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Tanaka T, Yamasaki K, Nofuji S, Maehana T, Shindo T, Kyoda Y, Hashimoto K, Kobayashi K, Masumori N. Development and preliminary evaluation of a novel procedure for creation of an ileal conduit stoma aimed at preventing parastomal hernia. Int J Urol 2024; 31:512-518. [PMID: 38238898 DOI: 10.1111/iju.15394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/04/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES Our previous study suggested that the operative procedure is critical for the development of parastomal hernia. We developed a novel procedure for the creation of an ileal conduit stoma to prevent parastomal hernia. Herein we evaluate the efficacy and safety of the procedure. METHODS A total of 113 Japanese patients underwent radical cystectomy and ileal conduit diversion for bladder cancer from January 2017 through December 2021 at our institution. After excluding those with incomplete data, 103 patients consisting of 46 (44.7%) with the conventional procedure and 57 (55.3%) with the novel procedure were consecutively enrolled. The main points of the novel procedure are as follows: (1) the passage of the ileal conduit is ≤2.4 cm in diameter in principle; (2) the posterior rectus sheath and peritoneum are vertically incised 2 cm laterally from the middle of the stoma site to make an oblique passage for the ileal conduit; and (3) the anterior rectus sheath and posterior rectus sheath with peritoneum are fixed to the ileal conduit separately. RESULTS Radiography-based parastomal hernia was observed in 11 patients (10.7%) with a median follow-up of 22.0 months. The incidences of parastomal hernia were 3.5% and 19.6% in the novel and the conventional procedure groups, respectively (p = 0.011). The former had a significantly lower cumulative incidence of parastomal hernia (p = 0.008, log-rank test). No specific complications associated with the procedure were observed. CONCLUSIONS The results of the preliminary cohort study suggest that the novel procedure is safe and effective for the prevention of parastomal hernia.
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Affiliation(s)
- Toshiaki Tanaka
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Koji Yamasaki
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Seisuke Nofuji
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Takeshi Maehana
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tetsuya Shindo
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yuki Kyoda
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Kohei Hashimoto
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Ko Kobayashi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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Zhou Z, Xiong L, Yao K, Ma H, Wei W, Zhang Z, Guo S, Dong P, Li X, Jiang L, Chen D, Qin Z, Han H, Ye Y, Li Y, Wang Y, Wu Z, Tian L, Yu C, Zhou F, Li Z, Liu Z. Extraperitonealization of the ileal conduit decreases the risk of parastomal hernia: A single-center, randomized clinical trial. Cell Rep Med 2024; 5:101343. [PMID: 38154462 PMCID: PMC10829722 DOI: 10.1016/j.xcrm.2023.101343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/28/2023] [Accepted: 11/23/2023] [Indexed: 12/30/2023]
Abstract
Parastomal hernia (PSH) is a common complication in patients receiving ileal conduit urinary diversion after radical cystectomy. In this randomized controlled clinical trial, we validate our previous finding that extraperitonealization of ileal conduit decreases incidence of PSH. In total, 104 consecutive patients undergoing radical cystectomy at Sun Yat-sen University Cancer Center are randomized 1:1 to receive either modified (extraperitonealized) ileal conduit (n = 52) or conventional ileal conduit (n = 52). Primary endpoint is incidence of radiological PSH during follow-up. Incidence of radiological PSH is lower in the modified group than in the conventional group (11.5% vs. 28.8%; p = 0.028) after a median follow-up of 32 months, corresponding to a hazard ratio of 0.374 (95% confidence interval: 0.145-0.965, p = 0.034) in the modified conduit group. The results support our previous finding that extraperitonealization of the ileal conduit is effective for reducing risk of PSH in patients receiving ileal conduit diversion.
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Affiliation(s)
- Zhaohui Zhou
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Longbin Xiong
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Kai Yao
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Huali Ma
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Wensu Wei
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Zhiling Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Shengjie Guo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Pei Dong
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Xiangdong Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Lijuan Jiang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Dong Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Zike Qin
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Hui Han
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Yunlin Ye
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Yonghong Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Yanjun Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Zhiming Wu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Li Tian
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Chunping Yu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Fangjian Zhou
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
| | - Zhiyong Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
| | - Zhuowei Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P.R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
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Goffioul L, Zjukovitsj D, Moise M, Waltregny D, Detry O. Repair of parastomal hernia after Bricker procedure: retrospective consecutive experience of a tertiary center. Hernia 2023:10.1007/s10029-023-02940-7. [PMID: 38150078 DOI: 10.1007/s10029-023-02940-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/26/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Ileal conduit parastomal hernias (ICPHs) are frequent after radical cystectomy with ileal conduit urinary diversion, but their management is debated. This study aimed to review the results of ICPH repair according to Sugarbaker or Sandwich techniques, with special interest in ICPH recurrence and urological complications. METHODS The authors reviewed a consecutive series of patients undergoing ICPH repair between January 2014 and December 2020. Primary endpoints were ICPH recurrences at clinical exam and cross-sectional abdominal computed tomography (CT) scans. Secondary endpoints were any other complications possibly related to the ICPH repair. RESULTS Twenty-three patients underwent ICPH repair surgery (16 Sugarbaker and 7 Sandwich techniques) during the study period. Sixteen patients underwent a primary laparoscopic approach. All but one patient underwent at least one abdominal CT during the follow-up. Median clinical and CT scan follow-up times were 57 and 50.5 months, respectively. Clinical and CT ICPH recurrence rates were 4.5% and 13% at 5 years, respectively. Eighteen patients (78%) suffered no urological complications during the follow-up period, but three patients (13%) needed redo surgery on the urinary ileal conduit. CONCLUSION The modified Sugarbaker or Sandwich techniques might be considered as promising techniques for ICPH repair with a low rate of recurrence. The urological complications, and particularly the ileal conduit-related issues, need to be evaluated in further studies. Controlled and prospective data are required to compare the Sugarbaker and Sandwich techniques to the Keyhole approach for ICPH repairs.
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Affiliation(s)
- L Goffioul
- Department of Abdominal Surgery and Transplantation, Division of Abdominal Wall Surgery, CHU Liege, University of Liege, Sart Tilman B35, B4000, Liege, Belgium
- Department of Abdominal Surgery, CHR Citadelle, Liege, Belgium
| | - D Zjukovitsj
- Department of Abdominal Surgery and Transplantation, Division of Abdominal Wall Surgery, CHU Liege, University of Liege, Sart Tilman B35, B4000, Liege, Belgium
| | - M Moise
- Department of Radiology, CHU Liege, University of Liege, Liege, Belgium
| | - D Waltregny
- Department of Urology, CHU Liege, University of Liege, Liege, Belgium
| | - O Detry
- Department of Abdominal Surgery and Transplantation, Division of Abdominal Wall Surgery, CHU Liege, University of Liege, Sart Tilman B35, B4000, Liege, Belgium.
- Centre de Recherche et d'Enseignement du Département de Chirurgie (CREDEC), University of Liege, Liege, Belgium.
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