{"paper_id":"38672f9c-3dce-4aea-8811-2aa50dec6671","body_text":"Parastomal Hernia After Robot-assisted Cystectomy and Ileum Conduit: Incidence, Risk or Protective Factors and Outcomes of Minimal-invasive Hernia Repair-systematic Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Parastomal Hernia After Robot-assisted Cystectomy and Ileum Conduit: Incidence, Risk or Protective Factors and Outcomes of Minimal-invasive Hernia Repair-systematic Review Stephan Buse, Julia Neldner, Pawel Rachubinski, Abolfazl Hosseini-Aliabad, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9387072/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 12 You are reading this latest preprint version Abstract Background and aims: Incidence of and risk factors for parastomal hernia after robot-assisted (RA) cystectomy with ileum conduit (IC) are not well established. The aims of this systematic review were to summarize the literature 1) on the incidence of parastomal hernia after RA cystectomy and IC reconstruction; 2) on risk or protective factors associated with the development of parastomal hernias after RA cystectomy and IC reconstruction; and 3) on outcomes of minimal invasive parastomal hernia repair in patients with IC. Methods we conducted literature searches in Medline, EMBASE, and CINHAL up to April 2025 without language restriction. Two independent assessors evaluated eligibility and quality of the included study. Due to high heterogeneity, meta-analysis was not attempted. Results out of 368 records, 11 and 2 papers provided information on the incidence of parastomal hernia and on risk factors, respectively. For the outcome of minimal invasive IC hernia repair, 7 studies were included. Most studied presented high risk of bias and the incidence rate varied widely across studies. Similar findings were observed for hernia recurrence after minimal invasive hernia repair. Conclusion A relevant proportion of patients may experience parastomal hernia of IC after RA-cystectomy, however incidence figures varied widely. Information on factors influencing the development of parastomal hernia after RA cystectomy is essentially lacking. Finally, the evidence on the outcome of minimal invasive hernia repair in IC patients is very limited both in terms of quantity and of quality. There is urgent need to address the knowledge gaps detected by this systematic review. Cooperation to achieve prospective multicentre designs with adequate sample size and systematic follow-up methods would be crucial factors to generate the high-quality data required to develop evidence-based strategies to prevent parastomal hernias. robot-assisted cystectomy ileum conduit parastomal hernia minimal-invasive hernia repair Figures Figure 1 BACKGROUND The incidence of parastomal hernias after radical cystectomy and ileum conduit is estimated at 4% to 24% [ 1 ]. The need for repair surgery varied from 9 to 75% [ 1 ]. Robot-assisted (RA) cystectomy with intracorporal urinary diversion has become standard of care in many institutions, however data on the incidence of parastomal hernia after RA cystectomy with ileum conduit (IC) are limited. In a single-centre cohort of round 400 patients [ 2 ], the incidence of parastomal hernias was estimated at 20%. Every third patient with parastomal hernia was symptomatic and every seventh required surgical repair [ 2 ]. Another single-centre study (n = 284 RA cystectomies) reported that 43% of patients developed parastomal hernia of IC during 2-years follow-up [ 3 ]. Therefore, there is relevant uncertainty regarding the incidence of parastomal hernia of IC after RA-cystectomy. Similarly, factors influencing the incidence of parastomal hernia after RA cystectomy are not established [ 2 – 4 ]. Finally, the outcomes of minimal-invasive parastomal hernia repair in IC patients remain rarely described [ 5 – 7 ]. The aim of this systematic review was to summarize the literature 1) on the incidence of parastomal hernia after RA cystectomy and IC reconstruction; 2) on risk or protective factors associated with the development of parastomal hernias after RA cystectomy and IC reconstruction; and 3) on outcomes of minimal invasive parastomal hernia repair in patients with IC. METHODS We conducted a systematic review on the incidence of and on risk or protective factors for parastomal hernia after RA cystectomy and ileum conduit (IC) in adults. A second systematic literature search focused on outcomes reported for minimal-invasive (RA or conventional laparoscopy) repair of parastomal hernias of IC. Data were extracted from published literature so that ethical board approval was not required. This report adheres to the PRISMA statement. Literature Search A literature search in Medline, EMBASE, and CINHAL was conducted from 1 January 1946 − 11 April 2025. The search was augmented by manual search. We did not apply any language restrictions. The search was developed in Medline and adapted to the other search engines. Key components included “parastomal”, “hernia”, “ileum OR ileal AND conduit“, and “urinary diversion”. In order to increase sensitivity, i.e., to avoid missing reports including robot-assisted and open procedure, we did not include the term robot-assisted in the search and limited the inclusion to papers with robot-assisted procedures during eligibility assessment (see exclusion criteria). Studies on RA cystectomy with intra- and extracorporal ileum conduit were included. Studies were included independent of their approach to parastomal hernia detection (systematic diagnostic work-up or clinical manifest hernias, see below). The other search (aim 3) included “minimal-invasive OR laparoscopic OR robot-assisted”, “hernia repair”, “(ileum OR ileal AND conduit) OR urinary diversion”. As long as the hernia repair was minimal-invasive, studies were included independent of the surgical approach to the initial cystectomy and IC. The search hits were exported to a Rayyan© database for screening. Eligibility was assessed by 2 independent reviewers. Disagreement was solved by discussion with involvement of a third senior assessor (SB). The following studies were excluded: Experimental studies (animal or material/tissue studies) Narrative reviews or letters to the editor (non-research letters) Children (< 18 years) Cystectomy was not robot-assisted or in studies reporting on various routes for radical cystectomy, no separate findings for robot-assisted procedure were available/provided Parastomal hernia repair was not minimal-invasive or in studies reporting on mixed populations (minimal-invasive and open or different types of hernia) no specific data available Case reports or series on minimal-invasive hernia repair reporting on less than 10 patients Outcomes of interest not reported. Endpoints The development of any parastomal hernia (symptomatic, clinically manifest, or radiologically detected- as defined by the single studies) after RA cystectomy was the primary endpoint. Secondary endpoints were symptomatic parastomal hernia and parastomal hernia requiring surgical repair. For aim 3 (outcome of minimal-invasive parastomal hernia repair) the primary endpoint was parastomal hernia recurrence. However, any clinical endpoint (complications, mortality, quality of life, …) and surgical benchmarks as available in the included studies were considered. Risk or protective factors for parastomal hernia Any risk or protective factor assessed, e.g., demographic data, details of surgical technique, comorbidities, and postoperative complications as explored and reported in the included studies was considered. Data extraction and risk of bias assessment Data were extracted into a predefined template and included the following information on methodology: study design, eligibility criteria, period of enrolment, details of initial procedures, methods for parastomal hernia detection, follow-up duration and approach to follow-up. Study results extracted included sample size, follow-up completeness, if applicable mean/median follow-up duration, baseline characteristics (age, body mass index, indication for RA cystectomy, comorbidities as far as reported), surgery duration, intra- and postoperative complications, and risk or protective factors for parastomal hernia assessed and their effect size (as far as reported). For studies included for aim 3, the following information was extracted: study design, eligibility criteria, period of enrolment, type of minimal-invasive approach, planned primary endpoint, planned follow-up duration, sample size, parastomal hernia severity and classification tool at baseline, age (mean/ median), BMI (mean/ median), ASA class, surgery duration, conversion rate, blood loss, transfusion rate, intraoperative complication rate, postoperative complications (including time horizon) and length of stay. For hernia recurrence, we collected approach to recurrence detection, follow-up duration, loss of follow-up, and incidence of parastomal hernia recurrence. Data was extracted by trained extractors. Authors of relevant studies were contacted to obtain missing information. Similarly, authors of manuscripts reporting on various approaches to cystectomy, i.e., mixed population with open and RA-procedures were contacted for data specific to RA cystectomy. Specific data to minimal invasive hernia repair in ileum conduit were also requested for studies reporting on mixed populations, e.g., reporting on open and minimal-invasive hernia repair or on minimal-invasive hernia repair for different types of parastomal hernia (e.g., colostomy, ileostomy and ileum conduit). If authors did not respond after a third reminder to provide the requested information, the data was considered as not available and if no separate findings specific to RA cystectomy or minimal invasive parastomal hernia repair for ileum conduit were provided, the study was excluded. Methodological quality of the included cohort was assessed using the Newcastle-Ottawa Scale for cohort, JBI critical appraisal tool for case series [ 8 ], and Cochrane Risk Of Bias (ROB) 2 tool for Randomized Control Trial (RCT). The outcome for ROB assessment using ROB 2 tool was parastomal hernia development. Of note, the RCTs reported on open and RA procedures and risk of bias was assessed for the whole trial (not specifically for RA procedures). Analyses In consideration of the expected heterogeneous duration of follow-up and methods of assessment of parastomal hernia, we primarily planned to summarize the incidence data descriptively while maintaining an option for meta-analytic pooling. The same applied to minimal-invasive hernia repair. The review of the available data confirmed the expected heterogeneity and a meta-analysis was not attempted. A meta-analytic approach for risk or protective factors and for outcome was never planned. RESULTS After duplicate removal, 368 records were identified. Thereof, 283 were excluded during title and abstract screening. After full-text eligibily assessment, 11 papers[ 2 – 4 , 9 – 16 ] were included for the assessment of the incidence of parastomal hernia, thereof 2 [ 2 , 10 ] provided information on risk or protective factors for parastomal hernia. For the outcome of minimal invasive parastomal heria repair in ileum conduit, 7 studies [ 5 – 7 , 17 – 20 ] were included. Reasons for exclusion in the full-text elegibility assessment are reported in the PRISMA flow chart (Fig. 1 ). Quality assessment Of the 11 studies for the assessemnt of the incidence of parastomal hernia after RA-cystectomy with ileum conduit, 9 (81.8%) were retrospective single-centre case series and 2 (18.2%) RCTs. Of the 9 case series, 4 (44.4%) presented high-risk of bias due to selection bias araising from relevant proportions of patients excluded due to missing data and due to high attrition. For the other 5 studies, risk of bias was unclear since information on missing data and on loss of follow-up was not reported. For both RCT, risk of bias was low for all domains of the ROB2 tool (of note the assessment referred to parastomal hernia after open or RA procedures [ 10 ]and open, laparoscopic and RA procedures [ 16 ], respectively since both RCT included different surgical techniques). Of the 7 studies reporting on minimal-invasive hernia repair for parastomal hernia in ileum conduit patients, 5 (71.4%) were retrospective single-centre case series with high or unclear risk of bias mainly due to selection and classification bias resulting from missing data and loss of followup and 2 studies, a retrospective single-centre [ 18 ] and a retrospective multicentre cohort [ 6 ] presented low risk of bias. Incidende of parastomal hernia after RA cystectomy and ileum conduit Eleven studies reported on the incidence of parastomal hernia in a total of 920 patients. The sample size ranged between 9 and 383 patients, the followup duration from 17 days to 45 months (median or mean depending on the study). As far as reported, the samples consisted mainly of men. The mean or median age ranged from 62 to 75 years, mean or median BMI from 22 to 30 kg/m2. Parastomal hernia was observed in 0 to 44% of patients after RA-cystectomy with IC diversion. Of note, in the 2 largest studies [ 2 , 3 ], parastomal hernia was reported in 19.6% [ 2 ] and 43% of patients [ 3 ], respectively. In 4 studies with a total of 490 patients [ 2 , 10 , 11 , 16 ] symptomatic hernias were reported and affected 0 to 9.5% of patients. Reoperation for parastomal hernia was necessary in 0 to 16.6% patients (assessed in 5 studies [ 2 , 9 – 11 , 16 ] with a total of 518 patients). The proportion of intracorporal IC creation ranged from 0 to 100%. Data were not sufficient to assess the impact of intra- vs extracorporal technique on parastomal hernia incidence. Table 1 reports the details of the studies included for the assessment of incidence of parastomal hernia. Table 1 Characteristics and findings of the studies reporting on the incidence of parastomal hernia after RA cystectomy and IC. Author Study design Period of enrolment N= M:F Age (mean/ median) BMI (mean/ median) Proportion of Intracorporal ileum conduit technique Follow-up duration (mean/ median N (%) parastomal hernia Mean/ median time to parastomal hernia N (%) symptomatic parastomal hernia N (%) parastomal hernia requiring surgery repair Miyake M, Asian J Endosc Surg 2025 [ 13 ] single-centre retrospective case series 2019–2022 27 24?M, 4F 75y (71–79) 22.2 (19.6–24.3) 100% median 20 mt 1 (3.7%) 11 mt not reported not reported Lone Z, BJU Int 2024 [ 3 ] single-centre retrospective case series 2010–2020 284 not reported for RARC only 70y (whole cohort) median BMI 26 in no PH, 30 in pat with PH (whole cohort) 59% median follow-up 45 mt in no PH and 43 mt in pat with PH (whole cohort) 125 (44.0%) \"125 hernia at 2 years\" not reported not reported for RARC only Faria EF, International Braz J Urol 2024 [ 11 ] single-centre retrospective case series 2018–2023 28 not reported for IC only 65y (46–88) 26.8 (17–40) 100% 90 days 0 90 days 0 0 Djaladat H, J Urol 2024 [ 10 ] single-centre RCT 2015–2021 73 58 M, 15F 74y 26.7 100% 20.4 mt (IQR 8–25) 18 (24.6%) 20.4 months (IQR 8–25) 7 (9.6%) 2 (2.7%) Carlton CE, Urology 2024 [ 9 ] single-centre retrospective case series 2011–2021 24 0 M, 24F 75y (range 53–87) 26 (23–30) not reported 14 mt (IQR 5–28) 7 (29.2%) 1–3 years not reported 4 (16.7%) Zhou Z, Cell Rep med 2024 [ 16 ] single-centre RCT 2019–2020 10 not reported for RARC only 62y ± 11 (whole cohort) mean 22.9 (whole cohort) not reported 31 mt (12–35) (whole cohort) 2 (20%) not applicable 0 0 Rezaee ME, Can J Urol 2020 [ 4 ] single-centre retrospective case series 2009–2018 9 not reported for RARC only 71y (whole cohort) mean 30.1 (whole cohort) not reported 3.4 years (whole cohort) 2 (22.2%) not reported not reported not reported Tenzel PL, Hernia 2018 [ 15 ] single-centre retrospective case series 2010–2017 38 28M; 10F 68y not reported 0% 21 mt in patients with and 11 mt without mesh 1 (2.6%) not reported not reported not reported Hussein AA, J Urol 2018 [ 2 ] single-centre retrospective case series 2005–2016 383 not reported not reported pat with vs without PSH BMI 30 vs 28 kg/m2 (p < 0.02) (wole cohort) 100% after 2009 18 mt (IQR 7–35) 75 (19.6%) 13 months (IQR 9–22) 23 (6.0%) 11 (2.9%) Huynh D, J Robot Surg 2017 [ 12 ] single-centre retrospective case series 2013–2015 15 12M, 3F 72y (58–90) mean 29 (23–43) 0% 17d (10–40) 0 not applicable 0 0 Pruthi RS, Urology 2008 [ 14 ] single-centre retrospective case series 2006–2007. 29 not reported for IC subgroup 64y (whole cohort) not reported 0% 13 mt (range 2–24) (whole cohort) 3 (10.3%) not reported not reported not reported Risk or protective factors for parastomal hernia after RA cystectomy with ileum conduit For 2 studies (1 RCT and 1 large retrospective case series) [ 2 , 10 ] with a total of 93 hernias in 456 patients, data specific for parastomal hernia in IC after RA cystectomy were available to assess risk or protective factors. In patients submitted to RA cystectomy, the prophylactic use of mesh [ 10 ] was not protective. Hussein et al. [ 2 ] reported longer surgery duration (adjusted odds ratio [OR]1.25, 95% CI 1.06–1.46), fascial defect size ≥ 30 mm (adj OR 5.23, 95% CI 2.32–11.80), and postoperative eGFR less than 60 ml per minute (adj OR 2.17, 95% CI 1.23–3.90) as significant predictive factors for parastomal hernia development. Outcome after minimal-invasive parastomal hernia repair after RA cystectomy and ileum conduit The 7 studies on the outcome after minimal invasive parastomal hernia repair included a total of 137 patients, thereof 25 RA parastomal hernia repairs. Sample size ranged from 10 to 35 patients. Only 2 studies [ 5 , 7 ] prespecified planned follow-up durations for hernia recurrence.Table 2 reports the characteristics of the studies addresing outcome after minimal invasive parastomal hernia repair and their findings. Table 2 Characteristics and findings of studies reporting on minimal invasive parastomal hernia repair in IC patients. Author Study design Period of enrolment Minimal invasive procedure Sample size M:F Age (mean/ median) BMI (mean/ median) Parastomal hernia classification (European Hernia Society) Surgery duration (min) Intraop complications Postop complication rate Length of stay Follow-up duraton for hernia recurrence (months) Incidence of parastomal hernia recurrence Violante, Hernia 2024 [ 7 ] single-cenre retrospective case series 2021–2023 robot-assisted 15 7M, 8F 69.1 ± 10.2 31.6 ± 6.2 5x class I, 5x class II, 4x class III, 1x class IV 249 ± 63 not reported 2x ileus, 1x abdominal collections, 1 exploratory laparoscopy 3.6d ± 1.9 15.2 ± 7.6 0/15 Suwa, Journal of the anus, rectum and colon 2024 [ 20 ] single-cenre retrospective case series 2012–2023 laparoscopic 10 6M, 4F 72 (48–84) 24 (22–32) 5x class I, 3x class II, 2x class 4 223 (120–423] 1 (10%) bowel lesion 1x (10%) ureteral obstruction 9d (6–14) 52 (20–104) 0 Fu, BMC Surg 2024 [ 17 ] single-cenre retrospective case series 2013–2022 laparoscopic 35 20M, 10F 69 (64.5–71) 25.1 (23.3–27.4) 16x class I, 13x class II, 5x class III, 1x class IV 90 (65–120) 3 (8.6%) bowel lesion 1x ileus; 2x peristomal abscess 5d (4–7) 32 (25.5–38) 3 (8.6) after a median of 14 mt Goffioul Hernia 2024 [ 18 ] single-cenre retrospective case series 2014–2020 lalaroscopic 16 9M, 7F 67 (65–75) 27,60 6x class I, 5x class II, 4x class III, 1x class IV 76 (58–105) 2 (12.5%) conversion 2x CDC 3a, 1x CDC 3b 3d (3-4.25) 30 (17–35) 2/16 Dewulf, Langenbeck's Arch Surg 2022 [ 5 ] single-cenre retrospective case series 2016–2020 robot-assisted and laparoscopic 15 10M, 5F 75 (73–77) 28.7 (25.7–34.2) not reported 197 (132–260) not reported 1x CDC 2, 2x CDC class 3 5d (3–9) 366d (241–1286) 1 of 15? (unclear loss of followup Laycock, Hernia 2022 [ 19 ] single-cenre retrospective case series 2008–2019 laparoscopic 27 16M, 11F median age 70 years (mean 67.5) median 29.6, mean 29.7 not reported mean 118 not reported 4x CDC 2 median 2d, mean 3.6d median 518 days, mean 750 2 (8.7%) Mäkäräinen-Uhlbäck, BMC Surg 2021 [ 6 ] multicentre retrospective case series 2007–2017 laparoscopic 19 not reported only for minimal invasive not reported only for laparoscopic not reported only for laparoscopic not reported not reported only for laparoscopic not reported 1x bleeding, 1x infection (not SSI) 4.8d ± 3.1 (range 2–15) 38+/-26 months (range 1-100) 4 of 19 DISCUSSION The main findings of this systematic review are that 1) a relevant proportion of patients may experience parastomal hernia of IC after RA-cystectomy. However, incidence figures varied widely (0 to 43%) and evidence was frequently affected by selection bias, so that the incidence for parastomal hernia of IC after RA cystectomy remains unestablished; 2) information on factors influencing the development of parastomal hernia after RA cystectomy is essentially lacking; 3) the evidence on the outcome of minimal invasive hernia repair in IC patients is very limited both in terms of quantity and of quality. Comparison with previous studies Narang et al [ 1 ] conducted a systematic literature review on the incidence of parastomal hernia of ileum conduit after cystectomy by any surgical technique. Out of 63 hits, they included 12 retrospective case series published between 1989 and 2016. In spite of varying or unclear follow-up duration, they reported a pooled incidence at 17.9% for parastomal hernia development. In the present study, we conducted an extensive search (368 hits) in April 2025 and we focused on robot-assisted cystectomies. Due to heterogenous follow-up durations, we avoided pooling. In the 2 larger samples, 19.6% [ 2 ] and 43% [ 3 ] of patients after robot-assisted cystectomy and IC creation, respectively, suffered parastomal hernia. In 2020, Feng et al [ 21 ] conducted a systematic literature search and included 15 studies reporting on parastomal hernia after radical cystectomy by any approach. They reported pooled incidences of radiological parastomal hernia of 14% at 1 year and of 26% at 2 years, respectively. However, as in the present review focused specifically on RA cystectomy, incidence of parastomal hernia varied widely between studies. Reasons for the high heterogeneity of the estimated incidence of parastomal hernia after RA cystectomy may include methodological issues, e.g., different follow-up durations, different follow-up approaches, and different definitions (radiological vs clinically manifest). However, the wide diverging incidence reported in the literature may also arise from the single centre design of most studies, since which surgeon conducted the procedure appears to have a major impact on the incidence of parastomal hernia [ 4 ] . With regard to risk factors for parastomal hernia, our findings confirm for RA cystectomy what was described for open cystectomy: the various studies addressed a large number of different risk factors, often without being adequately powered for such analyses, so that robust conclusions in this regard are not possible. In terms of the prophylactic use of mesh to prevent parastomal hernia during IC creation after cystectomy by any surgical technique, the pooled estimates of 3 RCTs suggested a protective effect, albeit with large confidence intervals (OR 0.49 [95%CI 0.25–0.97]) [ 22 ]. In addition to summarizing the evidence on the incidence of parastomal hernia and its risk factors with a focus on RA procedures, the current standard of care in many institutions, we expanded the perspective of previous systematic reviews by the consideration of outcomes after minimal-invasive parastomal hernia repair and the conduction of a corresponding systematic search. The body of evidence on this topic is severely limited. At the current stage, evidence is so limited that adequate patient counselling in term of outcome for minimal-invasive parastomal hernia repair may be considered not feasible. Strengths and limitations Strength of our approach include an extensive literature search, study selection according to predefined criteria by 2 assessors, and a focus not only on the incidence of parastomal hernia after RA cystectomy with IC but also on risk or protective factors for it. Further, this review summarizes also the outcomes of minimal invasive hernia repair, therefore addressing the whole trajectory of patients suffering a parastomal hernia after IC creation. We are aware of the following limitations: first, follow-up durations in the included studies were highly heterogeneous, thus preventing the calculation of pooled estimates for the incidence of parastomal hernia after RA cystectomy and IC. Second, while efforts were undertaken to obtain information specific to RA procedures, some papers had to be excluded since the necessary information was not provided. CONCLUSION A relevant proportion of patients may experience parastomal hernia of IC after RA-cystectomy, however incidence figures varied widely across studies and evidence was frequently affected by selection bias. Information on factors influencing the development of parastomal hernia after RA cystectomy is essentially lacking. Finally, the evidence on the outcome of minimal invasive hernia repair in IC patients is very limited both in terms of quantity and of quality. As such this systematic literature search discloses major knowledge gaps with regard to parastomal hernia after RA cystectomy with IC and its minimal-invasive repair. To develop strategies to prevent hernia development to offer guidance to surgeons and for patients´ counselling, there is an urgent need to address these knowledge gaps. Cooperation to achieve prospective multicentre designs with adequate sample size, systematic follow-up methods, and efforts to limits attrition would be crucial factors to generate the high-quality evidence that is currently missing. Declarations Ethics approval and consent to participate Not applicable (systematic review summarizing pooled estimates from published studies). Consent for publication Not applicable (systematic review summarizing pooled estimates from published studies). Availability of data and materials The datasets used in the current systematic review are available from the corresponding author on reasonable written request. Competing interests Stephan Buse act as a proctor for Da Vinci Surgical Inc. The other authors do not report any competing interests. Funding Intramural funding. Authors' contributions SB: conception and design, literature search, data generation, interpretation, manuscript drafting, approval of the final manuscript JN: literature search, data generation, interpretation, manuscript drafting, approval of the final manuscript PR: conception and design, interpretation, approval of the final manuscript AHA: conception and design, interpretation, approval of the final manuscript AR: conception and design, interpretation, approval of the final manuscript AH: conception and design, interpretation, approval of the final manuscript KA conception and design, interpretation, approval of the final manuscript Acknowledgements We thank all authors that provided additional information on their studies. References Narang SK et al (2017) Parastomal hernia following cystectomy and ileal conduit urinary diversion: a systematic review. Hernia 21(2):163–175 Hussein AA et al (2018) Natural History and Predictors of Parastomal Hernia after Robot-Assisted Radical Cystectomy and Ileal Conduit Urinary Diversion. J Urol 199(3):766–773 Lone Z et al (2024) Body morphometry may predict parastomal hernia following radical cystectomy with ileal conduit. BJU Int 134(5):841–847 Rezaee ME et al (2020) Parastomal hernia development after cystectomy and ileal conduit for bladder cancer: results from the Dartmouth ileal conduit enhancement (DICE) project. Can J Urol 27(5):10369–10377 Dewulf M et al (2022) How-I-do-it: minimally invasive repair of ileal conduit parastomal hernias. Langenbecks Arch Surg 407(3):1291–1301 Makarainen-Uhlback E et al (2021) Keyhole versus Sugarbaker techniques in parastomal hernia repair following ileal conduit urinary diversion: a retrospective nationwide cohort study. BMC Surg 21(1):231 Violante T et al (2024) Robotic parastomal hernia repair in Ileal-conduit patients: short-term results in a single-center cohort study. Hernia 28(6):2245–2253 Munn Z et al (2020) Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI Evid Synth 18(10):2127–2133 Carlton CE et al (2024) Robotic simple cystectomy as a last resort for antibiotic-recalcitrant recurrent urinary tract infections in women. Urology 186:139–143 Djaladat H et al (2024) Prophylactic Use of Biologic Mesh in Ileal Conduit (PUBMIC): A Randomized Clinical Trial. J Urol 211(6):743–753 Faria EF et al (2024) Mesentery-Sparing Technique: a New Intracorporeal Approach for Urinary Diversion in Robot-Assisted Radical Cystectomy. Int Braz J Urol 50(4):489–499 Huynh D et al (2017) Feasibility and safety study for the use of wound protectors during robotic radical cystectomy and ileal conduit. J Robot Surg 11(2):187–191 Miyake M et al (2025) Comparison of Post-Radical Cystectomy Renal Function and Ileal Conduit-Related Complications Between Extracorporeal and Robot-Assisted Intracorporeal Urinary Diversion: A Single-Center Experience. Asian J Endosc Surg 18(1):e70033 Pruthi RS, Wallen EM (2008) Is robotic radical cystectomy an appropriate treatment for bladder cancer? Short-term oncologic and clinical follow-up in 50 consecutive patients. Urology, 72(3): p. 617 – 20; discussion 620-2. Tenzel PL et al (2018) Prophylactic mesh used in ileal conduit formation following radical cystectomy: a retrospective cohort. Hernia 22(5):781–784 Zhou Z et al (2024) Extraperitonealization of the ileal conduit decreases the risk of parastomal hernia: A single-center, randomized clinical trial. Cell Rep Med 5(1):101343 Fu X et al (2024) Laparoscopic Sugarbaker repair of parastomal hernia following radical cystectomy and ileal conduit: a single-center experience. BMC Surg 24(1):258 Goffioul L et al (2024) Repair of parastomal hernia after Bricker procedure: retrospective consecutive experience of a tertiary center. Hernia 28(3):823–830 Laycock J et al (2022) A keyhole approach gives a sound repair for ileal conduit parastomal hernia. Hernia 26(2):647–651 Suwa K et al (2024) Surgical Outcomes after Laparoscopic Repairs of Para-colostomy Hernia and Para-ileal-conduit Hernia: A Comparative Study. J Anus Rectum Colon 8(4):340–347 Feng D et al (2021) Incidence and risk factors of parastomal hernia after radical cystectomy and ileal conduit diversion: a systematic review and meta-analysis. Transl Cancer Res 10(3):1389–1398 Hinojosa-Gonzalez DE et al (2024) Use of prophylactic mesh to prevent parastomal hernia formation: a systematic review, meta-analysis and network meta-analysis. Hernia 29(1):22 Additional Declarations Competing interest reported. Stephan Buse act as a proctor for Da Vinci Surgical Inc. The other authors do not report any competing interests Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 15 May, 2026 Reviews received at journal 14 May, 2026 Reviewers agreed at journal 10 May, 2026 Reviews received at journal 10 May, 2026 Reviewers agreed at journal 10 May, 2026 Reviewers agreed at journal 07 May, 2026 Reviewers agreed at journal 07 May, 2026 Reviewers agreed at journal 05 May, 2026 Reviewers invited by journal 18 Apr, 2026 Editor assigned by journal 13 Apr, 2026 Submission checks completed at journal 13 Apr, 2026 First submitted to journal 11 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-9387072\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":629214766,\"identity\":\"b9227fc9-d657-4654-b24f-0f67dd7f32f2\",\"order_by\":0,\"name\":\"Stephan Buse\",\"email\":\"data:image/png;base64,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\",\"orcid\":\"\",\"institution\":\"Alfried Krupp Hospital\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Stephan\",\"middleName\":\"\",\"lastName\":\"Buse\",\"suffix\":\"\"},{\"id\":629214786,\"identity\":\"a8acbbb8-01af-4df6-bc53-8b6fccda7a32\",\"order_by\":1,\"name\":\"Julia Neldner\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University Medical Center of the Johannes Gutenberg University Mainz\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Julia\",\"middleName\":\"\",\"lastName\":\"Neldner\",\"suffix\":\"\"},{\"id\":629214803,\"identity\":\"3d02ba61-60b3-419f-8470-9c3404f55eb9\",\"order_by\":2,\"name\":\"Pawel Rachubinski\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Alfried Krupp Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Pawel\",\"middleName\":\"\",\"lastName\":\"Rachubinski\",\"suffix\":\"\"},{\"id\":629214823,\"identity\":\"16382416-15e1-4606-9333-382e78518b41\",\"order_by\":3,\"name\":\"Abolfazl Hosseini-Aliabad\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Karolinska Institutet\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Abolfazl\",\"middleName\":\"\",\"lastName\":\"Hosseini-Aliabad\",\"suffix\":\"\"},{\"id\":629214838,\"identity\":\"1b68c3b1-fd4b-4356-99c1-5c4c8d94eb71\",\"order_by\":4,\"name\":\"Andre Reitz\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University Medical Center of the Johannes Gutenberg University Mainz\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Andre\",\"middleName\":\"\",\"lastName\":\"Reitz\",\"suffix\":\"\"},{\"id\":629214842,\"identity\":\"55aa835e-dc55-4630-af59-b0ef776fc2ba\",\"order_by\":5,\"name\":\"Axel Haferkamp\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University Medical Center of the Johannes Gutenberg University Mainz\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Axel\",\"middleName\":\"\",\"lastName\":\"Haferkamp\",\"suffix\":\"\"},{\"id\":629214848,\"identity\":\"3e40a8dc-71c5-4897-bd83-3a72ad23a5ea\",\"order_by\":6,\"name\":\"Kinan Almansur\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Alfried Krupp Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Kinan\",\"middleName\":\"\",\"lastName\":\"Almansur\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-04-11 10:38:37\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-9387072/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-9387072/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":107948188,\"identity\":\"499a374e-1bbc-4d20-94d2-07adf77bb01e\",\"added_by\":\"auto\",\"created_at\":\"2026-04-28 00:18:36\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":108427,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePRISM Flow chart of study selection\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9387072/v1/200c5802b5e267b65fc7ccd5.png\"},{\"id\":108007763,\"identity\":\"8d8ba022-ef66-4625-b307-8f63628fe338\",\"added_by\":\"auto\",\"created_at\":\"2026-04-28 13:01:48\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":402039,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9387072/v1/105fe5c3-b7d7-4397-a921-dc07de005794.pdf\"}],\"financialInterests\":\"Competing interest reported. Stephan Buse act as a proctor for Da Vinci Surgical Inc. The other authors do not report any competing interests\",\"formattedTitle\":\"\\u003cp\\u003eParastomal Hernia After Robot-assisted Cystectomy and Ileum Conduit: Incidence, Risk or Protective Factors and Outcomes of Minimal-invasive Hernia Repair-systematic Review\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"BACKGROUND\",\"content\":\"\\u003cp\\u003eThe incidence of parastomal hernias after radical cystectomy and ileum conduit is estimated at 4% to 24% [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. The need for repair surgery varied from 9 to 75% [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. Robot-assisted (RA) cystectomy with intracorporal urinary diversion has become standard of care in many institutions, however data on the incidence of parastomal hernia after RA cystectomy with ileum conduit (IC) are limited. In a single-centre cohort of round 400 patients [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e], the incidence of parastomal hernias was estimated at 20%. Every third patient with parastomal hernia was symptomatic and every seventh required surgical repair [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. Another single-centre study (n\\u0026thinsp;=\\u0026thinsp;284 RA cystectomies) reported that 43% of patients developed parastomal hernia of IC during 2-years follow-up [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. Therefore, there is relevant uncertainty regarding the incidence of parastomal hernia of IC after RA-cystectomy. Similarly, factors influencing the incidence of parastomal hernia after RA cystectomy are not established [\\u003cspan additionalcitationids=\\\"CR3\\\" citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Finally, the outcomes of minimal-invasive parastomal hernia repair in IC patients remain rarely described [\\u003cspan additionalcitationids=\\\"CR6\\\" citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe aim of this systematic review was to summarize the literature 1) on the incidence of parastomal hernia after RA cystectomy and IC reconstruction; 2) on risk or protective factors associated with the development of parastomal hernias after RA cystectomy and IC reconstruction; and 3) on outcomes of minimal invasive parastomal hernia repair in patients with IC.\\u003c/p\\u003e\"},{\"header\":\"METHODS\",\"content\":\"\\u003cp\\u003eWe conducted a systematic review on the incidence of and on risk or protective factors for parastomal hernia after RA cystectomy and ileum conduit (IC) in adults. A second systematic literature search focused on outcomes reported for minimal-invasive (RA or conventional laparoscopy) repair of parastomal hernias of IC. Data were extracted from published literature so that ethical board approval was not required. This report adheres to the PRISMA statement.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eLiterature Search\\u003c/h2\\u003e \\u003cp\\u003eA literature search in Medline, EMBASE, and CINHAL was conducted from 1 January 1946 \\u0026minus;\\u0026thinsp;11 April 2025. The search was augmented by manual search. We did not apply any language restrictions. The search was developed in Medline and adapted to the other search engines. Key components included \\u0026ldquo;parastomal\\u0026rdquo;, \\u0026ldquo;hernia\\u0026rdquo;, \\u0026ldquo;ileum OR ileal AND conduit\\u0026ldquo;, and \\u0026ldquo;urinary diversion\\u0026rdquo;. In order to increase sensitivity, i.e., to avoid missing reports including robot-assisted and open procedure, we did not include the term robot-assisted in the search and limited the inclusion to papers with robot-assisted procedures during eligibility assessment (see exclusion criteria). Studies on RA cystectomy with intra- and extracorporal ileum conduit were included. Studies were included independent of their approach to parastomal hernia detection (systematic diagnostic work-up or clinical manifest hernias, see below). The other search (aim 3) included \\u0026ldquo;minimal-invasive OR laparoscopic OR robot-assisted\\u0026rdquo;, \\u0026ldquo;hernia repair\\u0026rdquo;, \\u0026ldquo;(ileum OR ileal AND conduit) OR urinary diversion\\u0026rdquo;. As long as the hernia repair was minimal-invasive, studies were included independent of the surgical approach to the initial cystectomy and IC.\\u003c/p\\u003e \\u003cp\\u003eThe search hits were exported to a Rayyan\\u0026copy; database for screening. Eligibility was assessed by 2 independent reviewers. Disagreement was solved by discussion with involvement of a third senior assessor (SB).\\u003c/p\\u003e \\u003cp\\u003eThe following studies were excluded:\\u003c/p\\u003e \\u003cp\\u003e \\u003cul\\u003e \\u003cli\\u003e \\u003cp\\u003eExperimental studies (animal or material/tissue studies)\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003eNarrative reviews or letters to the editor (non-research letters)\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003eChildren (\\u0026lt;\\u0026thinsp;18 years)\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003eCystectomy was not robot-assisted or in studies reporting on various routes for radical cystectomy, no separate findings for robot-assisted procedure were available/provided\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003eParastomal hernia repair was not minimal-invasive or in studies reporting on mixed populations (minimal-invasive and open or different types of hernia) no specific data available\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003eCase reports or series on minimal-invasive hernia repair reporting on less than 10 patients\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003eOutcomes of interest not reported.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/ul\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eEndpoints\\u003c/h3\\u003e\\n\\u003cp\\u003eThe development of any parastomal hernia (symptomatic, clinically manifest, or radiologically detected- as defined by the single studies) after RA cystectomy was the primary endpoint. Secondary endpoints were symptomatic parastomal hernia and parastomal hernia requiring surgical repair.\\u003c/p\\u003e \\u003cp\\u003eFor aim 3 (outcome of minimal-invasive parastomal hernia repair) the primary endpoint was parastomal hernia recurrence. However, any clinical endpoint (complications, mortality, quality of life, \\u0026hellip;) and surgical benchmarks as available in the included studies were considered.\\u003c/p\\u003e\\n\\u003ch3\\u003eRisk or protective factors for parastomal hernia\\u003c/h3\\u003e\\n\\u003cp\\u003eAny risk or protective factor assessed, e.g., demographic data, details of surgical technique, comorbidities, and postoperative complications as explored and reported in the included studies was considered.\\u003c/p\\u003e\\n\\u003ch3\\u003eData extraction and risk of bias assessment\\u003c/h3\\u003e\\n\\u003cp\\u003eData were extracted into a predefined template and included the following information on methodology: study design, eligibility criteria, period of enrolment, details of initial procedures, methods for parastomal hernia detection, follow-up duration and approach to follow-up. Study results extracted included sample size, follow-up completeness, if applicable mean/median follow-up duration, baseline characteristics (age, body mass index, indication for RA cystectomy, comorbidities as far as reported), surgery duration, intra- and postoperative complications, and risk or protective factors for parastomal hernia assessed and their effect size (as far as reported). For studies included for aim 3, the following information was extracted: study design, eligibility criteria, period of enrolment, type of minimal-invasive approach, planned primary endpoint, planned follow-up duration, sample size, parastomal hernia severity and classification tool at baseline, age (mean/ median), BMI (mean/ median), ASA class, surgery duration, conversion rate, blood loss, transfusion rate, intraoperative complication rate, postoperative complications (including time horizon) and length of stay. For hernia recurrence, we collected approach to recurrence detection, follow-up duration, loss of follow-up, and incidence of parastomal hernia recurrence.\\u003c/p\\u003e \\u003cp\\u003eData was extracted by trained extractors. Authors of relevant studies were contacted to obtain missing information. Similarly, authors of manuscripts reporting on various approaches to cystectomy, i.e., mixed population with open and RA-procedures were contacted for data specific to RA cystectomy. Specific data to minimal invasive hernia repair in ileum conduit were also requested for studies reporting on mixed populations, e.g., reporting on open and minimal-invasive hernia repair or on minimal-invasive hernia repair for different types of parastomal hernia (e.g., colostomy, ileostomy and ileum conduit). If authors did not respond after a third reminder to provide the requested information, the data was considered as not available and if no separate findings specific to RA cystectomy or minimal invasive parastomal hernia repair for ileum conduit were provided, the study was excluded.\\u003c/p\\u003e \\u003cp\\u003eMethodological quality of the included cohort was assessed using the Newcastle-Ottawa Scale for cohort, JBI critical appraisal tool for case series [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e], and Cochrane Risk Of Bias (ROB) 2 tool for Randomized Control Trial (RCT). The outcome for ROB assessment using ROB 2 tool was parastomal hernia development. Of note, the RCTs reported on open and RA procedures and risk of bias was assessed for the whole trial (not specifically for RA procedures).\\u003c/p\\u003e\\n\\u003ch3\\u003eAnalyses\\u003c/h3\\u003e\\n\\u003cp\\u003eIn consideration of the expected heterogeneous duration of follow-up and methods of assessment of parastomal hernia, we primarily planned to summarize the incidence data descriptively while maintaining an option for meta-analytic pooling. The same applied to minimal-invasive hernia repair. The review of the available data confirmed the expected heterogeneity and a meta-analysis was not attempted. A meta-analytic approach for risk or protective factors and for outcome was never planned.\\u003c/p\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cp\\u003eAfter duplicate removal, 368 records were identified. Thereof, 283 were excluded during title and abstract screening. After full-text eligibily assessment, 11 papers[\\u003cspan additionalcitationids=\\\"CR3\\\" citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR10 CR11 CR12 CR13 CR14 CR15\\\" citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e] were included for the assessment of the incidence of parastomal hernia, thereof 2 [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e] provided information on risk or protective factors for parastomal hernia. For the outcome of minimal invasive parastomal heria repair in ileum conduit, 7 studies [\\u003cspan additionalcitationids=\\\"CR6\\\" citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR18 CR19\\\" citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e] were included. Reasons for exclusion in the full-text elegibility assessment are reported in the PRISMA flow chart (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e\\n\\u003ch3\\u003eQuality assessment\\u003c/h3\\u003e\\n\\u003cp\\u003eOf the 11 studies for the assessemnt of the incidence of parastomal hernia after RA-cystectomy with ileum conduit, 9 (81.8%) were retrospective single-centre case series and 2 (18.2%) RCTs. Of the 9 case series, 4 (44.4%) presented high-risk of bias due to selection bias araising from relevant proportions of patients excluded due to missing data and due to high attrition. For the other 5 studies, risk of bias was unclear since information on missing data and on loss of follow-up was not reported. For both RCT, risk of bias was low for all domains of the ROB2 tool (of note the assessment referred to parastomal hernia after open or RA procedures [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]and open, laparoscopic and RA procedures [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e], respectively since both RCT included different surgical techniques).\\u003c/p\\u003e \\u003cp\\u003eOf the 7 studies reporting on minimal-invasive hernia repair for parastomal hernia in ileum conduit patients, 5 (71.4%) were retrospective single-centre case series with high or unclear risk of bias mainly due to selection and classification bias resulting from missing data and loss of followup and 2 studies, a retrospective single-centre [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e] and a retrospective multicentre cohort [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e] presented low risk of bias.\\u003c/p\\u003e\\n\\u003ch3\\u003eIncidende of parastomal hernia after RA cystectomy and ileum conduit\\u003c/h3\\u003e\\n\\u003cp\\u003eEleven studies reported on the incidence of parastomal hernia in a total of 920 patients. The sample size ranged between 9 and 383 patients, the followup duration from 17 days to 45 months (median or mean depending on the study). As far as reported, the samples consisted mainly of men. The mean or median age ranged from 62 to 75 years, mean or median BMI from 22 to 30 kg/m2. Parastomal hernia was observed in 0 to 44% of patients after RA-cystectomy with IC diversion. Of note, in the 2 largest studies [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e], parastomal hernia was reported in 19.6% [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e] and 43% of patients [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e], respectively.\\u003c/p\\u003e \\u003cp\\u003eIn 4 studies with a total of 490 patients [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e] symptomatic hernias were reported and affected 0 to 9.5% of patients. Reoperation for parastomal hernia was necessary in 0 to 16.6% patients (assessed in 5 studies [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR10\\\" citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e] with a total of 518 patients).\\u003c/p\\u003e \\u003cp\\u003eThe proportion of intracorporal IC creation ranged from 0 to 100%. Data were not sufficient to assess the impact of intra- vs extracorporal technique on parastomal hernia incidence.\\u003c/p\\u003e \\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e reports the details of the studies included for the assessment of incidence of parastomal hernia.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eCharacteristics and findings of the studies reporting on the incidence of parastomal hernia after RA cystectomy and IC.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"13\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c11\\\" colnum=\\\"11\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c12\\\" colnum=\\\"12\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c13\\\" colnum=\\\"13\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAuthor\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStudy design\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePeriod of enrolment\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eN=\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eM:F\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eAge (mean/ median)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eBMI (mean/ median)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eProportion of Intracorporal ileum conduit technique\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eFollow-up duration (mean/ median\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eN (%) parastomal hernia\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003eMean/ median time to parastomal hernia\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003eN (%) symptomatic parastomal hernia\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003eN (%) parastomal hernia requiring surgery repair\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eMiyake M, Asian J Endosc Surg 2025\\u003c/b\\u003e [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003esingle-centre retrospective case series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2019\\u0026ndash;2022\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e27\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e24?M, 4F\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e75y (71\\u0026ndash;79)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e22.2 (19.6\\u0026ndash;24.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e100%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003emedian 20 mt\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e1 (3.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e11 mt\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eLone Z, BJU Int 2024\\u003c/b\\u003e [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003esingle-centre retrospective case series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2010\\u0026ndash;2020\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e284\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003enot reported for RARC only\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e70y (whole cohort)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003emedian BMI 26 in no PH, 30 in pat with PH (whole cohort)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e59%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003emedian follow-up 45 mt in no PH and 43 mt in pat with PH (whole cohort)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e125 (44.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e\\\"125 hernia at 2 years\\\"\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003enot reported for RARC only\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eFaria EF, International Braz J Urol 2024\\u003c/b\\u003e [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003esingle-centre retrospective case series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2018\\u0026ndash;2023\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e28\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003enot reported for IC only\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e65y (46\\u0026ndash;88)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e26.8 (17\\u0026ndash;40)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e100%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e90 days\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e90 days\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDjaladat H, J Urol 2024\\u003c/b\\u003e [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003esingle-centre RCT\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2015\\u0026ndash;2021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e73\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e58 M, 15F\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e74y\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e26.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e100%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e20.4 mt (IQR 8\\u0026ndash;25)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e18 (24.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e20.4 months (IQR 8\\u0026ndash;25)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e7 (9.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e2 (2.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eCarlton CE, Urology 2024\\u003c/b\\u003e [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003esingle-centre retrospective case series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2011\\u0026ndash;2021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0 M, 24F\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e75y (range 53\\u0026ndash;87)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e26 (23\\u0026ndash;30)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e14 mt (IQR 5\\u0026ndash;28)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e7 (29.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e1\\u0026ndash;3 years\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e4 (16.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eZhou Z, Cell Rep med 2024\\u003c/b\\u003e [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003esingle-centre RCT\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2019\\u0026ndash;2020\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003enot reported for RARC only\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e62y\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11 (whole cohort)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003emean 22.9 (whole cohort)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e31 mt (12\\u0026ndash;35) (whole cohort)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e2 (20%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003enot applicable\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eRezaee ME, Can J Urol 2020\\u003c/b\\u003e [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003esingle-centre retrospective case series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2009\\u0026ndash;2018\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003enot reported for RARC only\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e71y (whole cohort)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003emean 30.1 (whole cohort)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e3.4 years (whole cohort)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e2 (22.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eTenzel PL, Hernia 2018\\u003c/b\\u003e [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003esingle-centre retrospective case series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2010\\u0026ndash;2017\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e38\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e28M; 10F\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e68y\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e21 mt in patients with and 11 mt without mesh\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e1 (2.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eHussein AA, J Urol 2018\\u003c/b\\u003e [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003esingle-centre retrospective case series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2005\\u0026ndash;2016\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e383\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003epat with vs without PSH BMI 30 vs 28 kg/m2 (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.02) (wole cohort)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e100% after 2009\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e18 mt (IQR 7\\u0026ndash;35)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e75 (19.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e13 months (IQR 9\\u0026ndash;22)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e23 (6.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e11 (2.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eHuynh D, J Robot Surg 2017\\u003c/b\\u003e [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003esingle-centre retrospective case series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2013\\u0026ndash;2015\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e12M, 3F\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e72y (58\\u0026ndash;90)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003emean 29 (23\\u0026ndash;43)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e17d (10\\u0026ndash;40)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003enot applicable\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ePruthi RS, Urology 2008\\u003c/b\\u003e [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003esingle-centre retrospective case series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2006\\u0026ndash;2007.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e29\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003enot reported for IC subgroup\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e64y (whole cohort)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e13 mt (range 2\\u0026ndash;24) (whole cohort)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e3 (10.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eRisk or protective factors for parastomal hernia after RA cystectomy with ileum conduit\\u003c/h2\\u003e \\u003cp\\u003eFor 2 studies (1 RCT and 1 large retrospective case series) [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e] with a total of 93 hernias in 456 patients, data specific for parastomal hernia in IC after RA cystectomy were available to assess risk or protective factors. In patients submitted to RA cystectomy, the prophylactic use of mesh [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e] was not protective. Hussein et al. [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e] reported longer surgery duration (adjusted odds ratio [OR]1.25, 95% CI 1.06\\u0026ndash;1.46), fascial defect size\\u0026thinsp;\\u0026ge;\\u0026thinsp;30 mm (adj OR 5.23, 95% CI 2.32\\u0026ndash;11.80), and postoperative eGFR less than 60 ml per minute (adj OR 2.17, 95% CI 1.23\\u0026ndash;3.90) as significant predictive factors for parastomal hernia development.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eOutcome after minimal-invasive parastomal hernia repair after RA cystectomy and ileum conduit\\u003c/h2\\u003e \\u003cp\\u003eThe 7 studies on the outcome after minimal invasive parastomal hernia repair included a total of 137 patients, thereof 25 RA parastomal hernia repairs. Sample size ranged from 10 to 35 patients. Only 2 studies [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e] prespecified planned follow-up durations for hernia recurrence.Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e reports the characteristics of the studies addresing outcome after minimal invasive parastomal hernia repair and their findings.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eCharacteristics and findings of studies reporting on minimal invasive parastomal hernia repair in IC patients.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"15\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c11\\\" colnum=\\\"11\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c12\\\" colnum=\\\"12\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c13\\\" colnum=\\\"13\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c14\\\" colnum=\\\"14\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c15\\\" colnum=\\\"15\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAuthor\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStudy design\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePeriod of enrolment\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eMinimal invasive procedure\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eSample size\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eM:F\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eAge (mean/ median)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eBMI (mean/ median)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eParastomal hernia classification (European Hernia Society)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eSurgery duration (min)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003eIntraop complications\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003ePostop complication rate\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003eLength of stay\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003eFollow-up duraton for hernia recurrence (months)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003eIncidence of parastomal hernia recurrence\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eViolante, Hernia 2024 [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003esingle-cenre retrospective case series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2021\\u0026ndash;2023\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003erobot-assisted\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e7M, 8F\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e69.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e31.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e5x class I, 5x class II, 4x class III, 1x class IV\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e249\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;63\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e2x ileus, 1x abdominal collections, 1 exploratory laparoscopy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e3.6d\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e15.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e0/15\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSuwa, Journal of the anus, rectum and colon\\u0026nbsp;2024 [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003esingle-cenre retrospective case series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2012\\u0026ndash;2023\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003elaparoscopic\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e6M, 4F\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e72 (48\\u0026ndash;84)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e24 (22\\u0026ndash;32)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e5x class I, 3x class II, 2x class 4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e223 (120\\u0026ndash;423]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e1 (10%) bowel lesion\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e1x (10%) ureteral obstruction\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e9d (6\\u0026ndash;14)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e52 (20\\u0026ndash;104)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFu, BMC Surg 2024 [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003esingle-cenre retrospective case series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2013\\u0026ndash;2022\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003elaparoscopic\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e35\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e20M, 10F\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e69 (64.5\\u0026ndash;71)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e25.1 (23.3\\u0026ndash;27.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e16x class I, 13x class II, 5x class III, 1x class IV\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e90 (65\\u0026ndash;120)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e3 (8.6%) bowel lesion\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e1x ileus; 2x peristomal abscess\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e5d (4\\u0026ndash;7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e32 (25.5\\u0026ndash;38)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e3 (8.6) after a median of 14 mt\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGoffioul Hernia 2024 [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003esingle-cenre retrospective case series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2014\\u0026ndash;2020\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003elalaroscopic\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e9M, 7F\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e67 (65\\u0026ndash;75)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e27,60\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e6x class I, 5x class II, 4x class III, 1x class IV\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e76 (58\\u0026ndash;105)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e2 (12.5%) conversion\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e2x CDC 3a, 1x CDC 3b\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e3d (3-4.25)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e30 (17\\u0026ndash;35)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e2/16\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDewulf, Langenbeck's Arch Surg 2022 [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003esingle-cenre retrospective case series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2016\\u0026ndash;2020\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003erobot-assisted and laparoscopic\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e10M, 5F\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e75 (73\\u0026ndash;77)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e28.7 (25.7\\u0026ndash;34.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e197 (132\\u0026ndash;260)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e1x CDC 2, 2x CDC class 3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e5d (3\\u0026ndash;9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e366d (241\\u0026ndash;1286)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e1 of 15? (unclear loss of followup\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLaycock, Hernia 2022 [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003esingle-cenre retrospective case series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2008\\u0026ndash;2019\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003elaparoscopic\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e27\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e16M, 11F\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003emedian age 70\\u0026nbsp;years (mean 67.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003emedian 29.6, mean 29.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003emean 118\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e4x CDC 2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003emedian 2d, mean 3.6d\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003emedian 518 days, mean 750\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e2 (8.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eM\\u0026auml;k\\u0026auml;r\\u0026auml;inen-Uhlb\\u0026auml;ck, BMC Surg 2021 [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003emulticentre retrospective case series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2007\\u0026ndash;2017\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003elaparoscopic\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e19\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003enot reported only for minimal invasive\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003enot reported only for laparoscopic\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003enot reported only for laparoscopic\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003enot reported only for laparoscopic\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003enot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e1x bleeding, 1x infection (not SSI)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e4.8d\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.1 (range 2\\u0026ndash;15)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e \\u003cp\\u003e38+/-26 months (range 1-100)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e \\u003cp\\u003e4 of 19\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eThe main findings of this systematic review are that 1) a relevant proportion of patients may experience parastomal hernia of IC after RA-cystectomy. However, incidence figures varied widely (0 to 43%) and evidence was frequently affected by selection bias, so that the incidence for parastomal hernia of IC after RA cystectomy remains unestablished; 2) information on factors influencing the development of parastomal hernia after RA cystectomy is essentially lacking; 3) the evidence on the outcome of minimal invasive hernia repair in IC patients is very limited both in terms of quantity and of quality.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eComparison with previous studies\\u003c/h2\\u003e \\u003cp\\u003eNarang et al [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e] conducted a systematic literature review on the incidence of parastomal hernia of ileum conduit after cystectomy by any surgical technique. Out of 63 hits, they included 12 retrospective case series published between 1989 and 2016. In spite of varying or unclear follow-up duration, they reported a pooled incidence at 17.9% for parastomal hernia development. In the present study, we conducted an extensive search (368 hits) in April 2025 and we focused on robot-assisted cystectomies. Due to heterogenous follow-up durations, we avoided pooling. In the 2 larger samples, 19.6% [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e] and 43% [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e] of patients after robot-assisted cystectomy and IC creation, respectively, suffered parastomal hernia. In 2020, Feng et al [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e] conducted a systematic literature search and included 15 studies reporting on parastomal hernia after radical cystectomy by any approach. They reported pooled incidences of radiological parastomal hernia of 14% at 1 year and of 26% at 2 years, respectively. However, as in the present review focused specifically on RA cystectomy, incidence of parastomal hernia varied widely between studies. Reasons for the high heterogeneity of the estimated incidence of parastomal hernia after RA cystectomy may include methodological issues, e.g., different follow-up durations, different follow-up approaches, and different definitions (radiological vs clinically manifest). However, the wide diverging incidence reported in the literature may also arise from the single centre design of most studies, since which surgeon conducted the procedure appears to have a major impact on the incidence of parastomal hernia [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e] .\\u003c/p\\u003e \\u003cp\\u003eWith regard to risk factors for parastomal hernia, our findings confirm for RA cystectomy what was described for open cystectomy: the various studies addressed a large number of different risk factors, often without being adequately powered for such analyses, so that robust conclusions in this regard are not possible. In terms of the prophylactic use of mesh to prevent parastomal hernia during IC creation after cystectomy by any surgical technique, the pooled estimates of 3 RCTs suggested a protective effect, albeit with large confidence intervals (OR 0.49 [95%CI 0.25\\u0026ndash;0.97]) [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eIn addition to summarizing the evidence on the incidence of parastomal hernia and its risk factors with a focus on RA procedures, the current standard of care in many institutions, we expanded the perspective of previous systematic reviews by the consideration of outcomes after minimal-invasive parastomal hernia repair and the conduction of a corresponding systematic search. The body of evidence on this topic is severely limited. At the current stage, evidence is so limited that adequate patient counselling in term of outcome for minimal-invasive parastomal hernia repair may be considered not feasible.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStrengths and limitations\\u003c/h2\\u003e \\u003cp\\u003eStrength of our approach include an extensive literature search, study selection according to predefined criteria by 2 assessors, and a focus not only on the incidence of parastomal hernia after RA cystectomy with IC but also on risk or protective factors for it. Further, this review summarizes also the outcomes of minimal invasive hernia repair, therefore addressing the whole trajectory of patients suffering a parastomal hernia after IC creation.\\u003c/p\\u003e \\u003cp\\u003eWe are aware of the following limitations: first, follow-up durations in the included studies were highly heterogeneous, thus preventing the calculation of pooled estimates for the incidence of parastomal hernia after RA cystectomy and IC. Second, while efforts were undertaken to obtain information specific to RA procedures, some papers had to be excluded since the necessary information was not provided.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"CONCLUSION\",\"content\":\"\\u003cp\\u003eA relevant proportion of patients may experience parastomal hernia of IC after RA-cystectomy, however incidence figures varied widely across studies and evidence was frequently affected by selection bias. Information on factors influencing the development of parastomal hernia after RA cystectomy is essentially lacking. Finally, the evidence on the outcome of minimal invasive hernia repair in IC patients is very limited both in terms of quantity and of quality. As such this systematic literature search discloses major knowledge gaps with regard to parastomal hernia after RA cystectomy with IC and its minimal-invasive repair. To develop strategies to prevent hernia development to offer guidance to surgeons and for patients\\u0026acute; counselling, there is an urgent need to address these knowledge gaps. Cooperation to achieve prospective multicentre designs with adequate sample size, systematic follow-up methods, and efforts to limits attrition would be crucial factors to generate the high-quality evidence that is currently missing.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable (systematic review summarizing pooled estimates from published studies).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable (systematic review summarizing pooled estimates from published studies).\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets used in the current systematic review are available from the corresponding author on reasonable written request.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eStephan Buse act as a proctor for Da Vinci Surgical Inc. The other authors do not report any competing interests.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eIntramural funding.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026apos; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSB: conception and design, literature search, data generation, interpretation, manuscript drafting, approval of the final manuscript\\u003c/p\\u003e\\n\\u003cp\\u003eJN: literature search, data generation, interpretation, manuscript drafting, approval of the final manuscript\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003ePR: conception and design, interpretation, approval of the final manuscript\\u003c/p\\u003e\\n\\u003cp\\u003eAHA: conception and design, interpretation, approval of the final manuscript\\u003c/p\\u003e\\n\\u003cp\\u003eAR: conception and design, interpretation, approval of the final manuscript\\u003c/p\\u003e\\n\\u003cp\\u003eAH: conception and design, interpretation, approval of the final manuscript\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eKA conception and design, interpretation, approval of the final manuscript \\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe thank all authors that provided additional information on their studies.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eNarang SK et al (2017) Parastomal hernia following cystectomy and ileal conduit urinary diversion: a systematic review. Hernia 21(2):163\\u0026ndash;175\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHussein AA et al (2018) Natural History and Predictors of Parastomal Hernia after Robot-Assisted Radical Cystectomy and Ileal Conduit Urinary Diversion. J Urol 199(3):766\\u0026ndash;773\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLone Z et al (2024) Body morphometry may predict parastomal hernia following radical cystectomy with ileal conduit. BJU Int 134(5):841\\u0026ndash;847\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRezaee ME et al (2020) Parastomal hernia development after cystectomy and ileal conduit for bladder cancer: results from the Dartmouth ileal conduit enhancement (DICE) project. Can J Urol 27(5):10369\\u0026ndash;10377\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDewulf M et al (2022) How-I-do-it: minimally invasive repair of ileal conduit parastomal hernias. Langenbecks Arch Surg 407(3):1291\\u0026ndash;1301\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMakarainen-Uhlback E et al (2021) Keyhole versus Sugarbaker techniques in parastomal hernia repair following ileal conduit urinary diversion: a retrospective nationwide cohort study. BMC Surg 21(1):231\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eViolante T et al (2024) Robotic parastomal hernia repair in Ileal-conduit patients: short-term results in a single-center cohort study. Hernia 28(6):2245\\u0026ndash;2253\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMunn Z et al (2020) Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI Evid Synth 18(10):2127\\u0026ndash;2133\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCarlton CE et al (2024) Robotic simple cystectomy as a last resort for antibiotic-recalcitrant recurrent urinary tract infections in women. Urology 186:139\\u0026ndash;143\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDjaladat H et al (2024) Prophylactic Use of Biologic Mesh in Ileal Conduit (PUBMIC): A Randomized Clinical Trial. J Urol 211(6):743\\u0026ndash;753\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFaria EF et al (2024) Mesentery-Sparing Technique: a New Intracorporeal Approach for Urinary Diversion in Robot-Assisted Radical Cystectomy. Int Braz J Urol 50(4):489\\u0026ndash;499\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHuynh D et al (2017) Feasibility and safety study for the use of wound protectors during robotic radical cystectomy and ileal conduit. J Robot Surg 11(2):187\\u0026ndash;191\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMiyake M et al (2025) Comparison of Post-Radical Cystectomy Renal Function and Ileal Conduit-Related Complications Between Extracorporeal and Robot-Assisted Intracorporeal Urinary Diversion: A Single-Center Experience. Asian J Endosc Surg 18(1):e70033\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePruthi RS, Wallen EM (2008) Is robotic radical cystectomy an appropriate treatment for bladder cancer? Short-term oncologic and clinical follow-up in 50 consecutive patients. Urology, 72(3): p. 617\\u0026thinsp;\\u0026ndash;\\u0026thinsp;20; discussion 620-2.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTenzel PL et al (2018) Prophylactic mesh used in ileal conduit formation following radical cystectomy: a retrospective cohort. Hernia 22(5):781\\u0026ndash;784\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eZhou Z et al (2024) Extraperitonealization of the ileal conduit decreases the risk of parastomal hernia: A single-center, randomized clinical trial. Cell Rep Med 5(1):101343\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFu X et al (2024) Laparoscopic Sugarbaker repair of parastomal hernia following radical cystectomy and ileal conduit: a single-center experience. BMC Surg 24(1):258\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGoffioul L et al (2024) Repair of parastomal hernia after Bricker procedure: retrospective consecutive experience of a tertiary center. Hernia 28(3):823\\u0026ndash;830\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLaycock J et al (2022) A keyhole approach gives a sound repair for ileal conduit parastomal hernia. Hernia 26(2):647\\u0026ndash;651\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSuwa K et al (2024) Surgical Outcomes after Laparoscopic Repairs of Para-colostomy Hernia and Para-ileal-conduit Hernia: A Comparative Study. J Anus Rectum Colon 8(4):340\\u0026ndash;347\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFeng D et al (2021) Incidence and risk factors of parastomal hernia after radical cystectomy and ileal conduit diversion: a systematic review and meta-analysis. Transl Cancer Res 10(3):1389\\u0026ndash;1398\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHinojosa-Gonzalez DE et al (2024) Use of prophylactic mesh to prevent parastomal hernia formation: a systematic review, meta-analysis and network meta-analysis. Hernia 29(1):22\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"journal-of-robotic-surgery\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"jors\",\"sideBox\":\"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)\",\"snPcode\":\"11701\",\"submissionUrl\":\"https://submission.nature.com/new-submission/11701/3\",\"title\":\"Journal of Robotic Surgery\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false},\"keywords\":\"robot-assisted cystectomy, ileum conduit, parastomal hernia, minimal-invasive hernia repair\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-9387072/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-9387072/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground and aims:\\u003c/h2\\u003e \\u003cp\\u003eIncidence of and risk factors for parastomal hernia after robot-assisted (RA) cystectomy with ileum conduit (IC) are not well established. The aims of this systematic review were to summarize the literature 1) on the incidence of parastomal hernia after RA cystectomy and IC reconstruction; 2) on risk or protective factors associated with the development of parastomal hernias after RA cystectomy and IC reconstruction; and 3) on outcomes of minimal invasive parastomal hernia repair in patients with IC.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003ewe conducted literature searches in Medline, EMBASE, and CINHAL up to April 2025 without language restriction. Two independent assessors evaluated eligibility and quality of the included study. Due to high heterogeneity, meta-analysis was not attempted.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eout of 368 records, 11 and 2 papers provided information on the incidence of parastomal hernia and on risk factors, respectively. For the outcome of minimal invasive IC hernia repair, 7 studies were included. Most studied presented high risk of bias and the incidence rate varied widely across studies. Similar findings were observed for hernia recurrence after minimal invasive hernia repair.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eA relevant proportion of patients may experience parastomal hernia of IC after RA-cystectomy, however incidence figures varied widely. Information on factors influencing the development of parastomal hernia after RA cystectomy is essentially lacking. Finally, the evidence on the outcome of minimal invasive hernia repair in IC patients is very limited both in terms of quantity and of quality. There is urgent need to address the knowledge gaps detected by this systematic review. Cooperation to achieve prospective multicentre designs with adequate sample size and systematic follow-up methods would be crucial factors to generate the high-quality data required to develop evidence-based strategies to prevent parastomal hernias.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Parastomal Hernia After Robot-assisted Cystectomy and Ileum Conduit: Incidence, Risk or Protective Factors and Outcomes of Minimal-invasive Hernia Repair-systematic Review\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-04-28 00:18:33\",\"doi\":\"10.21203/rs.3.rs-9387072/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2026-05-15T10:48:17+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-05-15T02:13:54+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"88698690566092865787622471082620188158\",\"date\":\"2026-05-10T18:00:31+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-05-10T15:43:58+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"2130094868945329296149250822408138937\",\"date\":\"2026-05-10T06:55:56+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"330865148396493637531754931111058406006\",\"date\":\"2026-05-07T10:46:44+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"251973503472496818934494842792018207820\",\"date\":\"2026-05-07T05:17:40+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"74682388236895468392422778332308674243\",\"date\":\"2026-05-05T20:51:27+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2026-04-18T12:23:01+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-04-13T16:15:24+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2026-04-13T14:17:43+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Journal of Robotic Surgery\",\"date\":\"2026-04-11T10:26:03+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"journal-of-robotic-surgery\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"jors\",\"sideBox\":\"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)\",\"snPcode\":\"11701\",\"submissionUrl\":\"https://submission.nature.com/new-submission/11701/3\",\"title\":\"Journal of Robotic Surgery\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false}}],\"origin\":\"\",\"ownerIdentity\":\"df32fe57-e1c6-49cc-addc-1df54a1e87b3\",\"owner\":[],\"postedDate\":\"April 28th, 2026\",\"published\":true,\"recentEditorialEvents\":[{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2026-05-15T10:48:17+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-05-15T02:13:54+00:00\",\"index\":162,\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"88698690566092865787622471082620188158\",\"date\":\"2026-05-10T18:00:31+00:00\",\"index\":161,\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-05-10T15:43:58+00:00\",\"index\":160,\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"2130094868945329296149250822408138937\",\"date\":\"2026-05-10T06:55:56+00:00\",\"index\":158,\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"330865148396493637531754931111058406006\",\"date\":\"2026-05-07T10:46:44+00:00\",\"index\":156,\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"251973503472496818934494842792018207820\",\"date\":\"2026-05-07T05:17:40+00:00\",\"index\":155,\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"74682388236895468392422778332308674243\",\"date\":\"2026-05-05T20:51:27+00:00\",\"index\":153,\"fulltext\":\"\"}],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"in-revision\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-05-15T10:55:47+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-04-28 00:18:33\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-9387072\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-9387072\",\"identity\":\"rs-9387072\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}