Robotic modified Sugarbaker intraperitoneal onlay graft hernioplasty for ileal conduit urinary diversion associated parastomal hernia

Abstract Background Previous research on parastomal hernia repair following ileal conduit urinary diversion is limited. This nationwide cohort study aims to present the results of keyhole and Sugarbaker techniques in parastomal hernia repair in the setting of ileal conduit urinary diversion. Method All patients in this cohort underwent primary elective parastomal hernia repair following ileal conduit urinary diversion in four university hospitals and one central hospital in Finland in 2007–2017. Retrospective clinical data were collected from patient registries to compare keyhole and Sugarbaker parastomal hernia repair techniques. The primary outcome was parastomal hernia recurrence during the follow-up from primary surgery to the last confirmed follow-up date of the patient. The secondary outcomes were reoperations during the follow-up and complication rate at 30 days’ follow-up. Results The results of 28 hernioplasties were evaluated. The overall parastomal hernia recurrence rate was 18%, the re-operation rate was 14%, and the complication rate was 14% during the median follow-up time of 30 (21–64) months. Recurrence rates were 22% (4/18) after keyhole repair and 10% (1/10) after Sugarbaker repair. Re-operation rates referred to keyhole repair were 22% and Sugarbaker repair 0% during follow-up. The majority of reoperations were indicated by recurrence. Complication rates were 17% after keyhole and 10% after Sugarbaker repair during the 30 days’ follow-up. Conclusion The results of parastomal hernia repair in the setting of ileal conduits are below optimal in this nationwide cohort comparing keyhole to Sugarbaker repair in elective parastomal hernia repair. Nonetheless, the Sugarbaker technique should be further studied to confirm the encouraging results of this cohort in terms of recurrence.

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P153 CHALLENGES IN MINIMALLY INVASIVE REPAIR OF ILEAL CONDUIT PARASTOMAL HERNIAS

British Journal of Surgery ◽

10.1093/bjs/znab395.143 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Maxime Dewulf ◽

Pieter Pletinckx ◽

Femke Nachtergaele ◽

Filip Muysoms

Keyword(s):

Surgical Treatment ◽

Local Recurrence ◽

Incisional Hernia ◽

Minimally Invasive ◽

Urinary Diversion ◽

Parastomal Hernia ◽

Ileal Conduit ◽

Poor Quality ◽

Minimally Invasive Surgical ◽

Minimally Invasive Surgical Treatment

Abstract Aim Parastomal hernia after radical cystectomy and ileal conduit urinary diversion is an underestimated and probably undertreated condition with significant impact on quality of life. However, its surgical treatment is challenging and prone to recurrence and complications. Literature on the subject is scarce and of poor quality, and the optimal surgical treatment of this condition remains to be determined. Material and Methods In this retrospective patient series, 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. The incidence of local recurrence was defined as primary endpoint. The rate of in-hospital complications was defined as secondary endpoint. Results Between May 2016 and June 2020, 15 patients underwent minimally invasive repair of a parastomal hernia of an ileal conduit at our center. Almost half of the patients had a concomitant midline incisional hernia (7/15; 46,7%). The majority of patients were treated with robotic-assisted laparoscopic surgery (10/15; 66,7%). Median follow-up was 366 days. One patient developed a local recurrence of her parastomal hernia on day 66 postoperatively, this recurrence was treated with intraperitoneal mesh. Conclusions 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. This paper confirms the significant morbidity after this type of surgery and proposes a flow chart to standardize the choice of surgical technique, depending on the presence of a concomitant midline incisional hernia and perioperative findings.

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