Early postoperative outcomes of intraperitoneal funnel mesh for parastomal hernia prevention in robotic radical...

Although robotic and open cystectomies have similar parastomal hernia (PSH) rates, the robotic approach offers perioperative advantages. PSH nevertheless remains a clinically and economically significant complication, and evidence on prophylactic mesh use in robot-assisted radical cystectomy (RARC) with ileal conduit (IC) formation is limited. This feasibility study reports short-term outcomes following mesh insertion, focusing on postoperative complications, including mesh-related infection and ileus.

This retrospective, single-center, observational cohort study evaluates the use of prophylactic funnel mesh made of polyvinylidene fluoride (PVDF) during RARC with IC formation through a comprehensive assessment. This technique has been implemented routinely within our center.

From August 2023 to September 2024, 22 consecutive patients (41% of females) underwent RARC with IC formation. One robotic cystectomy was for a benign cause, whereas seven patients had bladder cancer stage T1, 11 - T2, 2 - T3, and 1 - T4. The average operating time was 310 ± 61 min. Perioperatively, 23% of patients had a Clavien-Dindo Class ≤2 ileus. After a median follow-up of 16 months, there was 1 (4.5%) clinical/radiological instance of PSH (Clavien-Dindo Class 3b) and 1 (4.5%) instance of mesh-related infection (Clavien-Dindo Class 2).

Placement of PVDF funnel mesh during RARC with IC formation appears feasible and was associated with a low rate of mesh-related complications in this series. Although only one PSH occurred during short-term follow-up, these results should be interpreted cautiously, given the small sample size and limited duration. Longer-term evaluation is required to determine the true effectiveness of this approach in preventing PSH.