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

Abstract

Objective. There are no data on the frequency of parastomal hernia (PSH) after ileal conduit with a prophylactic mesh. The primary objective of this study was to determine the prevalence of PSH. Secondary objectives were to elaborate whether age, gender, body mass index (BMI), previous laparotomy or diabetes influenced the outcome; and to find any mesh-related complications. Materials and methods. In a single centre during 2003-2012, a large-pore, lightweight mesh was placed in a sublay position in 114 consecutive patients with ileal conduits. Preoperative and postoperative patient data were retrospectively collected and cross-sectional follow-up was conducted. During the predefined clinical examination a PSH was defined as any protrusion in the vicinity of the ostomy with the patient straining in both an erect and a supine position. Results.Fifty-eight patients (24 women and 34 men, mean age 69 years) had follow-up examinations after a mean of 35 months (median 32 months). Bladder cancer was the most common cause for surgery. Eight patients (14%) had a PSH. Age, gender, BMI, previous laparotomy and diabetes did not affect the outcome. No mesh-related complications occurred among the 114 patients with a prophylactic mesh. Conclusions. The prevalence of PSH after ileal conduit with a prophylactic mesh corresponded to that of colostomies with a prophylactic mesh. A prophylactic mesh did not seem to be associated with complications. The degree to which a prophylactic mesh may reduce the rate of PSH after an ileal conduit should be established in randomized trials.

Key Words:

• bladder cancer
• ostomy
• parastomal hernia
• surgical mesh
• urinary diversion

Acknowledgements

The authors thank Magnus Widmark and Malin Lindell for highly valued support in the data collection, and the surgeons Lars Danielsson, Per Lindblad, Leif Rentzhog, Torsten Viktorin, Lars Åhsgren, and Kerstin Åslund for their dedicated work.

Declaration of interest: The authors have no conflicts of interest. The study was not supported by any grants.