title: Stomaplasty with pannicuectomy in an obese patient with stomal retraction: A case report.
abstract: BACKGROUND
  Stomal retraction is a common complication following stoma formation. A repeat surgical procedure for stomal revision is an invasive treatment that is often required as a result.
  
  
  METHODS
  An 81-year-old woman with obstructive rectal carcinoma and perforative peritonitis underwent an emergent anterior resection and colostomy (Hartmann's operation). After the operation, the patient changed the stoma pouch every day because of stomal retraction and leakage. Thirty-eight days after the operation, we performed a stomaplasty with pannicuectomy. Following this procedure, the patient changed the stoma pouch twice weekly.
  
  
  CONCLUSIONS
  Stomal retraction is caused by the thick subcutaneous fat and abnormal skin folds in obese patients, as well as the excess tension that is the result of inadequate mobilization. Treatment of stomal retraction typically requires an intraperitoneal stoma revision. Our method of panniculectomy with skin excision but without stomal revision does not involve an incision around the stoma and there is no risk of fecal contamination.
  
  
  CONCLUSIONS
  We report a case of an obese patient who underwent stomaplasty with pannicuectomy for stomal retraction. We believe that stomaplasty with pannicuectomy is a feasible option in obese patients with stomal retraction.
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan. Electronic address: i_eisaku_ukasie@yahoo.co.jp.
authors.forename: Eisaku
authors.initials: E
authors.lastname: Ito
authors.affiliation: Plastic Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan. Electronic address: kosaka@iuhw.ac.jp.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kosaka
authors.affiliation: Plastic Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan. Electronic address: c.k_6413@iuhw.ac.jp.
authors.forename: Chie
authors.initials: C
authors.lastname: Kawaguchi
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan. Electronic address: masashi@iuhw.ac.jp.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan. Electronic address: ohdaira@iuhw.ac.jp.
authors.forename: Hironori
authors.initials: H
authors.lastname: Ohdaira
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan. Electronic address: keigo_0613@yahoo.co.jp.
authors.forename: Keigo
authors.initials: K
authors.lastname: Nakashima
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan. Electronic address: norinori_sculler@yahoo.co.jp.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Suzuki
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan. Electronic address: imakita0626@gmail.com.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Imakita
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan. Electronic address: nobuhiro_mihoko@hotmail.com.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tsutsui
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan. Electronic address: kitajima@iuhw.ac.jp.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kitajima
authors.affiliation: Department of Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara City, Tochigi 329-2763, Japan. Electronic address: yutaka@iuhw.ac.jp.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Suzuki
keywords: Pannicuectomy; Stomal retraction; Stomaplasty