Department of Visceral and Digestive Surgery, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France.
CIC 1432, Module Epidémiologique Clinique, INSERM, Université de Bourgogne, Centre Hospitalier Universitaire de Dijon, Dijon, France.
World J Surg. 2024 Oct;48(10):2413-2420. doi: 10.1002/wjs.12317. Epub 2024 Sep 14.
Parastomal hernias are a challenging complication of digestive ostomies. Ileal-conduit parastomal hernias after cystectomy have specific aspects. The aim of this study was to describe the incidence and natural history of ileal-conduit parastomal hernias in order to guide their management, as well as to identify risk factors to prevent them.
All consecutive patients undergoing cystectomy with a Bricker's ileal conduit in 3 academic centers were retrospectively identified. Data were collected regarding their medical history prior to cystectomy, the operation, the postoperative period, imaging results within 5 years of follow-up, and the onset and timing of clinically or radiologically diagnosed ICPH.
Among 577 patients included in the study, 115 (20.6%) developed an ICPH during the study period. Most patients did not present any symptom and the diagnosis was made at imaging in 74.8% of them. Most hernias were detected between 1 and 2 years after the cystectomy, with a mean time to diagnosis of 12.4 months. At multivariate analysis, overweight and obesity were independent risk factors for developing an ICPH (adjusted hazard ratio [aHR] 1.96; p = 0.046), while a trans-rectus position of the ostomy was a significant protective factor (aHR 0.45; p = 0.011).
A PH develops in almost 20% of patients after ileal conduit urinary diversion, with a mean time of onset of 12.4 months. It is often a subclinical condition detected at medical imaging. Obesity increases the risk, while passing the ileal-conduit through the rectus muscle can help to prevent it.
造口旁疝是肠造口的一种棘手并发症。膀胱切除术后回肠造口旁疝具有特定的方面。本研究的目的是描述回肠造口旁疝的发生率和自然史，以便指导其管理，并确定预防造口旁疝的危险因素。
回顾性地确定了在 3 个学术中心接受膀胱切除和 Bricker 回肠造口术的所有连续患者。收集了他们在膀胱切除术前的病史、手术、术后、术后 5 年内的影像学结果以及临床或放射学诊断的 ICPH 的发病和时间。
在纳入研究的 577 名患者中，115 名（20.6%）在研究期间发生了 ICPH。大多数患者没有出现任何症状，74.8%的患者在影像学检查中做出了诊断。大多数疝在膀胱切除术后 1 至 2 年内被发现，平均诊断时间为 12.4 个月。多变量分析显示，超重和肥胖是发生 ICPH 的独立危险因素（调整后的危险比 [aHR] 1.96；p = 0.046），而造口的经直肠位置是显著的保护因素（aHR 0.45；p = 0.011）。
在接受回肠造口术进行尿流改道后，几乎 20%的患者会发生 PH，平均发病时间为 12.4 个月。它通常是在医疗影像学检查中发现的亚临床疾病。肥胖增加了风险，而将回肠造口穿过直肠肌肉可以帮助预防它。
