Login to Access Video or Poster Abstract: MP52-18
Sources of Funding: none

Introduction

Using cross-sectional imaging parastomal hernia (PSH) is detected with a frequency of up to 65% in patients treated with cystectomy and ileal conduit (IC) diversion. While many patients initially remain asymptomatic, up to 30% need surgical repair due to clinical symptoms impacting quality of life. Common repair methods to treat this most frequent complication after IC diversion using native tissue show unacceptable high recurrence rates (>70%), which has led to mesh based repair techniques. Effective and safe surgical techniques and outcomes need to be reported in the urologic literature. _x000D_ We report our open surgical technique and results using an intraperitoneal onlay mesh with a central funnel for the conduit aiming to minimize mesh penetration and PSH recurrence._x000D_

Methods

Between 1/2004 and 12/2015, 643 patients were treated with ileal conduit urinary diversion at our institution. Subsequently 40 Patients (6,2%) underwent open PSH repair between 2/2009 and 3/2016 using a novel intraperitoneal-onlay-mesh with a central hole (2cm diameter) and funnel for intestinal parts (DynaMesh IPST). As surgical access we used a 4 cm longitudinal incision below and above the stoma. The mesh was placed intraperitoneally as an onlay and fixed at four corner points with non-absorbent sutures. Patients received clinical and ultrasound follow-up to monitor treatment success and effectiveness. While perioperative data was available for 40 patients, 13 could not be followed at our institution, leading to 27 patients with follow-up data.

Results

Of the 40 patients perioperatively only one patient developed a wound infection, which was managed with multiple surgical debridements keeping the mesh in place._x000D_ 27 Patients (16 male, 11 female) with a median age of 74 years and a median BMI of 29.4 kg/m² (IQR 25; 31) could be followed with a median follow up of 29 months (IQR 16; 63). Two patients developed a stoma stenosis (7%) with consecutive dilation of the renal pelvis which needed to be drained with a nephrostomy. Only two patients (7%) developed a PSH recurrence after mesh implant with one of them being in need of revision at last follow-up._x000D_ No patient showed a penetration of the mesh into the intestine, stoma necrosis or stoma prolapse._x000D_

Conclusions

The described open surgical technique shows a low perioperative complication rate and a promising low PSH recurrence rate of only 7%. A specifically designed 2-component mesh with a central funnel implanted as an intraperitoneal onlay seems to provide an effective treatment option for PSH repair after ileal conduit diversion.

Funding

none