How-I-do-it: minimally invasive repair of ileal conduit parastomal hernias

Parastomal hernia after radical cystectomy and ileal conduit urinary diversion is an underestimated and undertreated condition with significant impact on quality of life. However, its surgical treatment is challenging and prone to complications and the optimal surgical treatment of this condition remains to be determined.

In this article, we describe our surgical techniques in the minimally invasive treatment of ileal conduit parastomal hernia and present our preliminary results. In a retrospective single-center design, a prospectively maintained database was screened. Data from all patients undergoing surgical treatment for a parastomal hernia after cystectomy and ileal conduit urinary diversion in our center were collected.

Between May 2016 and June 2020, 15 patients underwent minimally invasive repair of a parastomal hernia of an ileal conduit. Details on the surgical approach are provided, along with a flow chart to standardize the choice of surgical technique, depending on the presence of a concomitant midline incisional hernia and perioperative findings. The majority of patients were treated with robotic-assisted laparoscopic surgery (10/15; 66.7%). Median postoperative hospital stay was 5 days. One-third of patients developed a postoperative urinary infection. Median follow-up was 366 days. One patient developed a local recurrence of her parastomal hernia on day 66 postoperatively, treated with intraperitoneal mesh.

The minimally invasive surgical treatment of a parastomal hernia after ileal conduit urinary diversion poses specific perioperative challenges that require a broad surgical armamentarium and a tailored approach. Preliminary results confirm a significant morbidity after this type of surgery.