Parastomal hernia after ileal conduit with a prophylactic mesh: a 10 year consecutive case series

“…7-10 There have been no randomized, controlled trials of mesh placement in patients undergoing urinary diversion and published experience is limited to single institution series of select patients. 11 …”

Section: Introductionmentioning

confidence: 99%

Rationale and Early Experience with Prophylactic Placement of Mesh to Prevent Parastomal Hernia Formation after Ileal Conduit Urinary Diversion and Cystectomy for Bladder Cancer

2016

View full text Add to dashboard Cite

Parastomal hernias represent a clinically significant problem for many patients after radical cystectomy and ileal conduit diversion. The prevalence may be as high as 60% and in some series, up to 30% of patients require surgical intervention due to the complications of pain, poor fit of an ostomy appliance, leakage, urinary obstruction, and bowel obstruction or strangulation. Due to the potential morbidity associated with PH repair, there have been efforts to prevent PH development at the time of the index surgery. Four randomized trials of prophylactic mesh placement at the time of colostomy and ileostomy stoma formation have demonstrated significant reductions in PH rates with acceptably low complication rates. In this review, we describe the clinical and radiographic definitions of PH, the clinical impact and risk factors behind its development, and the rationale behind prophylactic mesh placement for patients undergoing ileal conduit urinary diversion. Additionally, we report our experience with prophylactic mesh placed at radical cystectomy at our institution.

show abstract

“…Nonrandomized series of consecutive patients receiving prophylactic mesh at the time of index surgery have recently been published. Styrke et al [ 47 ] reported a single institution, 10-year consecutive series of 114 patients having prophylactic mesh placed in the sublay position at the time of RC and IC formation. After a median follow-up of 35 months, they reported a cPH rate of 14% in 58 evaluable patients and no mesh-related complications.…”

Section: Mesh Placement At Index Surgery To Prevent Parastomal Herniamentioning

confidence: 99%

Parastomal hernias after radical cystectomy and ileal conduit diversion

Donahue

Bochner

2016

Investig Clin Urol

View full text Add to dashboard Cite

Parastomal hernia, defined as an "incisional hernia related to an abdominal wall stoma", is a frequent complication after conduit urinary diversion that can negatively impact quality of life and present a clinically significant problem for many patients. Parastomal hernia (PH) rates may be as high as 65% and while many patients are asymptomatic, in some series up to 30% of patients require surgical intervention due to pain, leakage, ostomy appliance problems, urinary obstruction, and rarely bowel obstruction or strangulation. Local tissue repair, stoma relocation, and mesh repairs have been performed to correct PH, however, long-term results have been disappointing with recurrence rates of 30%–76% reported after these techniques. Due to high recurrence rates and the potential morbidity of PH repair, efforts have been made to prevent PH development at the time of the initial surgery. Randomized trials of circumstomal prophylactic mesh placement at the time of colostomy and ileostomy stoma formation have shown significant reductions in PH rates with acceptably low complication profiles. We have placed prophylactic mesh at the time of ileal conduit creation in patients at high risk for PH development and found it to be safe and effective in reducing the PH rates over the short-term. In this review, we describe the clinical and radiographic definitions of PH, the clinical impact and risk factors associated with its development, and the use of prophylactic mesh placement for patients undergoing ileal conduit urinary diversion with the intent of reducing PH rates.

show abstract

Parastomal hernia after ileal conduit with a prophylactic mesh: a 10 year consecutive case series

Cited by 25 publications

References 30 publications

Meta-analysis of prophylactic mesh to prevent parastomal hernia

Meta-analysis of prophylactic mesh to prevent parastomal hernia

Rationale and Early Experience with Prophylactic Placement of Mesh to Prevent Parastomal Hernia Formation after Ileal Conduit Urinary Diversion and Cystectomy for Bladder Cancer

Parastomal hernias after radical cystectomy and ileal conduit diversion

Contact Info

Product

Resources

About