Risk factors for the development of parastomal hernia after radical cystectomy Journal Article

Authors: Donahue, T. F.; Bochner, B. H.; Sfakianos, J. P.; Kent, M.; Bernstein, M.; Hilton, W. M.; Cha, E. K.; Yee, A. M.; Dalbagni, G.; Vargas, H. A.
Article Title: Risk factors for the development of parastomal hernia after radical cystectomy
Abstract: Purpose: Parastomal hernia is a frequent complication of stoma formation after radical cystectomy. We determined the prevalence and risk factors for the development of parastomal hernia after radical cystectomy. Materials and Methods We conducted a retrospective study of 433 consecutive patients who underwent open radical cystectomy and ileal conduit between 2006 and 2010. Postoperative cross-sectional imaging studies performed for routine oncologic followup (1,736) were evaluated for parastomal hernia, defined as radiographic evidence of protrusion of abdominal contents through the abdominal wall defect created by forming the stoma. Univariable and multivariable Cox regression analyses were used to determine clinical and surgical factors associated with parastomal hernia. Results Complete data were available for 386 patients with radiographic parastomal hernia occurring in 136. The risk of a parastomal hernia developing was 27% (95% CI 22, 33) and 48% (95% CI 42, 55) at 1 and 2 years, respectively. Clinical diagnosis of parastomal hernia was documented in 93 patients and 37 were symptomatic. Of 16 patients with clinical parastomal hernia referred for repair 8 had surgery. On multivariable analysis female gender (HR 2.25; 95% CI 1.58, 3.21; p <0.0001), higher body mass index (HR 1.08 per unit increase; 95% CI 1.05, 1.12; p <0.0001) and lower preoperative albumin (HR 0.43 per gm/dl; 95% CI 0.25, 0.75; p = 0.003) were significantly associated with parastomal hernia. Conclusions The overall risk of radiographic evidence of parastomal hernia approached 50% at 2 years. Female gender, higher body mass index and lower preoperative albumin were most associated with the development of parastomal hernia. Identifying those at greatest risk may allow for prospective surgical maneuvers at the time of initial surgery, such as placement of prophylactic mesh in selected patients, to prevent the occurrence of parastomal hernia. © 2014 by American Urological Association Educaton and Research, Inc.
Keywords: risk factors; hernia; cystectomy
Journal Title: Journal of Urology
Volume: 191
Issue: 6
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2014-06-01
Start Page: 1708
End Page: 1713
Language: English
DOI: 10.1016/j.juro.2013.12.041
PROVIDER: scopus
PUBMED: 24384155
PMCID: PMC4156556
Notes: J. Urol. -- Export Date: 2 June 2014 -- CODEN: JOURA -- Source: Scopus
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MSK Authors
  1. Guido Dalbagni
    250 Dalbagni
  2. Bernard Bochner
    323 Bochner
  3. Timothy Francis Donahue
    17 Donahue
  4. Matthew T Kent
    26 Kent
  5. Alyssa Mae Yee
    3 Yee
  6. William Martin Hilton
    3 Hilton
  7. Eugene K. Cha
    58 Cha