Prophylactic mesh used in ileal conduit formation following radical cystectomy: a retrospective cohort
- 146 Downloads
Given the difficulty of durable repairs, there is continued interest in hernia prevention. One emerging prevention technique for parastomal hernias is prophylactic mesh placement, whereby mesh is inserted during the index procedure as hernia prophylaxis. We evaluated our experience using prophylactic mesh when creating an ileal conduit.
We retrospectively reviewed patients undergoing robotic cystectomy with ileal conduit from 6/2010 to 8/2017. Patient demographics and operative/perioperative outcomes were documented. We evaluated hernia recurrence using postoperative computed tomography scanning or physical exam. Prophylactic mesh was inserted at the operating surgeon’s discretion using a synthetic resorbable or biologic mesh.
During the study period, 38 patients underwent robotic-assisted cystectomy with ileal conduit formation. Average patient age was 68 years, with 28 (74%) male and 35 (92%) Caucasian patients. Three patients (8%) required conversion to open, and one patient (3%) had a concomitant colorectal resection. Thirty-one (88%) patients had postoperative computed tomography scanning. Prophylactic mesh was used in 18 patients (47%) in a retrorectus position. Of these, 15 (83%) patients had synthetic resorbable mesh and 3 (17%) patients had biologic mesh. At average follow-up of 21 months, one hernia recurred (5%) in a patient without mesh placement at the time of ileal conduit. At an average follow-up of 11 months, there have been no recurrences and no mesh-related complications in the prophylactic mesh group.
Using prophylactic mesh in ileal conduit, creation is feasible and may decrease the parastomal hernia formation rate. Further study of using synthetic resorbable and biologic meshes for hernia prophylaxis is warranted.
KeywordsHernia Prevention Prophylaxis Ostomy Ileal conduit
No financial support was received for this study.
Compliance with ethical standards
Conflict of interest
PLT declares no conflict of interest. ZFW declares no conflict of interest. RAM declares no conflict of interest. WH declares conflicts of interest not directly related to the submitted work. WH has consulted for CR Bard, served as a speaker for Bard, WL Gore and Intuitive Surgical, and has received research funding from Bard and Gore.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Human and animal rights
All procedures were approved by the New Hanover Regional Medical Center Institutional Review Board.
For this type of study formal consent is not required.
- 3.Wijeyekoon SP, Gurusamy K, El-Gendy K, Chan CL (2010) Prevention of parastomal herniation with biologic/composite prosthetic mesh: a systematic review and meta-analysis of randomized controlled trials. J Am Coll Surg 211(5):637–645. https://doi.org/10.1016/j.jamcollsurg.2010.06.111 CrossRefPubMedGoogle Scholar
- 4.Vierimaa M, Klintrup K, Biancari F, Victorzon M, Carpelan-Holmstrom M, Kossi J, Kellokumpu I, Rauvala E, Ohtonen P, Makela J, Rautio T (2015) Prospective, randomized study on the use of a prosthetic mesh for prevention of parastomal hernia of permanent colostomy. Dis Colon Rectum 58(10):943–949. https://doi.org/10.1097/DCR.0000000000000443 CrossRefPubMedGoogle Scholar
- 6.Antoniou SA, Agresta F, Garcia Alamino JM, Berger D, Berrevoet F, Brandsma HT, Bury K, Conze J, Cuccurullo D, Dietz UA, Fortelny RH, Frei-Lanter C, Hansson B, Helgstrand F, Hotouras A, Janes A, Kroese LF, Lambrecht JR, Kyle-Leinhase I, Lopez-Cano M, Maggiori L, Mandala V, Miserez M, Montgomery A, Morales-Conde S, Prudhomme M, Rautio T, Smart N, Smietanski M, Szczepkowski M, Stabilini C, Muysoms FE (2017) European Hernia Society guidelines on prevention and treatment of parastomal hernias. Hernia. https://doi.org/10.1007/s10029-017-1697-5 CrossRefPubMedGoogle Scholar
- 7.Donahue TF, Cha EK, Bochner BH (2016) Rationale and early experience with prophylactic placement of mesh to prevent parastomal hernia formation after ileal conduit urinary diversion and cystectomy for bladder cancer. Curr Urol Rep 17(2):9. https://doi.org/10.1007/s11934-015-0565-z CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Serra-Aracil X, Bombardo-Junca J, Moreno-Matias J, Darnell A, Mora-Lopez L, Alcantara-Moral M, Ayguavives-Garnica I, Navarro-Soto S (2009) Randomized, controlled, prospective trial of the use of a mesh to prevent parastomal hernia. Ann Surg 249(4):583–587. https://doi.org/10.1097/SLA.0b013e31819ec809 CrossRefPubMedGoogle Scholar
- 11.Lopez-Cano M, Lozoya-Trujillo R, Quiroga S, Sanchez JL, Vallribera F, Marti M, Jimenez LM, Armengol-Carrasco M, Espin E (2012) Use of a prosthetic mesh to prevent parastomal hernia during laparoscopic abdominoperineal resection: a randomized controlled trial. Hernia 16(6):661–667. https://doi.org/10.1007/s10029-012-0952-z CrossRefPubMedGoogle Scholar
- 12.Brandsma HT, Hansson BM, Aufenacker TJ, van Geldere D, van Lammeren FM, Mahabier C, Steenvoorde P, de Vries Reilingh TS, Wiezer RJ, de Wilt JH, Bleichrodt RP, Rosman C (2016) Prophylactic mesh placement to prevent parastomal hernia, early results of a prospective multicentre randomized trial. Hernia 20(4):535–541. https://doi.org/10.1007/s10029-015-1427-9 CrossRefPubMedGoogle Scholar