PDF(Pubmed)
Abstract：
OBJECTIVE: To report perioperative and long-term postoperative outcomes of cystectomy patients with ileal conduit (IC) urinary diversion undergoing parastomal hernia (PSH) repair.
METHODS: We reviewed patients who underwent cystectomy and IC diversion between 2003 and 2022 in our center. Baseline variables, including surgical approach of PSH repair and repair technique, were captured. Multivariable Cox regressionanalysis was performed to test for the associations between different variables and PSH recurrence.
RESULTS: Thirty-six patients with a median (IQR) age of 79 (73-82) years were included. The median time between cystectomy and PSH repair was 30 (14-49) months. Most PSH repairs (32/36, 89%) were performed electively, while 4 were due to small bowel obstruction. Hernia repairs were performed through open (n=25), robotic (10), and laparoscopic approaches (1). Surgical techniques included direct repair with mesh (20), direct repair without mesh (4), stoma relocation with mesh (5), and stomarelocation without mesh (7). The 90-day complication rate was 28%. In a median follow-up of 24 (7-47) months, 17 patients (47%) had a recurrence. The median time to recurrence was 9 (7-24) months. On multivariable analysis, 90-day complication following PSH repair was associated with an increased risk of recurrence.
CONCLUSIONS: In this report of one of the largest series of PSH repair in the Urology literature, 47% of patients had a recurrence following hernia repair with a median follow-up time of 2 years. There was no significant difference in recurrence rates when comparing repair technique or the use of open or minimally invasive approaches.
METHODS: We reviewed patients who underwent cystectomy and IC diversion between 2003 and 2022 in our center. Baseline variables, including surgical approach of PSH repair and repair technique, were captured. Multivariable Cox regressionanalysis was performed to test for the associations between different variables and PSH recurrence.
RESULTS: Thirty-six patients with a median (IQR) age of 79 (73-82) years were included. The median time between cystectomy and PSH repair was 30 (14-49) months. Most PSH repairs (32/36, 89%) were performed electively, while 4 were due to small bowel obstruction. Hernia repairs were performed through open (n=25), robotic (10), and laparoscopic approaches (1). Surgical techniques included direct repair with mesh (20), direct repair without mesh (4), stoma relocation with mesh (5), and stomarelocation without mesh (7). The 90-day complication rate was 28%. In a median follow-up of 24 (7-47) months, 17 patients (47%) had a recurrence. The median time to recurrence was 9 (7-24) months. On multivariable analysis, 90-day complication following PSH repair was associated with an increased risk of recurrence.
CONCLUSIONS: In this report of one of the largest series of PSH repair in the Urology literature, 47% of patients had a recurrence following hernia repair with a median follow-up time of 2 years. There was no significant difference in recurrence rates when comparing repair technique or the use of open or minimally invasive approaches.
摘要：
目的：报告膀胱切除术患者行回肠导管（IC）尿流改道行造口旁疝（PSH）修补术的围手术期和术后长期结果。
方法：我们回顾了2003年至2022年在我们中心接受膀胱切除术和IC改道的患者。基线变量，包括PSH修复的手术方法和修复技术，被捕获。进行多变量Cox回归分析以检验不同变量与PSH复发之间的关联。
结果：纳入36例中位年龄（IQR）为79（73-82）岁的患者。膀胱切除术至PSH修复的中位时间为30（14-49）个月。大多数PSH维修（32/36，89%）是选择性进行的，而4则是由于小肠梗阻。疝修补术通过开放进行（n=25），机器人(10),和腹腔镜方法（1）。手术技术包括用网状物直接修复(20)，无网格直接修复(4)，带网孔的造口重新定位(5)，和没有网格的气孔定位(7)。90天并发症发生率为28%。在24(7-47)个月的中位随访中，17例(47%)患者复发。中位复发时间为9（7-24）个月。在多变量分析中，PSH修复后90天的并发症与复发风险增加相关。
结论：在这篇关于泌尿外科文献中最大的PSH修复系列之一的报告中，47％的患者在疝修补术后复发，中位随访时间为2年。比较修复技术或使用开放或微创方法时，复发率没有显着差异。
方法：我们回顾了2003年至2022年在我们中心接受膀胱切除术和IC改道的患者。基线变量，包括PSH修复的手术方法和修复技术，被捕获。进行多变量Cox回归分析以检验不同变量与PSH复发之间的关联。
结果：纳入36例中位年龄（IQR）为79（73-82）岁的患者。膀胱切除术至PSH修复的中位时间为30（14-49）个月。大多数PSH维修（32/36，89%）是选择性进行的，而4则是由于小肠梗阻。疝修补术通过开放进行（n=25），机器人(10),和腹腔镜方法（1）。手术技术包括用网状物直接修复(20)，无网格直接修复(4)，带网孔的造口重新定位(5)，和没有网格的气孔定位(7)。90天并发症发生率为28%。在24(7-47)个月的中位随访中，17例(47%)患者复发。中位复发时间为9（7-24）个月。在多变量分析中，PSH修复后90天的并发症与复发风险增加相关。
结论：在这篇关于泌尿外科文献中最大的PSH修复系列之一的报告中，47％的患者在疝修补术后复发，中位随访时间为2年。比较修复技术或使用开放或微创方法时，复发率没有显着差异。
