Introduction
Permanent colostomy is necessitated in a variety of traumatic, inflammatory, neurologic and neoplastic pathologies. Although a large proportion of patients have high function and quality of life (1), a subset experience recurrent difficulties with scars, excess skin folds, hernias and leakage, resulting in significant psychosocial morbidity, often going underrecognized and undermanaged. Abdominoplasty in the colostomized abdominal wall represents a clinical solution the above problems, addressing a distinct set of concerns compared to the standard abdominoplasty patient.
Case A 53yo woman presented with several years of progressive abdominal discomfort, garment maintenance/leakage issues and skin irritation after previous permanent colostomy and total colectomy for Crohn’s disease. Modified vertical “Z-Abdoplasty” was performed- the contralateral limb to the stoma being designed as a standard Fleur-de-lys abdominoplasty configuration, the ipsilateral limb designed as a ‘reverse’ abdominoplasty with upper quadrant/submammary suture line to maximize distance and avoid stomal disruption or postoperative leakage. Rectus plication was performed in standard fashion.
At 6 weeks, there was significantly improved abdominal contour, with nil further garment leakage events and high patient satisfaction.
Discussion and Review of literature Recontouring techniques of colostomized abdominal walls are reported sparsely in the literature, 3 case series were identified
Conclusions The “Z-abdoplasty” is a viable technique in the colostomized abdomen wall with a favourable scar configuration, allowing access for concurrent rectus plication and incisional hernia repairs in scenarios where concurrent stoma revision is not required and thus preservation is a priority. The psychosocial morbidity inflicted by a misbehaving colostomized abdominal wall can be severe and underrecognized; successful corrective surgery has a high potential for profound improvement.