title: Parastomal hernia following cystectomy and ileal conduit urinary diversion: a systematic review.
abstract: The natural history of development of Parastomal hernia (PH) following cystectomy and ileal conduit diversion is poorly understood. The aim of this study was to systematically review the frequency and risk factors of PH following ileal conduit diversion.
  
  
  
  A systematic review of literature was performed and the Cochrane, EMBASE and PubMed databases were searched from 1stJanuary 1985 to 30th April 2016. All articles reporting occurrence of PH following cystectomy and ileal conduit diversion were analysed. The primary outcome measure was the frequency of development of PH. Secondary outcome measures were risk factors for PH development, complications of PH, frequency of PH repair and recurrence of PH.
  
  
  
  Twelve articles of the 63 originally identified were analysed. Sample sizes ranged from 36 to 1057 patients with a pooled total of 3170 undergoing ileal conduit surgery. Age at the time of surgery ranged from 31 to 92 years. Of the 3170 patients who underwent ileal conduit surgery, 529 patients (17.1%) developed a PH based on either clinical examination or cross sectional imaging. Female gender, high BMI, low preoperative albumin and previous laparotomy were significantly associated with the development of PH in two studies. Repair of PH was offered to 8-75% of patients. The rate of recurrence following repair of PH was reported to range from 27 to 50%.
  
  
  
  A PH is frequent following cystectomy and ileal conduit urinary diversion. The diagnosis of a PH depends upon duration of clinical follow-up and the use of cross-sectional imaging. The recurrence rates following the repair of a PH remain substantial.
authors.affiliation: Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Room E302, Barrack Road, Exeter, Devon, EX2 5DW, UK.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Narang
authors.affiliation: Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Room E302, Barrack Road, Exeter, Devon, EX2 5DW, UK.
authors.forename: Nasra N
authors.initials: NN
authors.lastname: Alam
authors.affiliation: Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Room E302, Barrack Road, Exeter, Devon, EX2 5DW, UK.
authors.forename: Nick J
authors.initials: NJ
authors.lastname: Campain
authors.affiliation: Bristol Royal Infirmary, Upper Maudlin Street, Bristol, BS2 8HW, UK.
authors.forename: Samir
authors.initials: S
authors.lastname: Pathak
authors.affiliation: Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Room E302, Barrack Road, Exeter, Devon, EX2 5DW, UK.
authors.forename: John S
authors.initials: JS
authors.lastname: McGrath
authors.affiliation: Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Room E302, Barrack Road, Exeter, Devon, EX2 5DW, UK.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Daniels
authors.affiliation: Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital, Room E302, Barrack Road, Exeter, Devon, EX2 5DW, UK. drneilsmart@hotmail.com.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Smart
mesh_terms: D015653:Cystectomy; D006555:Hernia, Ventral / Q000209:etiology*; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects*
keywords: Cystectomy; Ileal conduit; Morbidity; Parastomal hernia; Urinary diversion