Laparoscopic repair of parastomal hernia following radical cystectomy and ileal conduit: A Single-Center Experience

Laparoscopic repair of parastomal hernia following radical cystectomy and ileal conduit: A Single-Center Experience | 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 Laparoscopic repair of parastomal hernia following radical cystectomy and ileal conduit: A Single-Center Experience Xiaojian Fu, Rong Hua, Minglei Li, Hao Chen, Qiyuan Yao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4276763/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Sep, 2024 Read the published version in BMC Surgery → Version 1 posted 4 You are reading this latest preprint version Abstract Purpose: Parastomal hernia (PH) is a frequent complication following radical cystectomy and ileal conduit (IC). The purpose of this study was to summarize the clinical experience and technical characteristics of laparoscopic repair of PH following IC. Methods : We retrospectively evaluated all patients who underwent laparoscopic treatment of PH following IC at Huashan Hospital, Fudan University from May 2013 to December 2022. Results :Thirty-five patients were included in the study. Median follow up was 32 months. Three patients presented with a recurrence (8.6%), with a median time to recurrence of 14 months. Out of the 35 patients, Thirty-two underwent totally laparoscopic repair using the Sugarbaker technique, Three patients required open surgery to repair the intestinal injury after laparoscopic exploration. One patient died 9 months post-surgery due to COVID-19. During the follow-up period, two patients developed a peristomal abscess, and one patient experienced partial intestinal obstruction 10 days after surgery. Conclusion : Surgical management of PH following IC is challenging. The laparoscopic Sugarbaker technique for repairing PHfollowing IC has low complication and recurrence rate. Ileal conduit Parastomal hernia Laparoscopic surgery Sugarbaker technique Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction The ileal conduit (IC) is one of the simplest and most common forms of urinary diversion after radical cystectomy, with a history of over 60 years [ 1 ] . Despite its widespread use and improved surgical technique, parastomal hernia (PH) after IC remains a common complication, and occur in approximately 30% of patients [ 1 , 2 ] . PH affects the appearance of the abdominal wall, causing discomfort, bloating, and intermittent pain around the stoma. It also impacts the function of the stoma and can lead to more severe issues such as incarceration. More than 30% of patients with parastomal hernia require surgical treatment [ 3 , 4 ] . Surgical management of PH following IC is challenging, with a high risk of recurrence and complications, and there is no gold standard technique for treatment of PH following IC [ 5 ] .Open, laparoscopic, and robotic approaches are used in variety of surgical repairs. It is widely accepted that laparoscopic repair is more safe and effective than open surgery [ 6 , 7 ] .In this study, we reviewed and summarized the surgical experience, techniques, and complications of laparoscopic repair for PH following IC in 35 patients from May 2013 to December 2022. Methods Data collection We retrospectively evaluated all patients who underwent laparoscopic repair for PH following IC at Huashan Hospital, Fudan University from May 2013 to December 2022.Retrospective review of each patient’s notes was then undertaken. Patient demographics, including age, gender, body mass index were all recorded alongside Intraoperative situation, length of stay and post-operative complications. Defnition and diagnosis The decision to offer hernia repair was made by the senior surgeon. Following clinical review, all patients underwent pre-operative CTU scan to confirm the postoperative status of bladder tumor and presence of the hernia and peripheral anatomy. All images were reviewed by a senior radiologist. A PH was defined as a peritoneal sac protruding through the fascia beside the ileal conduit [ 6 ] . Surgical technique Preoperative preparations will be completed, and bowel preparation will be performed one day before the surgery. All operations were carried in a supine position under general anaesthesia and prophylactic antibiotics were routinely given at induction. The surgical field will be draped in a specific sequence, starting with disinfection of other parts and ending with disinfection of the stoma area. A Foley catheter was placed in the ileal conduit to facilitate identification of the conduit during the procedure and the balloon at the tip of the catheter will be filled with 10ml water to close the stoma and prevent urine leakage. The surgeon and assistant were sited on the patient’s left, opposite the side of the PSH. The first puncture hole will be located at the intersection of the left costal margin and the anterior axillary line. A 12mm trocar will be used to puncture directly into the abdomen under laparoscopic visualization, with an intra-abdominal pressure set at 12mmHg. Two further trocars (5 mm) were then sited under direct visualization, one at the level of the left anterior axillary line and the stoma, and another one between the xiphoid process and the umbilicus. The position of the stoma intestine and its mesentery needs to be confirmed during surgery. Adhesions between the stoma intestine and the surrounding intestine and abdominal wall, as well as adhesions between the stoma intestine and other tissues, are gradually separated. Care should be taken during the separation process to avoid inadvertent ureteric or small bowel injury. The stoma defect is exposed, and the hernia contents were reduced into the peritoneal cavity(Figure 1 ). The defect is then closed using a laparoscopic hernia needle grasper with 1 − 0 Surgilon braided nylon (Covidien) ensuring an appropriate tension that does not constrict the stoma intestine(Figure 2 & 3 ). A suitable mesh was then chosen depending on the size of the hernia defect which can completely cover the defect area, extend at least 3cm beyond the defect edge, and provide coverage of the stoma intestine by at least 6cm. Typically, a 15x15cm or 15x20cm DynaMesh®-IPOM patch were selected based on the actual situation. DynaMesh®-IPOM [ 8 ] (FEG Textiltechnik mbH, Aachen, Nordrhein-Westfalen, Germany) has a dualcomponent structure consisting of 88% anti-adhesive polyvinylidene difluoride (PVDF) and 12% polypropylene (PP). Adhesive PP is woven through the mesh structure on the side which is placed parietally to provide a rapid and safe incorporation into the abdominal wall. The anti-adhesive visceral PVDF side acts as a barrier to prevent adhesions of the intestines and/or omental fat with the mesh. The mesh was rolled and introduced to the peritoneal cavity via the 12 mm port. Then we do the Laparoscopic Sugarbaker repair and the mesh is fixed using a Covidien 5 mm Protack device requiring the placement of two rows of screws along the stoma, every1-2cm until the patch is completely laid flat and secured(Fig. 4 ). A negative pressure drainage tube will be placed in the abdominal cavity. Results A total of Thirty-five cases of parastomal hernia were reported following ileocecal bladder conduit surgery. Among these cases, 25 were males and 10 were females, with median age of 69 years (mean 67.7). The median BMI was 25.1kg/m 2 (mean 25.4 ). The distribution of Body Mass Index (BMI) was as follows: 16 cases had a BMI < 25, 16 cases had a BMI between 25 and 30, and 3 cases had a BMI ≥ 30. All patients underwent cystectomy as the primary surgery. Four patients had recurrent PH with two underwent suture repair and two underwent open mesh repair. The median time from index surgery to repair was 3 years (mean 4.2). Two repair was carried out as an emergency; all other cases were elective surgery. According to the classification of parastomal hernia types based on EHS [ 9 ] , there were 16 cases of Type I, 13 cases of Type II, 5 case of Type III and 1 case of Type IV. Out of the 35 cases, 32 cases underwent totally laparoscopic repair using the Sugarbaker technique. There were 3 cases experienced intestinal injury during adhesion separation and required open exploration and repair before undergoing laparoscopic Sugarbaker repair. The median operative time was 101.8 min (average 90).The median time to discharge was 5 days (mean 6.2). One patient died 9 months post-surgery due to COVID-19 and the Median follow up was 32 months. During the follow-up period, Three patients presented with a recurrence (8.6%), with a median time to recurrence of 14 months. They refused further surgery because the recurrence did not have significant impact on the quality of life. Two patients developed a peristomal abscess which was resolved after drainage and antimicrobial therapy, and one patient experienced partial intestinal obstruction 10 days after surgery which was resolved with fasting and fluid support. In all cases where mesh repair was performed, there was short-term pain at the repair site after surgery, which gradually subsided within three months. Discussion Bladder cancer ranks as the ninth most frequently-diagnosed cancer worldwide, and Bricker surgery is an important procedure for treating it [ 10 ] . Parastomal hernia (PH) following radical cystectomy and ileal conduit(IC) remains a common complication, and occur in approximately 30% of patients [ 1 , 2 ] . PH affects the appearance of the abdominal wall, causing discomfort, bloating, and intermittent pain around the stoma. It also impacts the function of the stoma and can lead to more severe issues such as incarceration. The treatment of PH include hernia support appliances, weight loss, avoidance of heavy lifting, patient education and surgery [ 6 , 11 ] . Surgical management of PH following IC is challenging, with a high risk of recurrence and complications. The surgical approach for repairing PH following IC is similar to paracostomy hernia, including suture repair, re-siting and mesh repair. The suture repair has been gradually abandoned due to its high recurrence rate up to 50% [ 7 , 12 ] . Stoma relocation and redo repair are difficult due to the limited length and displacement of the ureter, as well as the potential complications of incisional hernia and new parastomal hernia [ 6 , 7 , 13 ] .Mesh repair, performed by open, laparoscopic or robotic approaches, remains the primary choice [ 5 , 13 , 14 ] . It is widely accepted that laparoscopic repair is superior to open repair in terms of operative time, length of hospital stay, postoperative complications, and recurrence rate for colostomy-related hernia repair [ 6 , 7 ] . The European Guidelines for Parastomal Hernia Treatment recommends the Sugarbaker technique based on its lower recurrence rate than the Keyhole technique for colostomy-related hernia repair. But previous reports of the keyhole and Sugarbaker techniques regarding ileal conduit parastomal hernias are few and there were more reports about Keyhole repair than the Sugarbaker [ 5 , 6 , 15 – 18 ] .Some surgeon concerned the Sugarbaker repair was not feasible for ileal conduits due to the length of the conduit and torsion of the anastomosed ureter by the mesh [ 2 , 17 ] .But we think laparoscopic Sugarbaker technique is highly suitable for repairing PH following IC and there are several important recommendations for the surgeon: 1) Preoperative bowel preparation and prophylactic antibiotics. Preoperative bowel preparation and prophylactic antibiotics is crucial to prevent postoperative infections. A clean bowel can minimize the contamination of intestines damage during adhesion separation. 2) safe adhesion separation poses a challenge and requires careful manipulation. There are numerous small bowel adhesions to the lower abdomen due to the radical cystectomy and pelvic lymph node dissection of the previous surgery. During adhesion separation, we placed a Foley catheter helping us identify the conduit bowel and the bilateral ureters. Exposing the ureter can be challenging. The right ureter generally has minimal anatomical displacement and the left ureter may be partially exposed in the abdominal cavity as it needs to be pulled to the right side for anastomosis with the intestinal tract. The site where both ureters join the enterostomy is located far from the enterostomy end. Surgeons should be cautious not to damage the ureter when dealing with adhesions related to the enterostomy. As long as an adequately covered intestinal segment is freed, it is not necessary to overly pursue the complete mobilization of the enterostomy segment. It is crucial to identify the mesenteric structures based on the location of the enterostomy, because the blood vessels that supply the intestines within the mesentery are unique. By carefully identifying the enterostomy and its mesenteric structures, damage to the enterostomy and its blood supply can be minimized during adhesion separation. It is preferable to use scissors for separation to avoid thermal damage from ultrasonic or electric knives. In this study, three patients experienced multiple bowel injuries which can not repaired under laparoscopy, leading to open conversion for thorough examination and repair before the laparoscopic procedure for Sugarbaker repair. But it doesn't affect the outcome of the surgery. 3) close the defect using unabsorbable stitches. There are multiple ways to close the defect. Our approach is using a laparoscopic hernia needle grasper ensuring that the puncture site is outside the area where the stoma bag is attached to avoid contamination or interference. We can also perform the closure under laparoscopy using unabsorbable barbed stitching. We recommend using unabsorbable barbed stitching because there is higher tension in pneumoperitoneum state and barbed stitch can help achieve a better closure for certain defects. 4) Use a large enough patch. We recommend using a composite patch that is large enough to cover approximately 6cm of the intestinal tube and extend at least 3cm beyond the edges of the defect [ 19 , 20 ] . Some surgeons consider the use of slow resorbing mesh in order to theoretically reduce the risks of intestinal complication, digestive fstula, or bowel obstructions [ 21 ] . But we still use unabsorbable synthetic patch and In our study, there were no long-term complications related to mesh placement following IC PH repair. The patch can be secured using spiral tacks, starting with fixing the edges of the intestinal tube and gradually moving outward to secure and flatten the patch. Although there were more reports about Keyhole repair, more and more surgeons recommend Sugarbaker in recent years [ 5 , 21 ] .The intestine covered by the mesh is just related to urinary function instead of defecation and there is less passive dilation and peristalsis Comparing to para-colostomy hernia. This may explain the lower recurrence rate of the Sugarbaker technique in PH following IC than para-colostomy hernia. In this case study, three patients presented with a recurrence (8.6%), but they refused further surgery because the recurrence did not have significant impact on the quality of life. Many patients could be managed through nonoperative treatments [ 21 ] .Two patients developed a peristomal abscess and one patient experienced partial intestinal obstruction, and they were all relieved through non-surgical treatment. This is the largest study report so far, with a maximum of 10 cases reported about Sugarbaker technique in PH following IC before [ 5 , 21 ] and our study established that the Sugarbaker technique was associated with low complication and recurrence rate. However, it is important to note that this study has certain limitations. Firstly, it is a retrospective study conducted at a single center, which may introduce bias. Additionally, there was no control group included in this study, as none of the patients underwent open repair or laparoscopic repair using alternative methods. As a result, no statistical analyses could be performed. It is recommended that international studies and registries be conducted to compare different repair methods for PH following IC, given its relative rarity. Conclusion Surgical management of PH following IC is challenging. The laparoscopic Sugarbaker technique for repairing PH following IC has low complication and recurrence rate. Dedicated research and collaboration is required to improve the management of parastomal hernia after ileal conduit. Declarations Statements and Declarations Xiaojian Fu，Minglei Li, Rong Hua, Qiyuan Yao, Hao Chen declare no conflicts of interest. Ethics approval and consent to participate All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinky declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee (full name: Regional Ethics Committee of Huashan hospital, Fudan University）(reference number KY 2019-369) to the Department of General Surgery, Huashan hospital, Fudan University. Consent for publication NA Availability of data and materials The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. Competing interests NA Funding NA Author’s contributions Study conception and design: Hao Chen，Xiaojian Fu Acquisition of data: Xiaojian Fu, Minglei Li Analysis and interpretation of data :Xiaojian Fu, Minglei Li Drafting of manuscript: Xiaojian Fu, Rong Hua Critical revision of manuscript: Qiyuan Yao, Hao Chen Informed consent Informed consent was obtained from all individual participants included in the study. Acknowledgments No References Li Z, Zhang Z, Ma H, et al(2022)Extraperitonealization of ileal conduit reduces parastomal hernia after cystectomy and ileal conduit diversion[J]. Urol Oncol 40(4):117-162. Narang S K, Alam N N, Campain N J, et al(2017)Parastomal hernia following cystectomy and ileal conduit urinary diversion: a systematic review[J]. Hernia 21(2):163-175. Liu N W, Hackney J T, Gellhaus P T, et al(2014)Incidence and risk factors of parastomal hernia in patients undergoing radical cystectomy and ileal conduit diversion[J]. J Urol 191(5):1313-1318. Donahue T F, Bochner B H(2016)Parastomal hernias after radical cystectomy and ileal conduit diversion[J]. Investig Clin Urol 57(4):240-248. Makarainen-Uhlback E, Vironen J, Vaarala M, et al(2021)Keyhole versus Sugarbaker techniques in parastomal hernia repair following ileal conduit urinary diversion: a retrospective nationwide cohort study[J]. BMC Surg 21(1):231. Laycock J, Troller R, Hussain H, et al(2022)A keyhole approach gives a sound repair for ileal conduit parastomal hernia[J]. Hernia 26(2):647-651. Antoniou S A, Agresta F, Garcia A J, et al(2018)European Hernia Society guidelines on prevention and treatment of parastomal hernias[J]. Hernia 22(1):183-198. Domen A, Stabel C, Jawad R, et al(2021)Postoperative ileus after laparoscopic primary and incisional abdominal hernia repair with intraperitoneal mesh (DynaMesh(R)-IPOM versus Parietex Composite): a single institution experience[J]. Langenbecks Arch Surg 406(1):209-218. Smietanski M, Szczepkowski M, Alexandre J A, et al(2014)European Hernia Society classification of parastomal hernias[J]. Hernia 18(1):1-6. Antoni S, Ferlay J, Soerjomataram I, et al(2017)Bladder Cancer Incidence and Mortality: A Global Overview and Recent Trends[J]. Eur Urol 71(1):96-108. Pastor D M, Pauli E M, Koltun W A, et al(2009)Parastomal hernia repair: a single center experience[J]. JSLS 13(2):170-175. Gillern S, Bleier J I(2014)Parastomal hernia repair and reinforcement: the role of biologic and synthetic materials[J]. Clin Colon Rectal Surg 27(4):162-171. DeAsis F J, Lapin B, Gitelis M E, et al(2015)Current state of laparoscopic parastomal hernia repair: A meta-analysis[J]. World J Gastroenterol 21(28):8670-8677. Xu A J, Shakir N A, Jun M S, et al(2021)Robotic Assisted Repair of Post-Ileal Conduit Parastomal Hernia: Technique and Outcomes[J]. Urology 158:232-236. Dewulf M, Hildebrand N D, Bouwense S, et al(2022)Parastomal hernias after cystectomy and ileal conduit urinary diversion: surgical treatment and the use of prophylactic mesh: a systematic review[J]. BMC Surg 22(1):118. Melin I M, Navarro S M, Albersheim J, et al(2021)Illeal conduit associated parastomal hernias: A novel laparoscopic top hat repair[J]. Urol Case Rep 39:101758. Hatsuzawa Y, Tsujinaka S, Kakizawa N, et al(2022)Modified keyhole plus technique with partial release of posterior rectus sheath for parastomal hernia repair after ileal conduit[J]. Asian J Endosc Surg 15(4):850-853. Imamura K, Takada M, Umemoto K, et al(2021)Laparoscopic parastomal herniorrhaphy utilizing transversus abdominis release and a modified Sugarbaker technique: A case report[J]. Asian J Endosc Surg 14(1):106-108. Nardi M J, Millo P, Brachet C R, et al(2017)Laparoscopic ventral hernia repair with composite mesh: Analysis of risk factors for recurrence in 185 patients with 5 years follow-up[J]. Int J Surg, 40:38-44. Suwa K, Okamoto T, Yanaga K(2016)Closure versus non-closure of fascial defects in laparoscopic ventral and incisional hernia repairs: a review of the literature[J]. Surg Today 46(7):764-773. Bel N, Blanc P Y, Moszkowicz D, et al(2023)Surgical management of parastomal hernia following radical cystectomy and ileal conduit: A french multi-institutional experience[J]. Langenbecks Arch Surg 408(1):344. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 12 Sep, 2024 Read the published version in BMC Surgery → Version 1 posted Editorial decision: Revision requested 07 May, 2024 Submission checks completed at journal 06 May, 2024 Editor assigned by journal 06 May, 2024 First submitted to journal 16 Apr, 2024 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. 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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-4276763","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":299752273,"identity":"2c75dbe7-ccf6-41b3-b6aa-22a949bb1fea","order_by":0,"name":"Xiaojian Fu","email":"","orcid":"","institution":"Center for Obesity and Hernia Surgery, Department of General Surgery, Huashan Hospital, Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Xiaojian","middleName":"","lastName":"Fu","suffix":""},{"id":299752275,"identity":"2f91cf06-12fa-4e05-bcde-c12d48db98ba","order_by":1,"name":"Rong Hua","email":"","orcid":"","institution":"Center for Obesity and Hernia Surgery, Department of General Surgery, Huashan Hospital, Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Rong","middleName":"","lastName":"Hua","suffix":""},{"id":299752277,"identity":"e1d891f9-84f8-46a8-b454-f00bd5afc8b4","order_by":2,"name":"Minglei Li","email":"","orcid":"","institution":"Center for Obesity and Hernia Surgery, Department of General Surgery, Huashan Hospital, Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Minglei","middleName":"","lastName":"Li","suffix":""},{"id":299752279,"identity":"9770c754-6611-4b94-8e32-a5c290ae807f","order_by":3,"name":"Hao 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ring\u003c/p\u003e","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4276763/v1/9da116f668feca18fef49703.jpg"},{"id":56478631,"identity":"5b6b33bd-278d-451c-a33e-e363ddd189f9","added_by":"auto","created_at":"2024-05-14 17:52:30","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":901717,"visible":true,"origin":"","legend":"\u003cp\u003eClose the abdominal wall detect (before)\u003c/p\u003e","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4276763/v1/0c718cf318a536de12448d4c.jpg"},{"id":56478633,"identity":"af44aadb-7a8e-47c8-a7f7-d1dd44af51d5","added_by":"auto","created_at":"2024-05-14 17:52:30","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":732311,"visible":true,"origin":"","legend":"\u003cp\u003eClose the abdominal wall detect (after)\u003c/p\u003e","description":"","filename":"Fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4276763/v1/2975c9e9d80b299c042b8b5a.jpg"},{"id":56478632,"identity":"f3908276-6e1d-4683-9faf-4195d0004382","added_by":"auto","created_at":"2024-05-14 17:52:30","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":944767,"visible":true,"origin":"","legend":"\u003cp\u003eFinal placement of the intra-peritoneal mesh\u003c/p\u003e","description":"","filename":"Fig4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4276763/v1/ebc178df47be9b193bf66884.jpg"},{"id":64619326,"identity":"f6136961-f1d3-4e2b-9b5d-51e339c9280e","added_by":"auto","created_at":"2024-09-16 16:14:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3554128,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4276763/v1/2669413d-6b8d-4b5d-9d25-46b424bdb648.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Laparoscopic repair of parastomal hernia following radical cystectomy and ileal conduit: A Single-Center Experience","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe ileal conduit (IC) is one of the simplest and most common forms of urinary diversion after radical cystectomy, with a history of over 60 years\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Despite its widespread use and improved surgical technique, parastomal hernia (PH) after IC remains a common complication, and occur in approximately 30% of patients \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. PH affects the appearance of the abdominal wall, causing discomfort, bloating, and intermittent pain around the stoma. It also impacts the function of the stoma and can lead to more severe issues such as incarceration. More than 30% of patients with parastomal hernia require surgical treatment\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSurgical management of PH following IC is challenging, with a high risk of recurrence and complications, and there is no gold standard technique for treatment of PH following IC\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.Open, laparoscopic, and robotic approaches are used in variety of surgical repairs. It is widely accepted that laparoscopic repair is more safe and effective than open surgery\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.In this study, we reviewed and summarized the surgical experience, techniques, and complications of laparoscopic repair for PH following IC in 35 patients from May 2013 to December 2022.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eWe retrospectively evaluated all patients who underwent laparoscopic repair for PH following IC at Huashan Hospital, Fudan University from May 2013 to December 2022.Retrospective review of each patient\u0026rsquo;s notes was then undertaken. Patient demographics, including age, gender, body mass index were all recorded alongside Intraoperative situation, length of stay and post-operative complications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eDefnition and diagnosis\u003c/h2\u003e \u003cp\u003eThe decision to offer hernia repair was made by the senior surgeon. Following clinical review, all patients underwent pre-operative CTU scan to confirm the postoperative status of bladder tumor and presence of the hernia and peripheral anatomy. All images were reviewed by a senior radiologist. A PH was defined as a peritoneal sac protruding through the fascia beside the ileal conduit\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSurgical technique\u003c/h2\u003e \u003cp\u003ePreoperative preparations will be completed, and bowel preparation will be performed one day before the surgery. All operations were carried in a supine position under general anaesthesia and prophylactic antibiotics were routinely given at induction. The surgical field will be draped in a specific sequence, starting with disinfection of other parts and ending with disinfection of the stoma area. A Foley catheter was placed in the ileal conduit to facilitate identification of the conduit during the procedure and the balloon at the tip of the catheter will be filled with 10ml water to close the stoma and prevent urine leakage.\u003c/p\u003e \u003cp\u003eThe surgeon and assistant were sited on the patient\u0026rsquo;s left, opposite the side of the PSH. The first puncture hole will be located at the intersection of the left costal margin and the anterior axillary line. A 12mm trocar will be used to puncture directly into the abdomen under laparoscopic visualization, with an intra-abdominal pressure set at 12mmHg. Two further trocars (5 mm) were then sited under direct visualization, one at the level of the left anterior axillary line and the stoma, and another one between the xiphoid process and the umbilicus.\u003c/p\u003e \u003cp\u003eThe position of the stoma intestine and its mesentery needs to be confirmed during surgery. Adhesions between the stoma intestine and the surrounding intestine and abdominal wall, as well as adhesions between the stoma intestine and other tissues, are gradually separated. Care should be taken during the separation process to avoid inadvertent ureteric or small bowel injury. The stoma defect is exposed, and the hernia contents were reduced into the peritoneal cavity(Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe defect is then closed using a laparoscopic hernia needle grasper with 1\u0026thinsp;\u0026minus;\u0026thinsp;0 Surgilon braided nylon (Covidien) ensuring an appropriate tension that does not constrict the stoma intestine(Figure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026amp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). A suitable mesh was then chosen depending on the size of the hernia defect which can completely cover the defect area, extend at least 3cm beyond the defect edge, and provide coverage of the stoma intestine by at least 6cm. Typically, a 15x15cm or 15x20cm DynaMesh\u0026reg;-IPOM patch were selected based on the actual situation. DynaMesh\u0026reg;-IPOM\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e (FEG Textiltechnik mbH, Aachen, Nordrhein-Westfalen, Germany) has a dualcomponent structure consisting of 88% anti-adhesive polyvinylidene difluoride (PVDF) and 12% polypropylene (PP). Adhesive PP is woven through the mesh structure on the side which is placed parietally to provide a rapid and safe incorporation into the abdominal wall. The anti-adhesive visceral PVDF side acts as a barrier to prevent adhesions of the intestines and/or omental fat with the mesh.\u003c/p\u003e \u003cp\u003eThe mesh was rolled and introduced to the peritoneal cavity via the 12 mm port. Then we do the Laparoscopic Sugarbaker repair and the mesh is fixed using a Covidien 5 mm Protack device requiring the placement of two rows of screws along the stoma, every1-2cm until the patch is completely laid flat and secured(Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). A negative pressure drainage tube will be placed in the abdominal cavity.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of Thirty-five cases of parastomal hernia were reported following ileocecal bladder conduit surgery. Among these cases, 25 were males and 10 were females, with median age of 69 years (mean 67.7). The median BMI was 25.1kg/m\u003csup\u003e2\u003c/sup\u003e(mean 25.4 ). The distribution of Body Mass Index (BMI) was as follows: 16 cases had a BMI\u0026thinsp;\u0026lt;\u0026thinsp;25, 16 cases had a BMI between 25 and 30, and 3 cases had a BMI\u0026thinsp;\u0026ge;\u0026thinsp;30.\u003c/p\u003e \u003cp\u003eAll patients underwent cystectomy as the primary surgery. Four patients had recurrent PH with two underwent suture repair and two underwent open mesh repair. The median time from index surgery to repair was 3 years (mean 4.2). Two repair was carried out as an emergency; all other cases were elective surgery. According to the classification of parastomal hernia types based on EHS\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e, there were 16 cases of Type I, 13 cases of Type II, 5 case of Type III and 1 case of Type IV.\u003c/p\u003e \u003cp\u003eOut of the 35 cases, 32 cases underwent totally laparoscopic repair using the Sugarbaker technique. There were 3 cases experienced intestinal injury during adhesion separation and required open exploration and repair before undergoing laparoscopic Sugarbaker repair. The median operative time was 101.8 min (average 90).The median time to discharge was 5 days (mean 6.2).\u003c/p\u003e \u003cp\u003eOne patient died 9 months post-surgery due to COVID-19 and the Median follow up was 32 months. During the follow-up period, Three patients presented with a recurrence (8.6%), with a median time to recurrence of 14 months. They refused further surgery because the recurrence did not have significant impact on the quality of life. Two patients developed a peristomal abscess which was resolved after drainage and antimicrobial therapy, and one patient experienced partial intestinal obstruction 10 days after surgery which was resolved with fasting and fluid support. In all cases where mesh repair was performed, there was short-term pain at the repair site after surgery, which gradually subsided within three months.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eBladder cancer ranks as the ninth most frequently-diagnosed cancer worldwide, and Bricker surgery is an important procedure for treating it\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Parastomal hernia (PH) following radical cystectomy and ileal conduit(IC) remains a common complication, and occur in approximately 30% of patients \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. PH affects the appearance of the abdominal wall, causing discomfort, bloating, and intermittent pain around the stoma. It also impacts the function of the stoma and can lead to more severe issues such as incarceration. The treatment of PH include hernia support appliances, weight loss, avoidance of heavy lifting, patient education and surgery\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Surgical management of PH following IC is challenging, with a high risk of recurrence and complications. The surgical approach for repairing PH following IC is similar to paracostomy hernia, including suture repair, re-siting and mesh repair. The suture repair has been gradually abandoned due to its high recurrence rate up to 50%\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Stoma relocation and redo repair are difficult due to the limited length and displacement of the ureter, as well as the potential complications of incisional hernia and new parastomal hernia\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.Mesh repair, performed by open, laparoscopic or robotic approaches, remains the primary choice\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. It is widely accepted that laparoscopic repair is superior to open repair in terms of operative time, length of hospital stay, postoperative complications, and recurrence rate for colostomy-related hernia repair\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e The European Guidelines for Parastomal Hernia Treatment recommends the Sugarbaker technique based on its lower recurrence rate than the Keyhole technique for colostomy-related hernia repair. But previous reports of the keyhole and Sugarbaker techniques regarding ileal conduit parastomal hernias are few and there were more reports about Keyhole repair than the Sugarbaker\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.Some surgeon concerned the Sugarbaker repair was not feasible for ileal conduits due to the length of the conduit and torsion of the anastomosed ureter by the mesh\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e.But we think laparoscopic Sugarbaker technique is highly suitable for repairing PH following IC and there are several important recommendations for the surgeon:\u003c/p\u003e \u003cp\u003e1) Preoperative bowel preparation and prophylactic antibiotics. Preoperative bowel preparation and prophylactic antibiotics is crucial to prevent postoperative infections. A clean bowel can minimize the contamination of intestines damage during adhesion separation.\u003c/p\u003e \u003cp\u003e2) safe adhesion separation poses a challenge and requires careful manipulation. There are numerous small bowel adhesions to the lower abdomen due to the radical cystectomy and pelvic lymph node dissection of the previous surgery. During adhesion separation, we placed a Foley catheter helping us identify the conduit bowel and the bilateral ureters. Exposing the ureter can be challenging. The right ureter generally has minimal anatomical displacement and the left ureter may be partially exposed in the abdominal cavity as it needs to be pulled to the right side for anastomosis with the intestinal tract. The site where both ureters join the enterostomy is located far from the enterostomy end. Surgeons should be cautious not to damage the ureter when dealing with adhesions related to the enterostomy. As long as an adequately covered intestinal segment is freed, it is not necessary to overly pursue the complete mobilization of the enterostomy segment. It is crucial to identify the mesenteric structures based on the location of the enterostomy, because the blood vessels that supply the intestines within the mesentery are unique. By carefully identifying the enterostomy and its mesenteric structures, damage to the enterostomy and its blood supply can be minimized during adhesion separation. It is preferable to use scissors for separation to avoid thermal damage from ultrasonic or electric knives. In this study, three patients experienced multiple bowel injuries which can not repaired under laparoscopy, leading to open conversion for thorough examination and repair before the laparoscopic procedure for Sugarbaker repair. But it doesn't affect the outcome of the surgery.\u003c/p\u003e \u003cp\u003e3) close the defect using unabsorbable stitches. There are multiple ways to close the defect. Our approach is using a laparoscopic hernia needle grasper ensuring that the puncture site is outside the area where the stoma bag is attached to avoid contamination or interference. We can also perform the closure under laparoscopy using unabsorbable barbed stitching. We recommend using unabsorbable barbed stitching because there is higher tension in pneumoperitoneum state and barbed stitch can help achieve a better closure for certain defects.\u003c/p\u003e \u003cp\u003e4) Use a large enough patch. We recommend using a composite patch that is large enough to cover approximately 6cm of the intestinal tube and extend at least 3cm beyond the edges of the defect\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Some surgeons consider the use of slow resorbing mesh in order to theoretically reduce the risks of intestinal complication, digestive fstula, or bowel obstructions\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. But we still use unabsorbable synthetic patch and In our study, there were no long-term complications related to mesh placement following IC PH repair. The patch can be secured using spiral tacks, starting with fixing the edges of the intestinal tube and gradually moving outward to secure and flatten the patch.\u003c/p\u003e \u003cp\u003eAlthough there were more reports about Keyhole repair, more and more surgeons recommend Sugarbaker in recent years\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.The intestine covered by the mesh is just related to urinary function instead of defecation and there is less passive dilation and peristalsis Comparing to para-colostomy hernia. This may explain the lower recurrence rate of the Sugarbaker technique in PH following IC than para-colostomy hernia.\u003c/p\u003e \u003cp\u003eIn this case study, three patients presented with a recurrence (8.6%), but they refused further surgery because the recurrence did not have significant impact on the quality of life. Many patients could be managed through nonoperative treatments\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.Two patients developed a peristomal abscess and one patient experienced partial intestinal obstruction, and they were all relieved through non-surgical treatment. This is the largest study report so far, with a maximum of 10 cases reported about Sugarbaker technique in PH following IC before\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e and our study established that the Sugarbaker technique was associated with low complication and recurrence rate.\u003c/p\u003e \u003cp\u003eHowever, it is important to note that this study has certain limitations. Firstly, it is a retrospective study conducted at a single center, which may introduce bias. Additionally, there was no control group included in this study, as none of the patients underwent open repair or laparoscopic repair using alternative methods. As a result, no statistical analyses could be performed. It is recommended that international studies and registries be conducted to compare different repair methods for PH following IC, given its relative rarity.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSurgical management of PH following IC is challenging. The laparoscopic Sugarbaker technique for repairing PH following IC has low complication and recurrence rate. Dedicated research and collaboration is required to improve the management of parastomal hernia after ileal conduit.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eStatements and Declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXiaojian Fu，Minglei Li, Rong Hua, Qiyuan Yao, Hao Chen declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinky declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee (full name: Regional Ethics Committee of Huashan hospital, Fudan University）(reference number KY 2019-369) to the Department of General Surgery, Huashan hospital, Fudan University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy conception and design: Hao Chen，Xiaojian Fu\u003c/p\u003e\n\u003cp\u003eAcquisition of data: Xiaojian Fu, Minglei Li\u003c/p\u003e\n\u003cp\u003eAnalysis and interpretation of data :Xiaojian Fu, Minglei Li\u003c/p\u003e\n\u003cp\u003eDrafting of manuscript: Xiaojian Fu, Rong Hua\u003c/p\u003e\n\u003cp\u003eCritical revision of manuscript: Qiyuan Yao, Hao Chen\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLi Z, Zhang Z, Ma H, et al(2022)Extraperitonealization of ileal conduit reduces parastomal hernia after cystectomy and ileal conduit diversion[J]. Urol Oncol 40(4):117-162.\u003c/li\u003e\n\u003cli\u003eNarang S K, Alam N N, Campain N J, et al(2017)Parastomal hernia following cystectomy and ileal conduit urinary diversion: a systematic review[J]. Hernia 21(2):163-175.\u003c/li\u003e\n\u003cli\u003eLiu N W, Hackney J T, Gellhaus P T, et al(2014)Incidence and risk factors of parastomal hernia in patients undergoing radical cystectomy and ileal conduit diversion[J]. J Urol 191(5):1313-1318.\u003c/li\u003e\n\u003cli\u003eDonahue T F, Bochner B H(2016)Parastomal hernias after radical cystectomy and ileal conduit diversion[J]. Investig Clin Urol 57(4):240-248.\u003c/li\u003e\n\u003cli\u003eMakarainen-Uhlback E, Vironen J, Vaarala M, et al(2021)Keyhole versus Sugarbaker techniques in parastomal hernia repair following ileal conduit urinary diversion: a retrospective nationwide cohort study[J]. BMC Surg 21(1):231.\u003c/li\u003e\n\u003cli\u003eLaycock J, Troller R, Hussain H, et al(2022)A keyhole approach gives a sound repair for ileal conduit parastomal hernia[J]. Hernia 26(2):647-651.\u003c/li\u003e\n\u003cli\u003eAntoniou S A, Agresta F, Garcia A J, et al(2018)European Hernia Society guidelines on prevention and treatment of parastomal hernias[J]. Hernia 22(1):183-198.\u003c/li\u003e\n\u003cli\u003eDomen A, Stabel C, Jawad R, et al(2021)Postoperative ileus after laparoscopic primary and incisional abdominal hernia repair with intraperitoneal mesh (DynaMesh(R)-IPOM versus Parietex Composite): a single institution experience[J]. Langenbecks Arch Surg 406(1):209-218.\u003c/li\u003e\n\u003cli\u003eSmietanski M, Szczepkowski M, Alexandre J A, et al(2014)European Hernia Society classification of parastomal hernias[J]. Hernia 18(1):1-6.\u003c/li\u003e\n\u003cli\u003eAntoni S, Ferlay J, Soerjomataram I, et al(2017)Bladder Cancer Incidence and Mortality: A Global Overview and Recent Trends[J]. Eur Urol 71(1):96-108.\u003c/li\u003e\n\u003cli\u003ePastor D M, Pauli E M, Koltun W A, et al(2009)Parastomal hernia repair: a single center experience[J]. JSLS 13(2):170-175.\u003c/li\u003e\n\u003cli\u003eGillern S, Bleier J I(2014)Parastomal hernia repair and reinforcement: the role of biologic and synthetic materials[J]. Clin Colon Rectal Surg 27(4):162-171.\u003c/li\u003e\n\u003cli\u003eDeAsis F J, Lapin B, Gitelis M E, et al(2015)Current state of laparoscopic parastomal hernia repair: A meta-analysis[J]. World J Gastroenterol 21(28):8670-8677.\u003c/li\u003e\n\u003cli\u003eXu A J, Shakir N A, Jun M S, et al(2021)Robotic Assisted Repair of Post-Ileal Conduit Parastomal Hernia: Technique and Outcomes[J]. Urology 158:232-236.\u003c/li\u003e\n\u003cli\u003eDewulf M, Hildebrand N D, Bouwense S, et al(2022)Parastomal hernias after cystectomy and ileal conduit urinary diversion: surgical treatment and the use of prophylactic mesh: a systematic review[J]. BMC Surg 22(1):118.\u003c/li\u003e\n\u003cli\u003eMelin I M, Navarro S M, Albersheim J, et al(2021)Illeal conduit associated parastomal hernias: A novel laparoscopic top hat repair[J]. Urol Case Rep 39:101758.\u003c/li\u003e\n\u003cli\u003eHatsuzawa Y, Tsujinaka S, Kakizawa N, et al(2022)Modified keyhole plus technique with partial release of posterior rectus sheath for parastomal hernia repair after ileal conduit[J]. Asian J Endosc Surg 15(4):850-853.\u003c/li\u003e\n\u003cli\u003eImamura K, Takada M, Umemoto K, et al(2021)Laparoscopic parastomal herniorrhaphy utilizing transversus abdominis release and a modified Sugarbaker technique: A case report[J]. Asian J Endosc Surg 14(1):106-108.\u003c/li\u003e\n\u003cli\u003eNardi M J, Millo P, Brachet C R, et al(2017)Laparoscopic ventral hernia repair with composite mesh: Analysis of risk factors for recurrence in 185 patients with 5 years follow-up[J]. Int J Surg, 40:38-44.\u003c/li\u003e\n\u003cli\u003eSuwa K, Okamoto T, Yanaga K(2016)Closure versus non-closure of fascial defects in laparoscopic ventral and incisional hernia repairs: a review of the literature[J]. Surg Today 46(7):764-773.\u003c/li\u003e\n\u003cli\u003eBel N, Blanc P Y, Moszkowicz D, et al(2023)Surgical management of parastomal hernia following radical cystectomy and ileal conduit: A french multi-institutional experience[J]. Langenbecks Arch Surg 408(1):344.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Ileal conduit, Parastomal hernia, Laparoscopic surgery, Sugarbaker technique","lastPublishedDoi":"10.21203/rs.3.rs-4276763/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4276763/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e Parastomal hernia (PH) is a frequent complication following radical cystectomy and ileal conduit (IC). The purpose of this study was to summarize the clinical experience and technical characteristics of laparoscopic repair of PH following IC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: We retrospectively evaluated all patients who underwent laparoscopic treatment of PH following IC at Huashan Hospital, Fudan University from May 2013 to December 2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e:Thirty-five patients were included in the study. Median follow up was 32 months. Three patients presented with a recurrence (8.6%), with a median time to recurrence of 14 months. Out of the 35 patients, Thirty-two underwent totally laparoscopic repair using the Sugarbaker technique, Three patients required open surgery to repair the intestinal injury after laparoscopic exploration. One patient died 9 months post-surgery due to COVID-19. During the follow-up period, two patients developed a peristomal abscess, and one patient experienced partial intestinal obstruction 10 days after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Surgical management of PH following IC is challenging. The laparoscopic Sugarbaker technique for repairing PHfollowing IC has low complication and recurrence rate.\u003c/p\u003e","manuscriptTitle":"Laparoscopic repair of parastomal hernia following radical cystectomy and ileal conduit: A Single-Center Experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-14 17:52:23","doi":"10.21203/rs.3.rs-4276763/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-07T05:24:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-06T18:04:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-06T18:04:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2024-04-16T14:34:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9cfe5281-e273-466d-89b1-cea6577a4af9","owner":[],"postedDate":"May 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-16T16:06:44+00:00","versionOfRecord":{"articleIdentity":"rs-4276763","link":"https://doi.org/10.1186/s12893-024-02553-6","journal":{"identity":"bmc-surgery","isVorOnly":false,"title":"BMC Surgery"},"publishedOn":"2024-09-12 15:58:31","publishedOnDateReadable":"September 12th, 2024"},"versionCreatedAt":"2024-05-14 17:52:23","video":"","vorDoi":"10.1186/s12893-024-02553-6","vorDoiUrl":"https://doi.org/10.1186/s12893-024-02553-6","workflowStages":[]},"version":"v1","identity":"rs-4276763","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4276763","identity":"rs-4276763","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}