Prophylactic Mesh Placement for Preventing Parastomal Hernia in Patients Receiving a Bricker Ileal Conduit at Örebro University Hospital

摘要

Degree Project Thesis, Programme in Medicine. TITLE: Prophylactic Mesh Placement for Preventing Parastomal Hernia in Patients Receiving a Bricker Ileal Conduit at Örebro University Hospital. Background:Parastomal herniation is a common complication occurring after construction of stomas and may require additional medical resources and affects the patient’s quality of life. Surgical techniques for repairing parastomal hernias show less than ideal results with high recurrence rates and morbidity. Studies regarding stomas in colorectal surgery have shown a decreased incidence of parastomal hernia using a prophylactic mesh net reinforcement of the abdominal wall at the primary stoma operation. The pathophysiological mechanisms for occurrence of parastomal hernia in urinary diversions such as the Bricker ileal conduit are likely similar and therefore allow for similar prophylactic measures but up to this date there are no studies on the subject. Aims:The primary aim of this project is to compare the frequency of parastomal hernia in patients receiving a Bricker ileal conduit at the urology department of Örebro University Hospital with or without the placement of a prophylactic mesh. As a secondary aim the rate of stoma related complications in patients receiving prophylactic mesh will be reviewed.Method:A retrospective review of urological, surgical and emergency medical records for 40 consecutive patients who did not receive prophylactic mesh reinforcement and 42 consecutive patients who did receive mesh reinforcement of the abdominal wall during primary Bricker conduit construction was conducted. Appurtenant radiological records were also reviewed. Statistical comparative and descriptive analyses were performed on collected data using IBM SPSS. Results:A total of 82 patients’ medical records were reviewed. 40 patients did not receive prophylactic mesh implantation and 42 had the implantation, retaining two homogenous groups with no significant demographic differences (table 1). 19 (23%) patients developed parastomal hernias in a mean time of 16 months without any significant difference in frequency between the mesh and no-mesh group. There were no significant frequencies of mesh related complications, namely wound infection (1 patient), stomal necrosis (1 patient) or stomal stenosis (3 patients). The patients who developed parastomal hernias were found to have a significantly higher BMI than those who did not.Conclusion:This master thesis project failed to identify prophylactic mesh placement as a method of reducing the frequency of parastomal hernias in patients with Bricker ileal conduits. High BMI was identified as a significant risk factor for hernia development. Due to the low power of this study no applicable conclusions can be made. Nevertheless it highlights the need for further, larger and prospective randomized studies of the subject. Keywords: Parastomal hernia, prophylactic mesh, Bricker ileal conduit, urostomy, parastomal complications