Laparoscopic Sugarbaker Repair of Parastomal Hernia with Gastric Incarceration: A Case Report and Review of the Literature.

Abstract

<h4>Introduction</h4>Parastomal hernia is a common complication of stoma creation; however, gastric involvement is extremely rare, with only approximately 2 dozen cases reported. Gastric incarceration in a parastomal hernia can cause severe complications, including gastric outlet obstruction and ischemia, and requires timely surgical management.<h4>Case presentation</h4>We describe the case of a 57-year-old obese female who underwent transverse colostomy for ischemic colitis and presented with upper abdominal pain and vomiting. She had a history of Buerger's disease, bilateral lower limb amputation, central adrenal insufficiency, and recurrent colonic stoma prolapse requiring colonic resections. CT revealed gastric outlet obstruction due to stomach incarceration within the parastomal hernia sac. After stabilization of her general condition and nasogastric decompression, she underwent laparoscopic repair 18 days after admission. Intraoperatively, the stomach was incarcerated by traction on the gastrocolic ligament. The gastrocolic ligament was divided, and the stomach was dissected from the mesocolon to maintain a safe distance from the stoma and prevent further traction by the colon. The hernia defect was closed using barbed sutures, followed by laparoscopic Sugarbaker repair with mesh placement. Her postoperative course was uneventful, and no recurrence was observed at 10 months of follow-up.<h4>Conclusions</h4>We present a rare case of parastomal hernia with gastric incarceration that was successfully managed using laparoscopic Sugarbaker repair. Sufficient gastric mobilization, including division of the gastrocolic ligament and dissection from the mesocolon, is essential to ensure mesh coverage of the hernia defect and minimize recurrence risk.