MP52-18 EVALUATION OF A NOVEL THREE-DIMENSIONAL FUNNEL MESH FOR PARASTOMAL HERNIA REPAIR AFTER ILEAL CONDUIT DIVERSION

Abstract

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I1 Apr 2017MP52-18 EVALUATION OF A NOVEL THREE-DIMENSIONAL FUNNEL MESH FOR PARASTOMAL HERNIA REPAIR AFTER ILEAL CONDUIT DIVERSION Karl Tully, Florian Roghmann, Jobst Pastor, Rein Jüri Palisaar, Joachim Noldus, and Christian von Bodman Karl TullyKarl Tully More articles by this author , Florian RoghmannFlorian Roghmann More articles by this author , Jobst PastorJobst Pastor More articles by this author , Rein Jüri PalisaarRein Jüri Palisaar More articles by this author , Joachim NoldusJoachim Noldus More articles by this author , and Christian von BodmanChristian von Bodman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1648AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Using cross-sectional imaging parastomal hernia (PSH) is detected with a frequency of up to 65% in patients treated with cystectomy and ileal conduit (IC) diversion. While many patients initially remain asymptomatic, up to 30% need surgical repair due to clinical symptoms impacting quality of life. Common repair methods to treat this most frequent complication after IC diversion using native tissue show unacceptable high recurrence rates (>70%), which has led to mesh based repair techniques. Effective and safe surgical techniques and outcomes need to be reported in the urologic literature. We report our open surgical technique and results using an intraperitoneal onlay mesh with a central funnel for the conduit aiming to minimize mesh penetration and PSH recurrence. METHODS Between 1/2004 and 12/2015, 643 patients were treated with ileal conduit urinary diversion at our institution. Subsequently 40 Patients (6,2%) underwent open PSH repair between 2/2009 and 3/2016 using a novel intraperitoneal-onlay-mesh with a central hole (2cm diameter) and funnel for intestinal parts (DynaMesh IPST). As surgical access we used a 4 cm longitudinal incision below and above the stoma. The mesh was placed intraperitoneally as an onlay and fixed at four corner points with non-absorbent sutures. Patients received clinical and ultrasound follow-up to monitor treatment success and effectiveness. While perioperative data was available for 40 patients, 13 could not be followed at our institution, leading to 27 patients with follow-up data. RESULTS Of the 40 patients perioperatively only one patient developed a wound infection, which was managed with multiple surgical debridements keeping the mesh in place.27 Patients (16 male, 11 female) with a median age of 74 years and a median BMI of 29.4 kg/m2 (IQR 25; 31) could be followed with a median follow up of 29 months (IQR 16; 63). Two patients developed a stoma stenosis (7%) with consecutive dilation of the renal pelvis which needed to be drained with a nephrostomy. Only two patients (7%) developed a PSH recurrence after mesh implant with one of them being in need of revision at last follow-up. No patient showed a penetration of the mesh into the intestine, stoma necrosis or stoma prolapse. CONCLUSIONS The described open surgical technique shows a low perioperative complication rate and a promising low PSH recurrence rate of only 7%. A specifically designed 2-component mesh with a central funnel implanted as an intraperitoneal onlay seems to provide an effective treatment option for PSH repair after ileal conduit diversion. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e711 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Karl Tully More articles by this author Florian Roghmann More articles by this author Jobst Pastor More articles by this author Rein Jüri Palisaar More articles by this author Joachim Noldus More articles by this author Christian von Bodman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...