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Parastomal hernia after ileal conduit with a prophylactic mesh: a 10 year consecutive case series
Johan Styrke1, Markus Johansson, Gabriel Granåsen
1Department of Urology, Sundsvall Hospital , Sundsvall , Sweden.
Insights
A prophylactic mesh in ileal conduit surgery showed a parastomal hernia (PSH) prevalence similar to colostomies. This mesh did not appear to cause complications, but further trials are needed to confirm PSH rate reduction.
Area of Science:
- Urology
- Surgical Oncology
- Medical Devices
Background:
- Parastomal hernia (PSH) is a known complication after ostomy creation.
- Data on PSH frequency following ileal conduit surgery with prophylactic mesh is lacking.
- Understanding PSH prevalence and mesh-related complications is crucial for patient outcomes.
Purpose of the Study:
- To determine the prevalence of parastomal hernia (PSH) after ileal conduit surgery with prophylactic mesh.
- To investigate if patient factors (age, gender, BMI, prior laparotomy, diabetes) influence PSH occurrence.
- To identify any mesh-related complications associated with prophylactic mesh use.
Main Methods:
- A single-center retrospective study of 114 patients undergoing ileal conduit surgery with prophylactic mesh placement (2003-2012).
- Data collected included preoperative and postoperative patient information.
- Cross-sectional follow-up with clinical examination, defining PSH as protrusion during straining in erect and supine positions.
Main Results:
- Follow-up was conducted on 58 patients after a mean of 35 months.
- The prevalence of PSH was 14% (8 patients).
- No significant association was found between PSH and age, gender, BMI, previous laparotomy, or diabetes. No mesh-related complications were reported.
Conclusions:
- The prevalence of PSH after ileal conduit with prophylactic mesh is comparable to that observed with colostomies.
- Prophylactic mesh use in this context did not appear to increase complications.
- Randomized trials are recommended to definitively assess the efficacy of prophylactic mesh in reducing PSH rates after ileal conduit surgery.
Objective:
There are no data on the frequency of parastomal hernia (PSH) after ileal conduit with a prophylactic mesh. The primary objective of this study was to determine the prevalence of PSH. Secondary objectives were to elaborate whether age, gender, body mass index (BMI), previous laparotomy or diabetes influenced the outcome; and to find any mesh-related complications.
Materials And Methods:
In a single centre during 2003-2012, a large-pore, lightweight mesh was placed in a sublay position in 114 consecutive patients with ileal conduits. Preoperative and postoperative patient data were retrospectively collected and cross-sectional follow-up was conducted. During the predefined clinical examination a PSH was defined as any protrusion in the vicinity of the ostomy with the patient straining in both an erect and a supine position.
Results:
Fifty-eight patients (24 women and 34 men, mean age 69 years) had follow-up examinations after a mean of 35 months (median 32 months). Bladder cancer was the most common cause for surgery. Eight patients (14%) had a PSH. Age, gender, BMI, previous laparotomy and diabetes did not affect the outcome. No mesh-related complications occurred among the 114 patients with a prophylactic mesh.
Conclusions:
The prevalence of PSH after ileal conduit with a prophylactic mesh corresponded to that of colostomies with a prophylactic mesh. A prophylactic mesh did not seem to be associated with complications. The degree to which a prophylactic mesh may reduce the rate of PSH after an ileal conduit should be established in randomized trials.
