@article {166987, title = {Natural History and Predictors of Parastomal Hernia after Robot-Assisted Radical Cystectomy and Ileal Conduit Urinary Diversion.}, journal = {The Journal of urology}, volume = {199}, year = {2018}, note = {n/a}, month = {2018 Mar}, pages = {766-773}, abstract = {

PURPOSE: We investigated the prevalence of and variables associated with parastomal hernia and its outcomes after robot-assisted radical cystectomy and ileal conduit creation for bladder cancer.

MATERIALS AND METHODS: We retrospectively reviewed the records of patients who underwent robot-assisted radical cystectomy at our institution. Parastomal hernia was defined as the protrusion of abdominal contents through the stomal defect in the abdominal wall on cross-sectional imaging. Parastomal hernia was further described in terms of patient and hernia characteristics, symptoms, management and outcomes. The Kaplan-Meier method was used to determine time to parastomal hernia and time to surgery. Multivariate stepwise logistic regression was done to evaluate variables associated with parastomal hernia.

RESULTS: A total of 383 patients underwent robot-assisted radical cystectomy and ileal conduit creation. Of the patients 75 (20\%) had parastomal hernia, which was symptomatic in 23 (31\%), and 11 (15\%) underwent treatment. Median time to parastomal hernia was 13 months (IQR 9-22). Parastomal hernia developed in 9\%, 23\% and 32\% of cases at 1, 2 and 3 years, respectively. Patients with parastomal hernia had a significantly higher body mass index (30 vs 28 kg/m, p = 0.02), longer overall operative time (357 vs 340 minutes, p = 0.01) and greater blood loss (325 vs 250 ml, p~=~0.04). On multivariate analysis operative time (OR 1.25, 95\% CI 1.21-3.90, p \<0.001), a fascial defect 30 mm or greater (OR 5.23, 95\% CI~2.32-11.8, p \<0.001) and~a lower postoperative estimated glomerular filtration rate (OR 2.17, 95\% CI 1.21-3.90, p = 0.01) were significantly associated with parastomal hernia.

CONCLUSIONS: Symptoms develop in approximately a third of patients with parastomal hernia and 15\% will require surgery. The risk of parastomal hernia plateaued after postoperative year 3. Longer operative time, a larger fascial defect and lower postoperative kidney function were associated with parastomal hernia.

}, issn = {1527-3792}, doi = {10.1097/JU.0000000000000142}, author = {Hussein, Ahmed A and Ahmed, Youssef E and May, Paul and Ali, Taimoor and Ahmad, Basim and Raheem, Sana and Stone, Kevin and Hasasnah, Adam and Rana, Omer and Cole, Adam and Wang, Derek and Loud, Peter and Guru, Khurshid A} }