Sigmoid carcinoma and recurrent inguinal hernia - Forum

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surgery

Sigmoid carcinoma and recurrent inguinal hernia - Ärzteforum

Post#1 »

Let me present you a 68 y/o male patient with sigmoid carcinoma. He also has a leftsided recurrent inguinal hernia (Shouldice repair).

What to do?
1. sigmoid resection and herniorrhaphy at the same date?
2. sigmoid resection, (endoscopic) herniorrhaphy at a later date?
3. laparoscopic sigmoid resection in combination with laparoscopic hernioplasty?


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A Doctor

Re: Sigmoid carcinoma and recurrent inguinal hernia - Ärzteforum

Post#2 »

Is the hernia symptomatic? If not, do later under local anaesthesia with mesh, or never if ca is advanced. If it is a saccular defect, with more likliehood to incarcerate postop, reduce it preperitoneally and cobble the transverus/transversalis to effect a temporary repair. If it is large and bulging, asymptomatic, then it will be less likely to incarcerate postop. Finally, the best news this pt could have would be for the OR nurse to tell you the f--ing laparoscope was broken the day of surgery.

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Doctor Green

Re: Sigmoid carcinoma and recurrent inguinal hernia - Ärzteforum

Post#3 »

> What to do?
> 1. sigmoid resection and herniorrhaphy at the same date?

This will be my choice. Start with the "clean" part - hernia- close the wound and go on to the sigmoid. You could do the repair preperitoneally if you wish.

> 2. sigmoid resection, (endoscopic) herniorrhaphy at a later date?
> 3. laparoscopic sigmoid resection in combination with laparoscopic hernioplasty?

I do not do laparoscopic colonic surgery. Do you?

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StSt

Re: Sigmoid carcinoma and recurrent inguinal hernia - Ärzteforum

Post#4 »

Excellent advice but I would do it the opposite way, that is colon resection first, then hernia, following my maxim which is to do the essential parts of the operation first and leave the more discretionary parts for last.

canadian

Re: Sigmoid carcinoma and recurrent inguinal hernia - Ärzteforum

Post#5 »

Excellent advice but... after doing the colon you must chage the instruments. re-scrub, change drapes (now you spent 1000 $ extra) and you still may get a few bugs to infect your hernia.

Sigmoidectomy is not a big operation- not for you anyway as just a few hours ago you told us how fast you are; so perhaps it is a good idea to re-consider your maxim ?

Remember AAA surgery and a gallbladder? First the AAA- then re-peritonelaize the graft- then the GB.

I hope that the recent storms in the midwest do not affect your well being.

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Loit

Re: Sigmoid carcinoma and recurrent inguinal hernia - Ärzteforum

Post#6 »

Because it's a recurrent hernia I would do some form of mesh repair. Take care of his sigmoid Ca and do a mesh repair under local later (better results for a recurrent hernia). I wouldn't mesh repair his hernia before/during colectomy. I don't think doing a "clean" operation following a "contaminated" one is a good idea surgeon, surgeon pointed out the relevant factors.

Poland

Re: Sigmoid carcinoma and recurrent inguinal hernia - Ärzteforum

Post#7 »

We have done only two sigmoid resections laparoscopically so far, but only in benign disease.

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