MP64-11 PROPHYLACTIC MESH PLACEMENT AT RADICAL CYSTECTOMY TO PREVENT PARASTOMAL HERNIAS: TECHNIQUE AND EARLY COMPLICATIONS

Abstract

You have accessJournal of UrologyBladder Cancer: Natural History and Pathophysiology1 Apr 2015MP64-11 PROPHYLACTIC MESH PLACEMENT AT RADICAL CYSTECTOMY TO PREVENT PARASTOMAL HERNIAS: TECHNIQUE AND EARLY COMPLICATIONS Timothy Donahue, Eugene K. Cha, Hebert A. Vargas-Alvarez, Guido Dalbagni, and Bernard H. Bochner Timothy DonahueTimothy Donahue More articles by this author , Eugene K. ChaEugene K. Cha More articles by this author , Hebert A. Vargas-AlvarezHebert A. Vargas-Alvarez More articles by this author , Guido DalbagniGuido Dalbagni More articles by this author , and Bernard H. BochnerBernard H. Bochner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2322AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Parastomal hernia (PH) is a frequent complication of ileal conduit (IC) formation after radical cystectomy (RC) with up to 48% of patients having radiographic evidence of PH and 35% experiencing adverse clinical symptoms by 2 years. Placement of mesh at the time of IC may reduce the incidence of PH. We describe the technique and early complications of prophylactic mesh placed at RC. METHODS Patients at high risk for PH development (female gender or males with BMI>30) had partially absorbable mesh placed dorsal to the rectus muscle and anterior to the posterior rectus sheath at RC. The IC was brought through a 2.5cm – 3.0cm circle cut in the center of the mesh with overlap of mesh in all directions extending 3-5 cm beyond the conduit. The mesh was anchored to the posterior rectus sheath with absorbable sutures placed in the lateral corners. The anterior peritoneum/posterior rectus fascia along the medial aspect of dissection was re-approximated to completely exclude mesh from the abdominal contents. Standard perioperative antibiotics were administered. Complication rates for patients with > 90 days follow up are reported. RESULTS Of 29 patients having prophylactic mesh placed, 22 had >90 days follow up (Median=271 days, IQR 192, 351). Median age of the 12 men and 10 women was 70.9 years. Median BMI was 32 (IQR 30.1, 35.4) and median preoperative albumin level was 4.3 (IQR 4.1, 4.4). 32% had neoadjuvant chemotherapy prior to RC, 23% had prior radiation therapy, and 41% had prior abdominal surgery. Both Turnbull (n=11) and end-stoma (n=11) techniques were used for IC formation. Placement of mesh added on average 10:03 minutes of surgical time. There were no mesh infections, fistula formation, or conduit strictures identified. Wound complications, including seroma (n=4) and superficial wound infections (n=6), were the most frequent, followed by GI (n=5), Infectious (n=5), GU (n=4), Bleeding (n=4), and Cardiac, Pulmonary, Thromboembolic, and Neurologic (n=1 each). All wound related complications were managed with bedside drainage and local wound care. No patient had a mesh-related complication and there was no need for mesh removal. CONCLUSIONS The placement of prophylactic, partially absorbable mesh in patients at high risk for PH formation appears feasible and safe. Wound-related complications were the most frequently seen and were successfully managed with bedside drainage and local wound care. Over a short period of follow up, no fistulas, strictures, or mesh-related complications were identified. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e801-e802 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Timothy Donahue More articles by this author Eugene K. Cha More articles by this author Hebert A. Vargas-Alvarez More articles by this author Guido Dalbagni More articles by this author Bernard H. Bochner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...