Abstract
BackgroundPrevious research on parastomal hernia repair following ileal conduit urinary diversion is limited. This nationwide cohort study aims to present the results of keyhole and Sugarbaker techniques in parastomal hernia repair in the setting of ileal conduit urinary diversion.MethodAll patients in this cohort underwent primary elective parastomal hernia repair following ileal conduit urinary diversion in four university hospitals and one central hospital in Finland in 2007–2017. Retrospective clinical data were collected from patient registries to compare keyhole and Sugarbaker parastomal hernia repair techniques. The primary outcome was parastomal hernia recurrence during the follow-up from primary surgery to the last confirmed follow-up date of the patient. The secondary outcomes were reoperations during the follow-up and complication rate at 30 days’ follow-up.ResultsThe results of 28 hernioplasties were evaluated. The overall parastomal hernia recurrence rate was 18%, the re-operation rate was 14%, and the complication rate was 14% during the median follow-up time of 30 (21–64) months. Recurrence rates were 22% (4/18) after keyhole repair and 10% (1/10) after Sugarbaker repair. Re-operation rates referred to keyhole repair were 22% and Sugarbaker repair 0% during follow-up. The majority of reoperations were indicated by recurrence. Complication rates were 17% after keyhole and 10% after Sugarbaker repair during the 30 days’ follow-up.ConclusionThe results of parastomal hernia repair in the setting of ileal conduits are below optimal in this nationwide cohort comparing keyhole to Sugarbaker repair in elective parastomal hernia repair. Nonetheless, the Sugarbaker technique should be further studied to confirm the encouraging results of this cohort in terms of recurrence.
Highlights
Previous research on parastomal hernia repair following ileal conduit urinary diversion is limited
There were seven (15%) onlay mesh repairs, six (13%) retrorectus mesh repairs, three (6%) suture repairs, one (2%) change of stoma location and one (2%) repair with an intra-abdominal funnel-shaped mesh (Dynamesh IPSTTM, FEG Textiltechnik, Aachen, Germany), which were all excluded from the analysis due to heterogeneity and the Keyhole Sugarbaker Fig. 1 Parastomal hernias repaired following ileal conduit urinary diversion small number of each method used
parastomal hernia (PSH) is a frequent complication after cystectomy [2], hardly any knowledge exists of its repair using intra-abdominal keyhole and Sugarbaker techniques [7, 8]
Summary
Previous research on parastomal hernia repair following ileal conduit urinary diversion is limited. This nationwide cohort study aims to present the results of keyhole and Sugarbaker techniques in parastomal hernia repair in the setting of ileal conduit urinary diversion. The results of ileal conduit parastomal hernia (PSH) repair are unsatisfactory, with an overall recurrence rate of up to 28% in clinical examination [2]. The parastomal hernia is repaired with a flat mesh with a central hole through which the bowel is brought. Previous reports of the keyhole and Sugarbaker techniques regarding ileal conduit parastomal hernias are few [6, 7]
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