Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitamashi, Japan.
Asian J Endosc Surg. 2022 Oct;15(4):850-853. doi: 10.1111/ases.13093. Epub 2022 Jul 2.
Parastomal hernia (PH) is a common complication of ileal conduit diversions. The Sugarbaker technique has a lower recurrence rate than the keyhole (KH) technique and is typically preferred. However, it may not be feasible in some cases because of anatomical features including the length of the conduit and torsion of the ureter. An 80-year-old woman with complaints of abdominal distention was diagnosed with PH 5 years after radical cystectomy. Computed tomography revealed a 90 × 20-mm muscular layer defect on the cranial side of the ileal conduit. Therefore, we performed the KH technique with intracorporeal closure of the defect using a relief incision of the posterior rectus sheath, avoiding the possibility of torsion of the ureteral ileal anastomosis. No hernia recurrence was observed at postoperative 10 months. The proposed KH plus technique may be an effective method for PH after ileal conduit diversion, thus preventing urinary complications.
肠造口旁疝（PH）是回肠造口术的常见并发症。与锁眼（KH）技术相比，Sugarbaker 技术的复发率更低，通常是首选方法。然而，由于解剖学特征，包括导管的长度和输尿管的扭转，在某些情况下可能不可行。一位 80 岁女性因腹胀就诊，在根治性膀胱切除术后 5 年被诊断为 PH。计算机断层扫描显示回肠导管头侧有 90×20mm 的肌肉层缺损。因此，我们采用 KH 技术，通过后直肌鞘的减压切口进行缺陷的体腔内闭合，避免了输尿管-回肠吻合处扭转的可能性。术后 10 个月未观察到疝复发。提出的 KH 加技术可能是回肠造口术后 PH 的有效治疗方法，可预防尿并发症。
