PMC7242996_01
CT images of case 1.. a. Preoperative abdominal CT showed herniation of the ileal loop into the subcutaneous space, compatible with parastomal hernia.. b: CT image 2 years after the repair demonstrated no recurrence of parastomal hernia. There was no sign of mesh shrinkage or bowel obstruction.
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Abdominal Computed tomography (CT) showed herniation of the ileal loop into the subcutaneous space, compatible with parastomal hernia (Fig. 1a). The CT images 2 years after the repair demonstrated no recurrence of parastomal hernia, and there was no sign of mesh shrinkage or bowel obstruction (Fig. 1b).
Modified keyhole technique.. a: The hernia orifice was covered by elliptical ePTFE keyhole mesh while the elevated loop was passed through a cut-out hole. The mesh was fixed to the abdominal wall with interrupted 2-0 polypropylene monofilament sutures.. b, c: The elevated intestine was wrapped using a rectangular ePTFE mesh.. d: The wrapping mesh was secured to the keyhole mesh and to the elevated intestine with interrupted 2-0 polypropylene sutures.
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Finally, the cylinder and the bowel loop were fixed with interrupted 2-0 polypropylene (Fig. 2, Fig. 3).
PMC7242996_02
CT images of case 2.. a. Preoperative abdominal CT demonstrated large parastomal hernia with herniation of the small intestine into the subcutaneous space.. b: CT image 1 year after the repair demonstrated no recurrence of parastomal hernia.
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Abdominal CT findings were compatible with parastomal hernia (Fig. 4a). Abdominal CT confirmed no recurrence 1 year after the repair (Fig. 4b), and the patient has been free from hernia recurrence for 5 years.
Intraoperative images of case 2.. The hernia was repaired with modified keyhole technique using 15 x 10 cm elliptical and 12 x 4 cm rectangular ePTFE meshes.
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The hernia was repaired with the modified keyhole technique using 15 x 10 cm elliptical and 12 x 4 cm rectangular ePTFE meshes (Fig. 5).