Hospital Appointment

This morning I had my long-awaited hospital appointment to see my specialist colorectal surgeon. I had been promised an appointment before the end of the year, but this was not forthcoming – the whole system in the NHS is in a mess at the moment…

I was becoming increasingly concerned about the state of my parastomal hernia and anxious that it might cause another obstruction, as it did this time last year. This led to an emergency operation performed by a general surgeon who was not qualified to do more than a simple sutured repair of the hernia, and I knew that such repairs had a 100% failure rate. Mine did not even last the year, and my last CT scan in August revealed that the hernia had returned and was “substantial.” When I saw the surgeon before that, he discussed with me various options for repairing it should it become necessary, but nothing was decided at the time as a scan was needed first.

Today, he examined me and said that it was quite large, and he could feel the intestine quite easily. He reassured me that large hernias are less likely to cause obstructions than small ones which tend to be more restricted, and this has set my mind at rest somewhat.

He said the time had definitely come for something to be done about it, and he is going to book me in for an “urgent repair.” This is not emergency surgery, but will presumably take priority over more routine operations. I am hoping it will take place in February rather than March, but we shall have to see what is available.

He described in more detail how he will approach it. As he suggested in the summer, it would be preferable to enter at the stoma site, rather than opening up my whole abdomen yet again – this will be less traumatic for me, and will reduce the risk of causing further adhesions. He will need to enlarge the stoma wound, and also make two horizontal incisions, one on each side, to give him better access, and he will perform a sublay insertion of  biological mesh. Biological mesh (i.e. created from organic material such as pigskin) is generally thought to be superior to synthetic mesh and carries a lower risk of infection, although it is considerably more expensive. The sublay technique means that the mesh will be inserted between the muscle layers of the abdominal wall, as opposed to above all layers (higher rate of recurrence) and underneath all layers (can cause problems being in contact with internal organs).

I found this very interesting article online, which covers all the options for this kind of surgery, and the associated risks of infection, recurrence, etc.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226750/

He said that in view of my M.E. and the weak state of my muscles, he will need to insert quite a large piece of mesh to ensure adequate support.

He warned me that because the aperture in the mesh through which the small intestine will pass in order to form the stoma will be quite tight, initially post-operatively, I will experience some discomfort until the swelling and bruising subsides. I can live with this if it means a secure and long-lasting repair in the long-term.

Also, because he will need to make additional incisions in order to gain better access, management of the stoma post-operatively may be somewhat problematic because I shall still need to attach the bag and the adhesive will be in contact with these wounds. The stoma nurse said that they would be monitoring this while I am in hospital, and will advise me on the most suitable products. The products I currently use will most likely have to be changed afterwards, and it will be like starting again with a new stoma, but at least I now have nearly three years’ experience behind me of how to manage various problems, and the whole idea doesn’t freak me out as much as it did initially!

I am very glad that this decision has now been made, and that we are definitely going ahead with a proper repair. The stoma nurse told me afterwards that my surgeon is very expert in this kind of repair, and I told her that I was very happy to put myself in his hands as he knows me, and my particular needs associated with my M.E. and so on.