Trans oblique ileal conduit technique has a low risk of parastomal hernias Journal Article
| Authors: | Mekayten, M.; Tin, A. L.; Sidhu, A.; Liso, N.; Kimm, S.; Mansour, M.; Cheung, F.; Ajay, D.; Sandhu, J. S. |
| Article Title: | Trans oblique ileal conduit technique has a low risk of parastomal hernias |
| Abstract: | Objective: To outline our surgical technique and outcomes of a ipsilateral “transoblique” ileal conduit performed during pelvic exenteration with a Vertical Rectus Abdominis Myocutaneous flap. We report hernia rates in a transrectus group as reference. Methods: We identified patients from January 2007 to August 2020. The transoblique conduit is placed on the ipsilateral side as the VRAM, through the internal, external oblique, and transverse abdominis muscles. Stomal hernias were assessed radiologically. Transrectus patients were those undergoing radical cystectomy matched based on surgery date, age, and sex in a 3:1 ratio. We employed a Kaplan-Meier plot to visualize the duration between surgery and hernia. We calculated the hernia rate 2 years after surgery. Additionally, we present the 30-day postoperative complication rate. Results: Fifty underwent transoblique conduits and we matched them to 190 transrectus patients. Sixty-seven percent were men with a median age of 62. Exactly 10/50 patients in the transoblique and 44/190 in the transrectus group developed a hernia, with a median follow-up of 2.2 years (IQR 0.8, 4.0). The 2-year KM-estimated parastomal hernia rate was 14% (95% CI 1.6%, 25%) for the transoblique conduits, 21% (95% CI 15%, 28%) for the transrectus and 24% (95% CI 6.5%, 39%) for colostomies. Among the transoblique patients, 22 (44%) experienced at least 1 postoperative complication. Conclusion: A transoblique ileal conduit is safe in patients undergoing a right VRAM flap during a pelvic exenteration with a low parastomal hernia and complication rates. © 2024 Elsevier Inc. |
| Keywords: | adult; controlled study; aged; middle aged; surgical technique; retrospective studies; major clinical study; case control study; fistula; surgical flaps; follow up; infection; anemia; transplantation; retrospective study; bladder tumor; urinary bladder neoplasms; hypoxia; lung embolism; postoperative complication; postoperative complications; acute kidney failure; albumin; algorithm; cardiovascular disease; radical cystectomy; cystectomy; urinary diversion; pelvis exenteration; urinary tract infection; surgery; bacteremia; kaplan meier method; epidemiology; seroma; wound infection; ileus; heart arrest; small intestine obstruction; rectus abdominis; evisceration; rectus abdominis muscle; anastomosis leakage; etiology; adverse event; heart supraventricular arrhythmia; incisional hernia; pelvic exenteration; procedures; abdominal infection; bleeding disorder; apnea; faintness; ipsilateral side; humans; human; male; female; article; parastomal hernia; k nearest neighbor; vertical rectus abdominis musculocutaneous flap; contralateral colostomy; external oblique; fascial dehiscence; hernia rate; internal oblique; medial rectus muscle; trans oblique ileal conduit technique; transverse abdominis muscle |
| Journal Title: | Urology |
| Volume: | 194 |
| ISSN: | 0090-4295 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2024-12-01 |
| Start Page: | 241 |
| End Page: | 246 |
| Language: | English |
| DOI: | 10.1016/j.urology.2024.08.033 |
| PUBMED: | 39218081 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Source: Scopus |
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