the nonoperative and operative management of parastomal hernias by fascial repair and stomal relocation. Unfortunately, no randomized trials exist to guide the surgeon in the choice between the accepted nonoperative and surgical management options. Fascial repair without a prosthetic should probably be used only in the rarest of circumstances. If stoma relocation is selected, the stoma should be relocated to the opposite side of the abdominal wall and reconstructed using techniques associated with the lowest risk of stoma-related complications and parastomal hernia. However, the best outcomes may require the use of a prosthetic either to either repair or prevent a parastomal hernia.

Surgical Management of Parastomal Hernias.

Parastomal hernias are a common complication after ostomy formation that can require surgical repair when they become symptomatic. Operative planning and a thorough understanding of the anatomy of the abdominal wall are important. Simple fascial repair is associated with an unacceptably high recurrence rate and should be used as a temporary measure only. Stoma relocation has a high recurrence rate. Prophylactic mesh can and should be used. At this time, the use of mesh is considered the standard of care in the repair of parastomal hernias.

Parastomal Hernia Repair with a 3D Funnel Intraperitoneal Mesh Device and Same‐Sided Stoma Relocation: Results of 56 Cases

Parastomal hernias (PSHs) are a common and challenging issue. In previous studies, three-dimensional (3D) funnel mesh devices have been used successfully for the repair of PSHs. We performed an analysis of prospectively collected data of patients who underwent a same-sided stoma reposition with 3D funnel-shaped mesh augmentation in intraperitoneal (IPOM) position at our department between the years of 2012 and 2015. Primary outcome parameters were intra- and postoperative surgical complications and recurrence rate during the follow-up period. Fifty-six patients could be included in this analysis. PSH repair was performed in 89.3% as elective surgery and in 73% in laparoscopic technique. A concomitant incisional hernia (EHS type 2 and 4) was found in 50% and repaired in a single-step procedure with PSH. Major postoperative complications requiring redo surgery (Clavien-Dindo ≥3b) were identified in 8.9% (5/56). Overall recurrence rate was 12.5% (7/56). Median follow-up time was 38months, and a 1-year follow-up rate of 96.4% was reached. PSH repair with 3D funnel mesh in IPOM technique is safe, efficient and easy to perform in laparoscopic and open surgical approaches providing advantageous results compared to other techniques. Furthermore, simultaneous detection and treatment of concomitant incisional hernias has shown favorable. However, the mesh funnel distends and becomes shortened encasing a bulky bowel mesentery and further shrinkage happens eccentric. Changing mesh construction according to lengthening the funnel could possibly lead to reduction in recurrence.

Parastomal hernias after radical cystectomy and ileal conduit diversion.

Parastomal hernia, defined as an "incisional hernia related to an abdominal wall stoma", is a frequent complication after conduit urinary diversion that can negatively impact quality of life and present a clinically significant problem for many patients. Parastomal hernia (PH) rates may be as high as 65% and while many patients are asymptomatic, in some series up to 30% of patients require surgical intervention due to pain, leakage, ostomy appliance problems, urinary obstruction, and rarely bowel obstruction or strangulation. Local tissue repair, stoma relocation, and mesh repairs have been performed to correct PH, however, long-term results have been disappointing with recurrence rates of 30%–76% reported after these techniques. Due to high recurrence rates and the potential morbidity of PH repair, efforts have been made to prevent PH development at the time of the initial surgery. Randomized trials of circumstomal prophylactic mesh placement at the time of colostomy and ileostomy stoma formation have shown significant reductions in PH rates with acceptably low complication profiles. We have placed prophylactic mesh at the time of ileal conduit creation in patients at high risk for PH development and found it to be safe and effective in reducing the PH rates over the short-term. In this review, we describe the clinical and radiographic definitions of PH, the clinical impact and risk factors associated with its development, and the use of prophylactic mesh placement for patients undergoing ileal conduit urinary diversion with the intent of reducing PH rates.

New minimally invasive technique of parastomal hernia repair - methods and review.

IntroductionParastomal hernia is described as the most common complication in patients with ostomy. It is reported that its incidence varies from 3% to 39% for colostomies and 0 to 6% for ileostomies. Surgical repair remains the treatment of choice. There are three types of surgical treatment – fascial repair, stoma relocation and repair using prosthetic mesh via a laparoscopic or open approach. Recently there have been several meta-analyses and systematic reviews aiming to compare the results of surgical treatment, and the authors agreed that the quality of evidence precludes firm conclusions.AimTo describe the novel concept of parastomal hernia repair – HyPER/SPHR technique (hybrid parastomal endoscopic re-do/Szczepkowski parastomal hernia repair) and its early results in 12 consecutive cases.Material and methodsTwelve consecutive patients were operated on due to parastomal hernia using the new HyPER hybrid technique between June 2013 and May 2014. The patients’ condition was evaluated during the perioperative period, 6 weeks and then every 3 months after surgery.ResultsAfter 6 weeks of follow-up we have not observed any mesh-related complications. All 12 patients were examined 3 months and 6 months after repair surgery for evaluation. No recurrence, stoma site infection or stoma-related problems were found. None of the patients complained of pain and none of them needed to be hospitalized again. Reported quality of life on a 0–10 scale after 6 weeks of follow-up was 8 (range: 7–10).ConclusionsThe HyPER procedure for treatment of parastomal hernias proposed by the authors is a safe and feasible surgical technique with a high patient satisfaction rate and a low number of complications. The hybrid procedure seems to be a promising method for parastomal hernia repair.

Single-Center Experience With Parastomal Hernia Repair Using Retromuscular Mesh Placement

BackgroundParastomal hernias (PHs) are frequent complications of enterostomies. We aimed to evaluate our outcomes of open PH repair with retromuscular mesh reinforcement. MethodsFrom 2006 to 2013, 48 parastomal hernias were repaired in 46 consecutive patients undergoing open retromuscular repair. Surgical technique included stoma relocation, retromuscular dissection, posterior component separation, and retromuscular mesh placement. All stomas were prophylactically reinforced with cruciate incisions through mesh. Main outcome measures included demographics, perioperative details, wound complications (classified according to the CDC guidelines), and recurrences. ResultsThere were 24 male and 22 female patients with a mean age of 61.8 and body mass index (BMI) of 31.7 kg/m2. Twenty-four patients had recurrent PH with an average of 3.8 prior repairs. Ostomies included 18 colostomies, 20 ileostomies, and 10 ileal conduits. Thirty-two patients had a concurrent repair of a midline incisional hernia. All patients underwent mesh repair with either biologic (n = 29), lightweight polypropylene (n = 15), or absorbable synthetic mesh (n = 2). There were 15 superficial surgical site infections (SSIs) and 6 deep SSIs. There was one case of an ischemic ostomy requiring surgical revision. No mesh grafts required removal and there were no mesh erosions. At a mean follow-up time of 13 months, five patients (11 %) developed a recurrence; three patients required re-repair. ConclusionIn this largest series of complex open repairs with retromuscular mesh reinforcement and stoma relocation, we demonstrate that this results in an effective repair. This technique should be considered for complex parastomal hernia repair.

Systematic review of open techniques for parastomal hernia repair

Parastomal hernia formation is common following formation of an abdominal stoma, with the risk of subsequent incarceration, obstruction and strangulation. Current treatment options include non-operative management, stoma relocation and fascial repair with or without mesh. The purpose of this systematic review was to evaluate the effectiveness and safety of open mesh repair of a parastomal hernia and to compare open non-mesh fascial repair with mesh techniques of parastomal hernia repair. Electronic databases were searched for studies comparing the two surgical techniques in accordance with preferred reporting items for systematic reviews and meta-analyses. The primary outcome of the study was the comparison of recurrence rates of parastomal hernia for each technique. Secondary outcomes included comparison of mortality, wound infection, mesh infection and any other complication. Twenty-seven studies of parastomal hernia repair were included and divided into two subgroups for open mesh repair and non-mesh fascial repair. Non-mesh fascial repair resulted in a high recurrence rate (around 50%). Reported recurrence rates for mesh repair were substantially lower, at 7.9-14.8%, depending on the position of the mesh in relation to the abdominal fascia and the length of follow-up. Morbidity and mortality did not differ significantly between the techniques used to repair a parastomal hernia. This study shows that mesh repair of a parastomal hernia is safe and significantly reduces the rate of recurrence compared with sutured repair, which should only be used in exceptional circumstances. There is insufficient evidence to determine which mesh technique (onlay, sublay or underlay) is most successful in terms of recurrence rates and morbidity.

Single-port parastomal hernia repair by using 3-D textile implants.

Background:Parastomal hernias (PSHs) are a frequent complication and remain a surgical challenge. We present a new option for single-port PSH repair with equilateral stoma relocation using preshaped, prosthetic 3-dimensional implants and flat mesh insertion in intraperitoneal onlay placement for additional augmentation of the abdominal wall.Methods:We describe our novel technique in detail and performed an analysis of prospectively collected data from patients who underwent single-port PSH repair, focusing on feasibility, conversions, and complications.Results:From September 2013 to January 2014, 9 patients with symptomatic PSHs were included. Two conversions to reduced-port laparoscopy using a second 3-mm trocar were required because of difficult adhesiolysis, dissection, and reduction of the hernia sac content. No major intra- or postoperative complications or reoperations were encountered. One patient incurred a peristomal wound healing defect that could be treated conservatively.Conclusion:We found that single-port PSH repair using preshaped, elastic 3-dimensional devices and additional flat mesh repair of the abdominal wall is feasible, safe, and beneficial, relating to optimal coverage of unstable stoma edges with wide overlap to all sides and simultaneous augmentation of the midline in the IPOM technique. The stoma relocation enables prolapse treatment and prevention. The features of a modular and rotatable multichannel port system offer benefits in clear dissection ongoing from a single port. Long-term follow-up data on an adequate number of patients are awaited to examine efficacy.

Minimally invasive treatment of peristomal metastases from gastric cancer at an ileostomy site by electrochemotherapy

BackgroundPeristomal metastases are rare, but potentially associated with relevant morbidity. Surgical resection, followed by stoma relocation, represent the gold standard in most patients. We describe electrochemotherapy (ECT), a minimally invasive method for locally-enhancing drug delivery by means of electric pulses, as an alternative approach.Patient and methodsA 49-year-old man with advanced gastric cancer developed skin metastases around an ileostomy site. The ulcerated and oozing tumor growth impaired patient’s quality of life due to continuous trouble in fitting the ostomy appliance, its poor adherence and consequent stools spillage. ECT consisted of a 20-minute course under mild general sedation. A bleomycin bolus of 15 000 IU/m2 was followed by the percutaneous application of multiple, 1.5 ms -long electric pulses by means of a needle electrode.ResultsPost ECT course was uneventful and the patient was discharged on the same day. After one week, tumor nodules were flattened and partial tumor regression was appreciable at one-month follow-up. More importantly, peristomal skin conditions significantly improved, thus allowing for an effective application of the ostomy appliance during the following moths, until patient’s death.ConclusionsThis report suggests the feasibility of ECT as a minimally invasive approach for peristomal tumors. In selected cases, ECT, by achieving a rapid tumor control, may ensure effective ostomy management and preserve patients’ quality of life.

逆行性経静脈的塞栓術とストーマ再造設を施行した回腸ストーマ静脈瘤の1例

症例は73歳女性．41歳時直腸癌に対し腹会陰式直腸切断術，57歳時多発結腸癌に対し結腸全摘術および回腸人工肛門造設術の既往あり．また合併症としてC型肝炎を認めた．68歳時より回腸ストーマ周囲より出血を繰り返すようになった．72歳時出血の量および頻度ともに悪化傾向を認め，腹部造影CT検査で回腸ストーマ周囲に静脈瘤の形成を認めた．逆行性経静脈的塞栓術を施行したが，1年後に再出血をきたしたためストーマ再造設を施行した．現在軽度の出血を繰り返すが，保存的に軽快するため経過観察中である．門脈圧亢進症の原因として，ウイルス性肝炎が多い本邦においては，肝予備能および生命予後の点から過大侵襲を避けた治療選択が重要である．