This topic is about preparing for a surgical repair of a peristomal fistula after having an ileostomy. A fistula has developed at the site where the bowel meets the skin, and the person is scheduled for a laparoscopic repair, which might need to be converted to an open surgery. Here are some helpful insights and advice for someone in this situation:

1. The surgeon believes the fistula was caused by sutures from the stoma creation penetrating too deeply into the bowel wall.

2. The person has not had any pelvic or abdominal radiation; their previous treatments included surgery and chemotherapy.

3. Currently, output is coming through both the stoma and the fistula, reducing the bag wear-time from 4-5 days to just 2 days.

4. Although outpatient surgery was initially considered, it has been confirmed as an inpatient procedure with a hospital admission expected on July 10 and a stay of a few days.

5. This will be the third abdominal surgery since June 2018, with a medical history that includes Lynch Syndrome, complete colectomy, cholecystectomy, and a hysterectomy with salpingo-oophorectomy.

6. There are concerns about scar tissue, the integrity of abdominal muscles around the stoma, and the potential for an extended hospital stay due to previous complications.

Advice and insights for preparation and recovery:

- Meet with the surgeon again before the operation to ask detailed questions and ensure all concerns are addressed for informed consent.

- Clarify with the surgeon the reason for the fistula formation and how it will be corrected, the specific surgical technique planned, and the surgeon’s experience with similar repairs.

- Consider seeking a second or third opinion, as reputable surgeons support additional consultations.

- Understand that fistulas rarely close on their own, and without correcting the cause, another may form.

- Possible repair options include surgically opening the fistula tract to heal from the inside out or cleaning the tract and placing a plug or sealant if anatomy permits.

- An inpatient stay may be safer, allowing for careful closure, pain control, and immediate monitoring for leaks or infection.

- Hospitals have strict COVID-19 protocols; remain cautious but do not let virus fears delay essential surgery.

- Bring a laptop or tablet, phone, charger cords, and reading material or DVDs to the hospital to combat boredom, as daytime TV is limited.

- Expect more frequent pouch changes (every 2 days) as normal for some patients, and plan supplies accordingly if longer wear time does not return.

- Continue vigilant cancer surveillance due to the increased lifetime risk for multiple cancers associated with Lynch Syndrome.