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Goffioul L, Zjukovitsj D, Moise M, Waltregny D, Detry O. Repair of parastomal hernia after Bricker procedure: retrospective consecutive experience of a tertiary center. Hernia 2024; 28:823-830. [PMID: 38150078 DOI: 10.1007/s10029-023-02940-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/26/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Ileal conduit parastomal hernias (ICPHs) are frequent after radical cystectomy with ileal conduit urinary diversion, but their management is debated. This study aimed to review the results of ICPH repair according to Sugarbaker or Sandwich techniques, with special interest in ICPH recurrence and urological complications. METHODS The authors reviewed a consecutive series of patients undergoing ICPH repair between January 2014 and December 2020. Primary endpoints were ICPH recurrences at clinical exam and cross-sectional abdominal computed tomography (CT) scans. Secondary endpoints were any other complications possibly related to the ICPH repair. RESULTS Twenty-three patients underwent ICPH repair surgery (16 Sugarbaker and 7 Sandwich techniques) during the study period. Sixteen patients underwent a primary laparoscopic approach. All but one patient underwent at least one abdominal CT during the follow-up. Median clinical and CT scan follow-up times were 57 and 50.5 months, respectively. Clinical and CT ICPH recurrence rates were 4.5% and 13% at 5 years, respectively. Eighteen patients (78%) suffered no urological complications during the follow-up period, but three patients (13%) needed redo surgery on the urinary ileal conduit. CONCLUSION The modified Sugarbaker or Sandwich techniques might be considered as promising techniques for ICPH repair with a low rate of recurrence. The urological complications, and particularly the ileal conduit-related issues, need to be evaluated in further studies. Controlled and prospective data are required to compare the Sugarbaker and Sandwich techniques to the Keyhole approach for ICPH repairs.
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Affiliation(s)
- L Goffioul
- Department of Abdominal Surgery and Transplantation, Division of Abdominal Wall Surgery, CHU Liege, University of Liege, Sart Tilman B35, B4000, Liege, Belgium
- Department of Abdominal Surgery, CHR Citadelle, Liege, Belgium
| | - D Zjukovitsj
- Department of Abdominal Surgery and Transplantation, Division of Abdominal Wall Surgery, CHU Liege, University of Liege, Sart Tilman B35, B4000, Liege, Belgium
| | - M Moise
- Department of Radiology, CHU Liege, University of Liege, Liege, Belgium
| | - D Waltregny
- Department of Urology, CHU Liege, University of Liege, Liege, Belgium
| | - O Detry
- Department of Abdominal Surgery and Transplantation, Division of Abdominal Wall Surgery, CHU Liege, University of Liege, Sart Tilman B35, B4000, Liege, Belgium.
- Centre de Recherche et d'Enseignement du Département de Chirurgie (CREDEC), University of Liege, Liege, Belgium.
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Martínez-López P, Rodrigues-Gonçalves V, Verdaguer-Tremolosa M, Pereira JA, Hernández-Granados P, López-Cano M. Lateral incisional hernia. EVEREG registry analysis. Hernia 2024:10.1007/s10029-024-03073-1. [PMID: 38771440 DOI: 10.1007/s10029-024-03073-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/12/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The aim of this study is to analyze the data collected on lateral incisional hernias (LIH) in the National Incisional Hernia Registry (EVEREG) and assess current practices and outcomes in LIH repair. METHODS A retrospective cohort study was conducted using LIH data recorded over 10 years (2012-2022). Comorbidities, hernia characteristics, short-term complications, and recurrences were studied, along with their association with the type of approach used, either open or laparoscopic, in elective surgery. RESULTS 1742 LIH cases were studied. According to the EHS classification, these included L1 409 (23.5%), L2 388 (22.3%), L3 565 (32.4%), L4 150 (8.6%) and combined 230 (13.2%). An open approach was performed in 1528 (87.7%) cases and laparoscopic in 214 (12.3%). The median age was 66 ± 12.45 years, with a majority of males, 934 (53.6%). The median body mass index was 29 ± 5.18 kg/m2. The most observed comorbidity was arterial hypertension (957 patients, 55%). A specialist was present in 638 interventions (56%). The 24-month follow-up was 17.9%, and recurrence in those cases was 27.2%, with a higher incidence when there was no specialist present during the intervention, onlay mesh position, and larger defect size. CONCLUSIONS Surgery for LIH is common, although laparoscopic approach remains infrequent. Furthermore, it is associated with a high percentage of recurrences that increases when there is no specialist in abdominal wall surgery present.
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Affiliation(s)
- P Martínez-López
- Abdominal Wall Surgery Unit, General Surgery Service, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
| | - V Rodrigues-Gonçalves
- Abdominal Wall Surgery Unit, General Surgery Service, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - M Verdaguer-Tremolosa
- Abdominal Wall Surgery Unit, General Surgery Service, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - J A Pereira
- General Surgery Service, Department of Experimental and Health Sciences, Hospital Universitari del Mar, Pompeu Fabra University, Barcelona, Spain
| | | | - M López-Cano
- Abdominal Wall Surgery Unit, General Surgery Service, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
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Barranquero AG, Espert JJ, Llompart Coll MM, Maestre González Y, Gas Ruiz C, Olsina Kissler JJ, Villalobos Mori R. Analysis of recurrence and risk factors in laparoscopic sandwich technique for parastomal hernia repair. Surg Endosc 2023; 37:9125-9131. [PMID: 37814164 DOI: 10.1007/s00464-023-10475-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/17/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Parastomal hernias are frequent and highly recurrent. The sandwich technique is a combination of the keyhole and Sugarbaker techniques, using a double intraperitoneal mesh. The objective of this study was to assess the outcomes of the sandwich technique, specifically focusing on recurrence rates. MATERIALS AND METHODS Observational retrospective study conducted in two tertiary referral centers in Catalonia, Spain. All consecutive patients who underwent parastomal hernia repair using the sandwich technique between 1st January 2016 and 31st December 2021 were included. RESULTS A total of 38 patients underwent the laparoscopic sandwich technique for parastomal hernia repair. The overall recurrence rate was 7.9% (3/38), with a median follow-up of 39 months (IQR: 12.3-56.5). According to the EHS classification for parastomal hernia, there were 47.4% (18/38) type I defects, 10.5% (4/38) type II defects, 28.9% (11/38) type III defects, and 13.2% (5/38) type IV defects. The used mesh was predominantly TiMesh® (76.3%; 29/38), followed by DynaMesh® IPOM (23.7%; 9/38). Patients with recurrence exhibited higher rates of seroma, hematoma, surgical site infection, and one case of early recurrence attributed to mesh retraction. Consequently, postoperative complications emerged as the primary risk factor for hernia recurrence. CONCLUSION The sandwich technique demonstrated recurrence rates consistent with those reported in the existing literature.
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Affiliation(s)
- Alberto G Barranquero
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Catalonia, Spain.
| | - Juan José Espert
- Abdominal Wall Unit, General and Digestive Surgery Department, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - María Magdalena Llompart Coll
- Abdominal Wall Unit, General and Digestive Surgery Department, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Yolanda Maestre González
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Catalonia, Spain
| | - Cristina Gas Ruiz
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Catalonia, Spain
| | - Jorge Juan Olsina Kissler
- General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Lleida, Catalonia, Spain
| | - Rafael Villalobos Mori
- Abdominal Wall Surgery Division, General and Digestive Surgery Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Catalonia, Spain
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Dewulf M, Hildebrand ND, Bouwense SAW, Bouvy ND, Muysoms F. Parastomal hernias after cystectomy and ileal conduit urinary diversion: surgical treatment and the use of prophylactic mesh: a systematic review. BMC Surg 2022; 22:118. [PMID: 35351086 PMCID: PMC8966280 DOI: 10.1186/s12893-022-01509-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/04/2022] [Indexed: 12/03/2022] Open
Abstract
Background Parastomal hernia after ileal conduit urinary diversion is an underestimated and undertreated clinical entity, which heavily impairs patients’ quality of life due to symptoms of pain, leakage, application or skin problems. As for all gastrointestinal stomata the best surgical repair technique has yet to be determined. Thereby, surgery for ileal conduit parastomal hernias poses some specific perioperative challenges. This review aims to give an overview of current evidence on the surgical treatment of parastomal hernia after cystectomy and ileal conduit urinary diversion, and on the use of prophylactic mesh at index surgery in its prevention. Methods A systematic review was performed according to PRISMA-guidelines. The electronic databases Embase, PubMed, Cochrane Library, and Web of Science were searched. Studies were included if they presented postoperative outcomes of patients undergoing surgical treatment of parastomal hernia at the ileal conduit site, irrespective of the technique used. A search was performed to identify additional studies on prophylactic mesh in the prevention of ileal conduit parastomal hernia, that were not identified by the initial search. Results Eight retrospective case-series were included for analysis, reporting different surgical techniques. If reported, highest complication rate was 45%. Recurrence rates varied highly, ranging from 0 to 80%. Notably, lower recurrence rates were reported in studies with shorter follow-up. Overall, available data suggest significant morbidity after the surgical treatment of ileal conduit parastomal hernias. Data from five conference abstracts on the matter were retrieved, and systematically reported. Regarding prophylactic mesh in the prevention of ileal conduit parastomal hernia, 5 communications were identified. All of them used keyhole mesh in a retromuscular position, and reported on favorable results in the mesh group without an increase in mesh-related complications. Conclusion Data on the surgical treatment of ileal conduit parastomal hernias and the use of prophylactic mesh in its prevention is scarce. Given the specific perioperative challenges and the paucity of reported results, more high-quality evidence is needed to determine the optimal treatment of this specific surgical problem. Initial results on the use of prophylactic mesh in the prevention of ileal conduit parastomal hernias seem promising. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01509-y.
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Affiliation(s)
- M Dewulf
- Department of Surgery, Maastricht UMC+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands. .,Department of Surgery, Maria Middelares, Gent, Belgium.
| | - N D Hildebrand
- Department of Surgery, Maastricht UMC+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - S A W Bouwense
- Department of Surgery, Maastricht UMC+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - N D Bouvy
- Department of Surgery, Maastricht UMC+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - F Muysoms
- Department of Surgery, Maria Middelares, Gent, Belgium
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