title: Rationale and Early Experience with Prophylactic Placement of Mesh to Prevent Parastomal Hernia Formation after Ileal Conduit Urinary Diversion and Cystectomy for Bladder Cancer.
abstract: Parastomal hernias (PH) represent a clinically significant problem for many patients after radical cystectomy and ileal conduit diversion. The prevalence may be as high as 60% and in some series, up to 30% of patients require surgical intervention due to the complications of pain, poor fit of an ostomy appliance, leakage, urinary obstruction, and bowel obstruction or strangulation. Due to the potential morbidity associated with PH repair, there have been efforts to prevent PH development at the time of the index surgery. Four randomized trials of prophylactic mesh placement at the time of colostomy and ileostomy stoma formation have demonstrated significant reductions in PH rates with acceptably low complication rates. In this review, we describe the clinical and radiographic definitions of PH, the clinical impact and risk factors behind its development, and the rationale behind prophylactic mesh placement for patients undergoing ileal conduit urinary diversion. Additionally, we report our experience with prophylactic mesh placed at radical cystectomy at our institution.
authors.affiliation: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, 20889, USA. timothy.f.donahue@gmail.com.
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Donahue
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. chae@mskcc.org.
authors.forename: Eugene K
authors.initials: EK
authors.lastname: Cha
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. bochnerb@mskcc.org.
authors.forename: Bernard H
authors.initials: BH
authors.lastname: Bochner
mesh_terms: D015653:Cystectomy / Q000009:adverse effects*; D006555:Hernia, Ventral / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D006801:Humans; D015995:Prevalence; D012307:Risk Factors; D013526:Surgical Mesh; D001749:Urinary Bladder Neoplasms / Q000601:surgery
keywords: Ileal conduit; Parastomal hernia; Radical cystectomy