Anterior fascial fixation does not reduce the parastomal hernia rate after radical cystectomy and ileal conduit.
OBJECTIVE
To compare the rate of parastomal hernia in patients undergoing anterior fascial fixation of the ileal conduit with that in patients without fascial fixation. Limited data exist on whether anterior fascial fixation of the ileal conduit impacts the rate of parastomal hernia.


METHODS
A total of 496 consecutive patients undergoing radical cystectomy and ileal conduit reconstruction from 1995 to 2012 were retrospectively evaluated for parastomal hernia. All patients had a 2-fingerbreadth aperture and the ileal conduit brought through the rectus muscle and sheath. Patients were divided into 1 of 3 groups based on stoma fixation and/or reinforcement: anterior fascial fixation, posterior reinforcement, or no fascial fixation. A parastomal hernia was defined as a palpable bulge at the stoma site. Multivariate logistic regression was conducted for the primary end point of parastomal hernia, controlling for other patient- and treatment-related factors that might affect the rate of parastomal hernia.


RESULTS
Median follow-up was 16 months (range, 1-189 months). The parastomal hernia rate was significantly greater in the anterior fascial suture group (43 of 281; 15.3%) than the no fascial suture group (12 of 164; 7.3%; P=.02). Multivariate logistic regression analysis modeled for the occurrence of a parastomal hernia demonstrated that anterior fascial fixation was an independent predictor of the development of parastomal hernia (odds ratio, 2.3; 95% confidence interval, 1.03-5.14; P=.04).


CONCLUSIONS
Anterior fascial fixation of the ileal conduit does not reduce the risk of parastomal hernia formation compared with the patients treated without fascial fixation. Surgeons should consider avoiding anterior suture fixation during ileal conduit creation.
Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: cimedina@mdanderson.org.
Andrew L
AL
Pisters
Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
Ashish M
AM
Kamat
Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX.
Wei
W
Wei
Department of Urology, Assaf Harofeh Medical Center, Zerifin, Israel.
Dan
D
Leibovici
Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX.
Jun
J
Liu
Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
H Barton
HB
Grossman
Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX.
Charles E
CE
Butler
D000368:Aged; D015331:Cohort Studies; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D054047:Surgical Stomas / Q000009:adverse effects*; D013536:Suture Techniques; D013718:Tensile Strength; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery; D014547:Urinary Diversion / Q000009:adverse effects*