title: Incidence and risk factors of parastomal hernia in patients undergoing radical cystectomy and ileal conduit diversion.
abstract: OBJECTIVE
  We evaluate the incidence and risk factors of parastomal hernia formation in patients undergoing radical cystectomy and ileal conduit urinary diversion.
  
  
  METHODS
  We retrospectively reviewed the Indiana University cystectomy database between 2001 and 2011, and identified 516 patients who underwent radical cystectomy and ileal conduit diversion. Overall 199 patients had a clinical followup of at least 12 months and all underwent postoperative staging computerized tomography to confirm the presence of parastomal hernia. The incidence of parastomal hernia is reported with correlations made to demographic, patient level and perioperative risk factors.
  
  
  RESULTS
  A parastomal hernia developed in 58 patients (29%) at a median followup of 27 months (range 12 to 125). Of these patients 26 (45%) underwent surgical repair due to abdominal discomfort (58%), acute strangulation or obstruction of the small bowel (15%), partial small bowel obstructions (15%) and elective repair for other intra-abdominal procedures (12%). Prior exploratory laparotomy (adjusted HR 1.98, 95% CI 1.97-3.36, p = 0.011) and severe obesity (adjusted HR 4.26, 95% CI 1.52-11.93, p = 0.006) were predictive of parastomal herniation. The cumulative risk of parastomal hernia formation at 1 and 2 years after cystectomy was 12.2% and 22.5%, respectively.
  
  
  CONCLUSIONS
  We demonstrated that parastomal hernia will develop in nearly a third of patients after radical cystectomy with ileal conduit diversion. Prior laparotomy and severe obesity are independent risk factors. Preoperative counseling and preventative measures regarding parastomal hernia formation should be emphasized, particularly in these at risk patients.
authors: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
authors: Nick W
authors: NW
authors: Liu
authors: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
authors: Jeromy T
authors: JT
authors: Hackney
authors: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
authors: Paul T
authors: PT
authors: Gellhaus
authors: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
authors: M Francesca
authors: MF
authors: Monn
authors: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
authors: Timothy A
authors: TA
authors: Masterson
authors: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
authors: Richard
authors: R
authors: Bihrle
authors: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
authors: Thomas A
authors: TA
authors: Gardner
authors: Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors: Michael G
authors: MG
authors: House
authors: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: mkoch2@iuhealth.org.
authors: Michael O
authors: MO
authors: Koch
mesh_terms: D000368:Aged; D015653:Cystectomy; D005260:Female; D006555:Hernia, Ventral / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D054047:Surgical Stomas; D014547:Urinary Diversion
keywords: abdominal; cystectomy; hernia; urinary bladder neoplasms; urinary diversion