V06-12 PROPHYLACTIC MESH STRIPS: AN EFFECTIVE WAY TO REDUCE HERNIA DURING RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyCME1 Apr 2023V06-12 PROPHYLACTIC MESH STRIPS: AN EFFECTIVE WAY TO REDUCE HERNIA DURING RADICAL CYSTECTOMY Noah Frydenlund, Eric Li, Clayton Neill, Gergory Dumanian, and Joshua J. Meeks Noah FrydenlundNoah Frydenlund More articles by this author , Eric LiEric Li More articles by this author , Clayton NeillClayton Neill More articles by this author , Gergory DumanianGergory Dumanian More articles by this author , and Joshua J. MeeksJoshua J. Meeks More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003274.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Postoperative hernia development, especially parastomal hernia (PSH), remains a challenging problem after radical cystectomy (RC). The incidence of incisional hernia (IH) has been reported to range from 5-15%, while PSHs occur between 15-65%. The use of prophylactic mesh sheets during RC has been shown to reduce the incidence of PSH in a recent randomized trial. We present our technique for the prophylactic use of soft polypropylene mesh strips as sutures at the time of RC as a potential alternative to mesh sheets and review our early experience. METHODS: A retrospective review of a single surgeon's experience with RC from January 2017 to July 2022 was performed. The inclusion criteria were the use of prophylactic parastomal and/or ventral mesh strips. Patients that required intra-operative assistance from plastic surgery for complex abdominal closure were excluded. Radiographic hernias were identified by radiology reports. Hernias that were noticeable on physical exam, symptomatic, or required operative repair were classified as clinical hernias. RESULTS: A total of 72 patients with prophylactic mesh strip placement during radical cystectomy were included. The average age was 73.5 years (Range 41-88 years), with an average follow of 10.8 months (range 1.1 – 63 months) and an average BMI of 27.9 (range 16.0 – 39.13). Sixty-one patients underwent RC with ileal conduit (IC), while 11 underwent RC with neobladder (NB) creation. 93% of the cases were performed robotically with extracorporeal diversion, and the remainder were open. In the RC with IC cohort, 54 patients had ventral and stomal mesh strips placed while 4 had ventral only and 3 had stomal only strips. Radiographic IH was reported in 6/69 (8.7%) patients with ventral mesh strips. Clinical IH was reported in 2/69 (2.9%) patients. For the RC/IC cohort, radiographic PSH was identified in 11/57 (19.3%) patients, and clinical PSH occurred in 6/57 (10.5%) patients. 2/57 (3.5%) patients underwent parastomal hernia repair, 2/57 (3.5%) developed stomal stenosis, and one patient underwent incisional hernia repair. No mesh-related complications were identified. CONCLUSIONS: The prophylactic use of mesh strips as sutures during RC may provide a safe and effective method to reduce postoperative hernia. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e512 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Noah Frydenlund More articles by this author Eric Li More articles by this author Clayton Neill More articles by this author Gergory Dumanian More articles by this author Joshua J. Meeks More articles by this author Expand All Advertisement PDF downloadLoading ...