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P024: KEYHOLE VERSUS SUGARBAKER TECHNIQUES IN PARASTOMAL HERNIA REPAIR AT BRICKER CONDUIT: A RETROSPECTIVE NATIONWIDE COHORT STUDY WITH LONG-TERM FOLLOW-UP
Elisa Mäkäräinen-Uhlbäck, MD1; Jaana Vironen, MD, PhD2; Markku Vaarala, MD, PhD1; Ville Falenius, MD3; Anu Välikoski, MD, PhD4; Jyrki Kössi, MD, PhD5; Aristoteles Kechagias, MD, PhD6; Tom Scheinin, MD, PhD2; Anne Mattila, MD, PhD7; Pasi Ohtonen, MSc1; Tero Rautio, MD, PhD1; 1Oulu University Hospital; 2Helsinki University Hospital; 3Turku University Hospital; 4Tampere University Hospital; 5Lahti Central Hospital; 6Hämeenlinna Central Hospital; 7Jyväskylä Central Hospital
Background: Despite parastomal hernia (PSH) is a frequent complication following cystectomy and ileal conduit urinary diversion, only few reports have been published on the surgical treatment of PSH. The aim of this retrospective nationwide cohort study is to report the results of parastomal hernia repair at ileal conduit with special interest in comparing keyhole and Sugarbaker techniques.
Methods: Data of all patients who had a primary ileal conduit parastomal hernia repaired 2007-2017 were retrospectively retrieved from each hospital’s patient database using existing ICD-10 and operation codes. Clinical data was collected using specially designed electrical case report forms. The primary outcome of this study was parastomal hernia recurrence after primary repair. Secondary outcomes were complication and reoperation rates.
Results: A total of 34 patients were operated for primary ileal conduit parastomal hernia in three university and three central hospitals in Finland 2007-2017. The most common techniques to repair PSH in this study were keyhole technique (25/34, 73.5%) divided to intra-abdominal mesh location (15/25, 60.0%) and other locations (10/25, 40.0%) and Sugarbaker technique (6/34, 17.6 %). The overall mean follow-up time was 57.4 months (1-145 months, SD 42.2), which was significantly shorter after Sugarbaker repair with mean follow-up of 16.5 months (1-25, SD 8.9 months). The overall PSH recurrence rate is 35.3 % (12/34) after primary PSH repair. The recurrence rate is 36.0 % (9/25) for parastomal hernias repaired by keyhole technique. However, when patients operated by keyhole technique are divided to subgroups according to mesh location, the recurrence rate after intra-abdominal keyhole repair is 26.7% (4/15) and other mesh locations 50.0% (5/10). None of the parastomal hernias operated by Sugarbaker technique (n=6) had a recurrence during follow-up (p=0.222). Re-operation had undergone 38.2 % of all patients (13/34) during follow-up including re-operation rates 33.3% (5/15) and 50.0% (5/10) after intra-abdominal and other location keyhole repairs, respectively. None of the patients had a re-operation after primary Sugarbaker repair. There was no difference in complications. The overall complications rate is 24.5% (8/34).
Conclusion: Parastomal hernia repair after ileal conduit urinary diversion is a rare complex operation with unacceptable nationwide results in terms of recurrence, complications and reoperations. Lessons learned from end-colostomy parastomal hernia repairs should guide both practice and research to abandon traditional keyhole technique. Further international research and registries are demanded due to rarity of the ileal conduit parastomal hernia repair and to compare more advanced methods and meshes.
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