This topic is about preparing for a colostomy reversal and repairing a large parastomal hernia with mesh after an unexpected colostomy. Here’s a breakdown of the situation and some advice and insights that might be helpful:

- In November 2022, Lynda had exploratory surgery due to abdominal pain, vomiting, and no bowel movements, which unexpectedly resulted in an end colostomy. The surgeon found a perforated bowel from diverticulitis, although pre-op scans showed no perforation.
- Lynda experienced a five-week hospital stay and severe constipation, which was eventually managed with Lactulose and Milk of Magnesia.
- Since then, she has developed a large parastomal hernia, about the size of a grapefruit, which traps stool in two noticeable pockets every few days.
- Over two years, she faced multiple complications, including issues with medical care and limited support from the original surgeon.
- Lynda has Crohn’s disease, which flared up three months post-surgery. She was put on Stelara in mid-2023 but later learned that Stelara combined with diverticulosis is not advisable.
- She also developed painful peristomal Pyoderma Gangrenosum, requiring treatment with crushed prednisone and calcium alginate.

In the summer of 2023, a second surgeon declined to perform the reversal and hernia repair due to its complexity. A new plan involves a highly recommended colorectal surgeon for the reversal and a separate hernia team for the mesh repair, scheduled for February 14. Lynda aims to gather positive experiences and set realistic expectations to ease her anxiety after this challenging journey.

Additional considerations include:

- Elevated calprotectin levels may indicate a Crohn’s flare, diverticulosis activity, or inflammation from the hernia.
- Lynda is considering postponing the surgery until her medical team reaches a consensus, especially since the two-day bowel prep is challenging with a stoma and an ill-fitting appliance.
- Past medical mishaps, like a liver nick during a procedure in 2013 and an unexplained vertebral fracture after the 2022 surgery, have increased her mistrust.
- The parastomal hernia causes appliance leakage due to the distorted abdominal wall.
- Lynda seeks advice from other ostomates about their experiences with reversal and hernia repair, recovery, the sensation of the mesh, and tips to avoid further complications.

Advice and insights include:

1. Choose surgeons carefully:
- Parastomal hernia repair has a high recurrence rate, even with experts. Insist on a surgeon experienced in these cases or use two specialists.
- Ensure the surgeon collaborates with an experienced radiologist to review imaging and explain the surgical plan.
- Seek second opinions and feedback from ostomy nurses and primary care providers. Be ready to walk away if questions remain unanswered.

2. Be your own advocate:
- Ask about risks, options, and intra-operative decisions.
- Participate actively in decision-making for elective surgery.
- Postpone surgery if information is inconsistent or incomplete.

3. Manage imaging limitations:
- CT scans can miss small perforations or leaks. Consider whether additional imaging like MRI is needed.

4. Bowel prep and stoma logistics:
- Confirm the exact protocol for the two-day prep with the medical team and have extra supplies ready for high-output or leak risks.

5. Psychological strategies:
- Long medical ordeals can lead to anger and mistrust. Work on finding confidence in the chosen team to ease control during surgery and recovery.

6. Alternative stoma management:
- Sigmoid-colostomy irrigation can reduce output and leaks, but it may not be suitable for everyone. Some patients prefer regular pouching if it provides a good seal.

7. Mesh-related anecdotes:
- Abdominal mesh can cause organ adhesions or punctures, but most patients do not feel the mesh daily after repair.

8. General support:
- Many ostomates have faced complicated journeys but achieved good outcomes. Perseverance, thorough research, and careful decision-making can improve the chances of success.