EP615 - Out of Navel Necessity: Utilizing an Umbilical Hernia Site for Stoma Creation in a Morbidly Obese Patient

Sunday, May 10, 2026

2:57 PM - 3:02 PM ET

Author(s)

KK

Kaelen Kay, DO

General Surgery Resident Physician
Kern Medical Center
Bakersfield, California, United States

Disclosure information not submitted.

Senior Author(s)

Alexandra W. Elias, MD, FASCRS

Director Colorectal Surgery, GS Associate Program Director, Director Robotics, Research, & Wellness
Kern Medical
Bakersfield, California, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.

ePoster Presenter(s)

Shivam Patel, MD

Medical Student
Kern Medical
Kern Medical
Bakersfield, CA, United States

Disclosure information not submitted.

View ePoster

Purpose/Background: Morbid obesity poses significant challenges in rectal cancer surgery, particularly in stoma site selection, due to thick abdominal walls, large pannus, and coexisting hernias. Traditional stoma sites may be inaccessible or impractical in such patients. While the umbilicus is typically avoided, emerging evidence suggests it can be a viable alternative in select high-risk cases. This report describes the innovative use of a pre-existing incarcerated umbilical hernia for colostomy in a patient with a BMI of 65 undergoing abdominoperineal resection (APR) for advanced rectal cancer.

Methods/Interventions: A 57-year-old male with a BMI of 65 and cT4N2 rectal adenocarcinoma completed total neoadjuvant therapy with incomplete response, followed by robotic-assisted APR with bilateral gracilis flap reconstruction. Due to the inaccessibility of conventional stoma sites, high risk of recurrent hernia with repair, and optimal size of hernia for stoma orifice, the incarcerated umbilical hernia was reduced and used for the end colostomy site (Figure 1). Prior to creation, the umbilical hernia site was discussed with the wound ostomy continence RN as an optimal option.

Results/Outcomes: Pathology confirmed moderately differentiated adenocarcinoma, ypT3N0M0, with negative margins. The umbilical colostomy remained functional throughout the postoperative course, with no evidence of stoma-related complications, including ischemia, retraction, leakage, or poor appliance fit (Figure 2). The patient tolerated the location well, and the site proved ergonomically favorable despite his body habitus. Subsequent postoperative hospitalizations were unrelated to the stoma.

Conclusion/Discussion: This case demonstrates that an umbilical hernia site can serve as a functional, safe, and durable stoma location in morbidly obese patients when traditional sites are not feasible. The approach minimized additional incisions, avoided mesh use in a contaminated field, and provided satisfactory appliance fit. Postoperative morbidity was unrelated to the stoma. Umbilical stomas may offer anatomical and ergonomic advantages in patients with excessive subcutaneous adiposity. Further studies are warranted to evaluate long-term outcomes of this strategy.

Figure 1

Umbilical hernia stoma site initial creation
Figure 2

Umbilical hernia stoma site at 1-month follow-up