This topic is about an 83-year-old man who is considering undergoing surgery to reverse his ostomy and repair a hernia and fistula. He had emergency surgery in December 2024 due to a perforated sigmoid colon caused by diverticulitis, which led to the creation of a stoma. Now, he is dealing with a parastomal hernia and a small fistula and is seeking advice on whether to proceed with the reversal and repairs.

Here are some key points and advice related to his situation:

- He has a parastomal hernia above the stoma and a small fistula below it. The first surgeon recommends a stoma reversal because the hernia cannot be repaired alone. A second opinion is scheduled for early May.

- There are concerns about the risks of surgery, such as infection, anastomotic leak, short-bowel syndrome, and general complications due to age. There are also risks if he decides not to have surgery, like the hernia or fistula worsening.

- After the initial surgery, his weight dropped to 112 lbs but is now slowly increasing. He is experiencing unusual hunger between meals.

- The tentative plan is to have the reversal, with or without hernia repair, in early June if both surgeons agree.

- He is seeking feedback from others who have had similar experiences, particularly about whether to have the reversal and hernia repair in one operation or to stage them separately.

- There is some controversy in the medical literature about whether to perform these surgeries simultaneously or in stages. The first surgeon suggested doing both at once, while many articles recommend a two-stage approach.

- The first surgeon is close to home, while the second-opinion surgeon is 30 miles away in downtown Chicago.

- It is advised to get a second opinion to help clarify whether combined surgery is necessary. Different surgeons may have different views.

- Parastomal hernia repairs are often delayed, with some surgeons recommending a support belt unless the hernia is dangerous. The first surgeon's recommendation to repair it suggests it may be medically necessary.

- If the hernia poses a significant risk, combined reversal and hernia repair might be unavoidable. However, staged surgery can reduce complication rates, so it's important to discuss both strategies with each surgeon.

- Some patients choose to keep their stoma and manage hernias conservatively, such as by wearing a support belt continuously, to avoid additional surgery, especially at an older age.

- Hernia repairs have their own risks, including infection and recurrence. Age and overall health should be important factors in the decision-making process.

- Emotional readiness is important. One person facing a reversal after nine months with a stoma reported anxiety and trauma recovery issues. It's important to anticipate both psychological and physical challenges and seek support resources.