Hussein AA, et al. - The physicians tried to find out the frequency, variables associated with parastomal hernia (PSH), and its outcomes of after robot-assisted radical cystectomy (RARC) and ileal conduit (IC) for bladder cancer. It was considered that approximately one-third of PSH patients will develop symptoms and 15% will require surgery. Risk for establishing PSH plateaued after the 3rd postoperative year. Remarkably, longer operative time, larger fascial defect and lower postoperative kidney functions were correlated with PSH.

Methods

• Physicians carried out a retrospective review of RARC at their institution.
• They characterized PSH as protrusion of abdominal contents through the stoma defect in the abdominal wall on cross sectional imaging.
• They further described in terms of patient and hernia characteristics, symptoms, management and outcomes.
• They applied Kaplan Meier method to depict time to PSH and time to surgery.
• They used multivariate stepwise logistic regression to assess variables associated with PSH.

Results

• 383 patients underwent RARC and IC.
• As per the outcomes, 75 patients (20%) had PSH, of whom 23 (31%) were symptomatic and 11 (15 %) underwent treatment.
• For this analysis, median time to PSH was 13 months (IQR 9-22).
• The results confirmed that PSH occurred at a rate of 9%, 23% and 32% at 1, 2 and 3 years respectively.
• The data showed that patients with PSH had significantly higher BMI (30 vs 28, p=0.02), longer overall operative time (357 vs 340 min, p=0.01), and higher blood loss (325 vs 250, p=0.04).
• On Multivariate analysis, it was noted that operative time (OR 1.25, 95% CI 1.21-3.90, p<0.001), fascial defect ≥30mm (OR 5.23, 95% CI 2.32-11.8, p<0.001) and lower postoperative eGFR (OR 2.17, 95%CI 1.21-3.90, p=0.01) were significantly correlated with PSH.