Roussel Edouard, Dupuis Hugo, Grosjean Julien, Cornu Jean-Nicolas, Khalil Haitham
Department of Digestive and Oncologic Surgery, Charles Nicolle University Hospital, Rouen Cedex, France.
Department of Digestive Surgery, Rouen University Hospital, 1 Rue de Germont, Rouen Cedex, F-76031, France.
Hernia. 2024 Dec 30;29(1):57. doi: 10.1007/s10029-024-03207-5.
The management of parastomal hernia following cystectomy and ileal conduit diversion is challenging due to its specific nature and a high recurrence rate, yet is poorly described.
We retrospectively searched the clinical data warehouse of our center for patients who had primary parastomal hernia repair following cystectomy and ileal conduit diversion. The primary endpoint was recurrence of parastomal hernia; secondary endpoints were postoperative complications and surgical management of recurrences.
From January 1st 2012 to January 1st 2022, 35 patients were included in the study, 13 patients (37.1%) were operated with the Keyhole technique and 22 patients (62.9%) with the Sugarbaker technique. The median follow-up was 24 months. The main complication was urinary tract infection, in 6 patients (17.4%). Postoperative complications were severe in 4 patients (11.4%), 3 (8.6%) for prosthesis extraction due to infection. Ninety-day mortality was null. Eight patients (22.9%) had a symptomatic recurrence of parastomal hernia leading to a second surgery, 4 patients (30.7%) in the Keyhole group and 4 patients (18.2%) in the Sugarbaker group. Surgical management of recurrences involved repair without synthetic mesh in 4 patients (50%) due to difficult adhesiolysis, leading to a third surgery for 3 patients (37.5%).
The high rates of recurrence observed with the Keyhole technique, in particular, but also with the Sugarbaker technique, suggest that these techniques should no longer be used for the repair of parastomal hernia after ileal conduit urinary diversion. New preventive and curative approaches need to be explored to improve the surgical management of parastomal hernia.
膀胱切除术后回肠代膀胱造口旁疝的管理具有挑战性，因其性质特殊且复发率高，但相关描述较少。
我们回顾性检索了本中心临床数据仓库中膀胱切除术后回肠代膀胱造口旁疝初次修复患者的资料。主要终点是造口旁疝复发；次要终点是术后并发症及复发的手术处理。
2012年1月1日至2022年1月1日，35例患者纳入研究，13例（37.1%）采用钥匙孔技术手术，22例（62.9%）采用舒格贝克技术手术。中位随访时间为24个月。主要并发症为尿路感染，共6例（17.4%）。4例（11.4%）患者术后出现严重并发症，3例（8.6%）因感染取出假体。90天死亡率为零。8例（22.9%）患者出现有症状的造口旁疝复发并接受二次手术，钥匙孔组4例（30.7%），舒格贝克组4例（18.2%）。4例（50%）复发患者因粘连松解困难，手术处理时未使用合成补片修复，其中3例（37.5%）接受了第三次手术。
特别是钥匙孔技术，以及舒格贝克技术，观察到的高复发率表明，这些技术不应再用于回肠代膀胱尿流改道后造口旁疝的修复。需要探索新的预防和治疗方法，以改善造口旁疝的手术管理。
