https://doi.org/10.4081/aiua.2023.12108

Parastomal hernia after radical cystectomy. Incidence, natural history and predictive factors – A single center study

Vol. 95 No. 4 (2023)
Published: December 29, 2023
Parastomal hernia, Radical cystectomy, Ileal conduit, Risk factors, Natural history
Abstract Views: 354
PDF: 315
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Maria Alonso Grandes
marialonsograndes@gmail.com
https://orcid.org/0000-0002-0061-4665
University Hospital of Fuenlabrada, Department of Urology, Fuenlabrada, Madrid, Spain.
José Antonio Herranz Yagüe
University Hospital of Fuenlabrada, Department of Urology, Fuenlabrada, Madrid, Spain.
Rocío Roldán Testillano
University Hospital of Fuenlabrada, Department of Urology, Fuenlabrada, Madrid, Spain.
Alfonso María Márquez Negro
University Hospital of Fuenlabrada, Department of Urology, Fuenlabrada, Madrid, Spain.
Casilda Cernuda Pereira
University Hospital of Fuenlabrada, Department of Urology, Fuenlabrada, Madrid, Spain.
Emilio And´rés Ripalda Ferretti
University Hospital of Fuenlabrada, Department of Urology, Fuenlabrada, Madrid, Spain.
Álvaro Páez Borda
University Hospital of Fuenlabrada, Department of Urology, Fuenlabrada, Madrid, Spain.

Purpose: Parastomal hernia (PH) is one of the most frequent complications after stoma creation. Our objective was to analyze the incidence, evolution and predictive factors of PH in Bricker-type urinary diversion. Patients and methods: Case series analysis of 125 patients submitted to radical cystectomy and ileal conduit diversion for cancer in a single center during 2006-2021. Patient’s record and imaging tests were reviewed to identify those suffering PH. Moreno-Matías classification was used to define radiological PH (rPH). Demographic and preoperative characteristics of the patients, surgical details and postoperative complications were recorded. Univariate and multivariate analyses were conducted to determine the effect of each predictive variable on the development and progression of PH. Results: 21.6% of patients developed PH (median follow-up 37 months). Incidence increased with follow-up time (15.2% at 1 year, 20.8% at 2 years). BMI ≥ 25 (Expβ 8.31, 95% CI 1.06- 65.18, p = 0.04), previous midline laparotomy (Expβ 6.74, 95% CI 1.14-39.66, p = 0.04) and wound infection (Expβ 3.87, 95% CI 1.21-12.33, p = 0.02) were significantly associated with PH. Half of the patients with hernia had symptoms, 25.9% requiring surgical correction. 46% of type 1 hernias and 40% of type 2 hernias progressed to grade 3 with a median of 11 months. No variable was associated with radiological progression. Conclusions: This study proved 3 independent factors (overweight, laparotomy and wound infection) that increase the risk of developing PH.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Caricato M, Ausania F, Ripetti V, Bartolozzi F, Campoli G, Coppola R (2007) Retrospective analysis of long-term defunctioning stoma complications after colorectal surgery. Colorectal Dis. 9:559-61. https://doi.org/10.1111/j.1463-1318.2006.01187.x DOI: https://doi.org/10.1111/j.1463-1318.2006.01187.x
Gerharz EW, Mansson A, Hunt S, Skinner EC, Månsson W (2005) Quality of life after cystectomy and urinary diversion: an evidence-based analysis. J Urol 174:1729-36. https://doi.org/10.1097/01.ju.0000176463.40530.05 DOI: https://doi.org/10.1097/01.ju.0000176463.40530.05
Uriarte Vergara B, Gutiérrez Ferreras AI, Pérez de Villarreal Amilburu P, Hierro-Olabarria Salgado L, Roca Domínguez MB, Zorraquino González A (2021) Guía para el manejo actualizado de la hernia paraestomal. Rev Hispanoam Hernia 9(2):126-130
Donahue TF, Bochner BH, Sfakianos JP, Kent M, Bernstein M, Hilton WM, et al (2014) Risk factors for the development of parastomal hernia after radical cystectomy. J Urol 191:1708-13 https://doi.org/10.1016/j.juro.2013.12.041 DOI: https://doi.org/10.1016/j.juro.2013.12.041
Liu NW, Hackney JT, Gellhaus PT, Monn MF, Masterson TA, Bihrle R, et al (2014) Incidence and risk factors of parastomal hernia in patients undergoing radical cystectomy and ileal conduit diversion. J Urol 191:1313-8 https://doi.org/10.1016/j.juro.2013.11.104 DOI: https://doi.org/10.1016/j.juro.2013.11.104
Muysoms F, Campanelli G, Champault GG (2012) EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair. Hernia. 2012;16:239-250. https://doi.org/10.1007/s10029-012-0912-7 DOI: https://doi.org/10.1007/s10029-012-0912-7
Martínez Lahoz Y, Casas Sicilia E, Castán Villanueva N, Domingo Bretón M, Delfau Lafuente D, Valero Lázaro MI (2022) Hernias paraestomales. Revisión de la literatura. Revista Sanitaria de Investigación, ISSN-e 2660-7085, 3;8
Martin L, Foster G (1996) Parastomal hernia. Ann R Coll Surg Engl 78:81-4
Marimuthu K, Vijayasekar C, Ghosh D, Mathew G (2006) Prevention of parastomal hernia using preperitoneal mesh: a prospective observational study. Colorectal Dis 8:672-5. https://doi.org/10.1111/j.1463-1318.2006.00996.x DOI: https://doi.org/10.1111/j.1463-1318.2006.00996.x
Ripoche J, Basurko C, Fabbro-Perray P, Prudhomme M (2011) Parastomal hernia. A study of the French federation of ostomy patients. J Visc Surg 148:e435-41 https://doi.org/10.1016/j.jviscsurg.2011.10.006 DOI: https://doi.org/10.1016/j.jviscsurg.2011.10.006
Cingi A, Cakir T, Sever A, Aktan AO (2006) Enterostomy site hernias: a clinical and computerized tomographic evaluation. DisColon Rectum 49:1559-63 DOI: https://doi.org/10.1007/s10350-006-0681-4
Feng D, Wang Z, Yang Y, Li D, Wei W, Li L (2021) Incidence and risk factors of parastomal hernia after radical cystectomy and ileal conduit diversion: a systematic review and meta-analysis. Transl Cancer Res. 10(3):1389-1398 http://dx.doi.org/10.21037/tcr-2 DOI: https://doi.org/10.21037/tcr-20-3349
Seo SH, Kim HJ, Oh SY, Lee JH, Suh KW (2011) Computed tomography classification for parastomal hernia. J Korean Surg Soc 81:111-4 https://doi.org/10.4174/jkss.2011.81.2.111 DOI: https://doi.org/10.4174/jkss.2011.81.2.111
Aquina CT, Iannuzzi JC, Probst CP, Kelly KN, Noyes K, Fleming FJ et al (2014) Parastomal hernia: a growing problem with new solutions. DigSurg. 31:366-76 https://doi.org/10.1159/000369279 DOI: https://doi.org/10.1159/000369279
Donahue TF, Bochner BH (2016) Parastomal hernias after radical cystectomy and ileal conduit diversion. Investig Clin Urol. 57(4):240-8 https://doi.org/10.4111/icu.2016.57.4.240 DOI: https://doi.org/10.4111/icu.2016.57.4.240
Ghoreifi A, Allgood E, Whang G, Douglawi A, Yu W, Cai J, Miranda G, Aron M, Schuckman A, Desai M, Gill I, Daneshmand S, Duddalwar V, Djaladat H. (2022) Risk factors and natural history of parastomal hernia after radical cystectomy and ileal conduit. BJU Int. 130(3):381-388 https://doi.org/10.1111/bju.15658 DOI: https://doi.org/10.1111/bju.15658
Hussein AA, Ahmed YE, May P, Ali T, Ahmad B, Raheem S, Stone K, Hasasnah A, Rana O, Cole A, Wang D, Loud P, Guru KA (2017) Natural History and Predictors of Parastomal Hernia after Robot-Assisted Radical Cystectomy and Ileal Conduit Urinary Diversion. J Urol. 199(3):766-773 https://doi.org/10.1016/j.juro.2017.08.112 DOI: https://doi.org/10.1016/j.juro.2017.08.112
Pallisera A, Serra X, Mora L, et al. (2017) Actualización de las hernias paraestomales: diagnóstico, tratamiento y prevención Parastomal. Rev Hispanoam Hernia. 5:3-12 DOI: https://doi.org/10.20960/rhh.23
Pisters AL, Kamat AM, Wei W, Leibovici D, Liu J, Grossman HB, et al (2014) Anterior fascial fixation does not reduce the parastomal hernia rate after radical cystectomy and ileal conduit. Urology 83:1427-31 https://doi.org/10.1016/j.urology.2014.01.041 DOI: https://doi.org/10.1016/j.urology.2014.01.041
Israelsson LA (2008) Parastomal hernias. Surg Clin North Am 88:113-25 https://doi.org/10.1016/j.suc.2007.10.003 DOI: https://doi.org/10.1016/j.suc.2007.10.003
Carne PW, Frye JN, Robertson GM, Frizelle FA (2003) Parastomal hernia. Br J Surg. 90:784-93 https://doi.org/10.1002/bjs.4220 DOI: https://doi.org/10.1002/bjs.4220
Janes A, Cengiz Y and Israelsson LA (2004) Randomized clinical trial of the use of a prosthetic mesh to prevent parastomal hernia. Br J Surg 91:280 https://doi.org/10.1002/bjs.4417 DOI: https://doi.org/10.1002/bjs.4417
Liedberg F, Kollberg P, Allerbo M et al (2020) Preventing parastomal hernia after ileal conduit by the use of a prophylactic mesh: a randomised study. Eur Urol 78: 757–63 https://doi.org/10.1016/j.eururo.2020.07.033 DOI: https://doi.org/10.1016/j.eururo.2020.07.033
Hammond TM, Huang A, Prosser K et al (2008) Parastomal hernia prevention using a novel collagen implant: a randomised controlled phase 1 study. Hernia 12: 475 https://doi.org/10.1007/s10029-008-0383-z DOI: https://doi.org/10.1007/s10029-008-0383-z

How to Cite

Alonso Grandes, M., Herranz Yagüe, J. A., Roldán Testillano, R., Márquez Negro, A. M., Cernuda Pereira, C., Ripalda Ferretti, E. A., & Páez Borda, Álvaro. (2023). Parastomal hernia after radical cystectomy. Incidence, natural history and predictive factors – A single center study. Archivio Italiano Di Urologia E Andrologia, 95(4). https://doi.org/10.4081/aiua.2023.12108
Copyright (c) 2023 the Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.