Parietal complications after cystectomy: Incisional and parastomal hernia, epidemiology and risk factors

Abstract

IntroductionIncisional and parastomal hernias are frequent complications after cystectomy. The aim of our study was to define their incidence, identify risk factors related to the patient and the surgical technique, and identify means of prevention. MaterialThis was a multicenter, retrospective study, analyzing clinical and radiological data from 521 patients operated on for cystectomy between January 2010 and December 2020. ResultsIn total, 521 patients, 471 men and 50 women, mean age 68.8years, were included. Thirty-one patients (6.6%) presented with an evisceration. Risk factors were a history of evisceration (OR: 14.1; 95% CI: [3–66]; P=0.0008), COPD (OR: 3.5; 95% CI: [1.3–9 .4]; P=0.0119), ischemic heart disease (OR: 4; 95% CI: [1. 6–10]; P=0.0036), and split-stitch closure (OR: 3.1; 95% CI: [1.065–8.9]; P=0.0493). Fifty-one patients (9.9%) presented with an incisional hernia. Risk factors were a history of COPD (OR: 4, 95% CI: [2.1–7.6]; P<0.001) and postoperative pulmonary infection (OR: 5.3; 95% CI: [1.05–26.4]; P=0.0079). Seventy-nine patients (15.28%) had a parastomal hernia. Overweight was a risk factor (OR: 2.3; 95% CI: [1.3–4.5]; P=0.0073). ConclusionPatients who are overweight or have pulmonary comorbidities are at greater risk of developing parietal complications after cystectomy. Level of evidenceIII.