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

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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References

  1. Gakis G, Efstathiou J, Lerner S, Cookson M, Keegan K, Guru K et al (2013) International Consultation on Urologic Disease-European Association of Urology Consultation on Bladder Cancer 2012. ICUD-EAU International Consultation on Bladder Cancer 2012: Radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. Eur Urol 63(1):45–57

    Article  Google Scholar 

  2. Bricker EM (1950) Bladder substitution after pelvic evisceration. Surg Clin North Am 30(5):1511–1521

    Article  CAS  Google Scholar 

  3. Su J, Hoy N, Fafaj A, Tastaldi L, Strong A, Rosen M et al (2021) The European Hernia Society classification applied to the rare cases of parastomal hernia after ileal conduit urinary diversion: a retrospective cohort of 96 patients. Hernia 25(1):125–131

    Article  CAS  Google Scholar 

  4. Narang S, Alam N, Campain N, Pathak S, McGrath J, Daniels I et al (2017) Parastomal hernia following cystectomy and ileal conduit urinary diversion: a systematic review. Hernia 21(2):163–175

    Article  Google Scholar 

  5. Gore J, Litwin M (2009) Urologic diseases in America project. Quality of care in bladder cancer: trends in urinary diversion following radical cystectomy. World J Urol 27(1):45–50

    Article  Google Scholar 

  6. Śmietański M, Szczepkowski M, Alexandre J, Berger D, Bury K, Conze J et al (2014) European Hernia Society classification of parastomal hernias. Hernia 18(1):1–6

    Article  Google Scholar 

  7. Rezaee M, Goldwag J, Goddard B, Bihrle W, Viazmenski A, Wilson M et al (2020) Parastomal hernia development after cystectomy and ileal conduit for bladder cancer: results from the Dartmouth ileal conduit enhancement (DICE) project. Can J Urol 27(5):10369–10377

    PubMed  Google Scholar 

  8. Liedberg F, Kollberg P, Allerbo M, Baseckas G, Brändstedt J, Gudjonsson S et al (2020) Preventing parastomal hernia after ileal conduit by the use of a prophylactic mesh: a randomised study. Eur Urol 78(5):757–763

    Article  Google Scholar 

  9. Tenzel P, Williams Z, McCarthy R, Hope W (2018) Prophylactic mesh used in ileal conduit formation following radical cystectomy: a retrospective cohort. Hernia 22(5):781–784

    Article  CAS  Google Scholar 

  10. Muysoms F, Campanelli G, Champault G, DeBeaux A, Dietz U, Jeekel J et al (2012) EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair. Hernia 16:239–250

    Article  CAS  Google Scholar 

  11. Dindo D, Demartines N, Clavien P (2004) Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–13

    Article  Google Scholar 

  12. Pauli E, Juza R, Winder J (2016) How I do it: novel parastomal herniorrhaphy utilizing transversus abdominis release. Hernia 20(4):547–552

    Article  Google Scholar 

  13. Hansson B, Slater N, van der Velden A, Groenewoud H, Buyne O, de Hingh I et al (2012) Surgical techniques for parastomal hernia repair: a systematic review of the literature. Ann Surg 255(4):685–695

    Article  Google Scholar 

  14. De Robles M, Young C (2020) Parastomal hernia repair with onlay mesh remains a safe and effective approach. BMC Surg 20(1):296

    Article  Google Scholar 

  15. Faba O, Rosales A, Breda A, Palou J, Gaya J, Esquena S et al (2011) Simplified technique for parastomal hernia repair after radical cystectomy and ileal conduit creation. Urology 77(6):1491–1494

    Article  Google Scholar 

  16. Franks M, Hrebinko R (2001) Technique of parastomal hernia repair using synthetic mesh. Urology 57(3):551–553

    Article  CAS  Google Scholar 

  17. Helal M, Austin P, Spyropoulos E, Pow-Sang J, Persky L, Lockhart J (1997) Evaluation and management of parastomal hernia in association with continent urinary diversion. J Urol 157(5):1630–1632

    Article  CAS  Google Scholar 

  18. Safadi B (2004) Laparoscopic repair of parastomal hernias: early results. Surg Endosc 18(4):676–680

    Article  CAS  Google Scholar 

  19. Ho K, Fawcett D (2004) Parastomal hernia repair using the lateral approach. BJU Int 94(4):598–602

    Article  Google Scholar 

  20. Tully K, Roghmann F, Pastor J, Noldus J, von Bodman C (2019) Parastomal hernia repair with 3-d mesh implants after radical cystectomy and ileal conduit urinary diversion - a single-center experience using a purpose made alloplastic mesh implant. Urology 131:245–249

    Article  Google Scholar 

  21. Ayuso S, Shao J, Deerenberg E, Elhage S, George M, Heniford B et al (2020) Robotic Sugarbaker parastomal hernia repair: technique and outcomes. Hernia. https://doi.org/10.1007/s10029-020-02328-x (Epub ahead of print)

    Article  PubMed  Google Scholar 

  22. Fitzgerald M, Ullrich S, Singh K, Misholy O, Kingham P, Brady M (2018) Parastomal hernia repair using the “top hat” technique - an initial experience in 30 patients at Memorial Sloan Kettering Cancer Center. Am J Surg 216(3):465–470

    Article  Google Scholar 

  23. Olmi S, Oldani A, Uccelli M, Scotto B, Cesana G, Ciccarese F et al (2019) Laparoscopic modified keyhole technique with coated polyester mesh for treatment of parastomal hernia: measures for improving the outcome. J Laparoendosc Adv Surg Tech A 29(5):681–684

    Article  Google Scholar 

  24. Dewulf M, Aspeslagh L, Nachtergaele F, Pletinckx P, Muysoms F (2021) Robotic-assisted laparoscopic inguinal hernia repair after previous transabdominal prostatectomy. Surg Endosc. https://doi.org/10.1007/s00464-021-08497-9 (Epub ahead of print)

    Article  PubMed  PubMed Central  Google Scholar 

  25. Grossi J, Lee B, Belyansky I, Carbonell A, Cavazzola L, Novitsky Y et al (2021) Critical view of robotic-assisted transverse abdominal release (r-TAR). Hernia. https://doi.org/10.1007/s10029-021-02391-y (Epub ahead of print)

    Article  PubMed  Google Scholar 

  26. Christopher A, Fowler C, Patel V, Mellia J, Morris M, Broach R et al (2021) Bilateral transversus abdominis release: complex hernia repair without sacrificing quality of life. Am J Surg. https://doi.org/10.1016/j.amjsurg.2021.03.020 (Epub ahead of print)

    Article  PubMed  Google Scholar 

  27. Sadava E, Peña M, Bras Harriott C, Casas M, Schlottmann F, Laxague F (2021) Long-term outcomes and quality of life assessment after posterior component separation with transversus abdominis muscle release (TAR). Surg Endosc. https://doi.org/10.1007/s00464-021-08402-4 (Epub ahead of print)

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Maria Middelares, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium

    M. Dewulf, P. Pletinckx, F. Nachtergaele & Filip Muysoms

  2. Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands

    M. Dewulf & N. Hildebrand

  3. Department of Urology, Maria Middelares, Ghent, Belgium

    F. Ameye & P. Dekuyper

Authors
  1. M. Dewulf
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  2. P. Pletinckx
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  3. F. Nachtergaele
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  4. F. Ameye
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  5. P. Dekuyper
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  6. N. Hildebrand
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  7. Filip Muysoms
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Corresponding author

Correspondence to Filip Muysoms.

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Conflict of interest

M. Dewulf, P. Pletinckx, F. Nachtergaele, F. Ameye, P. Dekuyper, and N. Hildebrand have no conflicts of interest or financial ties to disclose. F. Muysoms reports having received research grants from Intuitive, Medtronic, Dynamesh and received speakers honorarium from Medtronic, Bard-Davol, Dynamesh, Intuitive, WL Gore, and received consultancy fees from Medtronic, Intuitive, CMR Surgical.

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Dewulf, M., Pletinckx, P., Nachtergaele, F. et al. How-I-do-it: minimally invasive repair of ileal conduit parastomal hernias. Langenbecks Arch Surg 407, 1291–1301 (2022). https://doi.org/10.1007/s00423-021-02393-5

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  • DOI: https://doi.org/10.1007/s00423-021-02393-5

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