Type IV Parastomal Hernia Repair and Simultaneous Colostomy Closure. Case Report

Objective: To describe the repair of a complex parastomal hernia and simultaneous ileostomy closure using abdominal wall prehabilitation. Case report: A 53-year-old male patient with an ileostomy developed a parastomal hernia and a midline incisional hernia following a previous laparotomy. Abdominal wall prehabilitation was performed with botulinum toxin administration and abbreviated pneumoperitoneum. Subsequently, abdominal wall reconstruction and restoration of intestinal transit were performed in a single procedure. Results: The surgery was performed without complications. The patient presented good clinical evolution in the immediate postoperative period and at follow-up. Discussion: The treatment of complex abdominal hernias requiring restoration of intestinal transit represents a challenge. Prehabilitation with botulinum toxin and the use of pneumoperitoneum are useful tools to optimize abdominal closure and facilitate reconstructive surgery. The decision to use combined management should be individualized and carried out by a specialized team to ensure the best results.