Parastomal hernias are a frequent problem for patients undergoing bladder removal surgery, also known as cystectomy, with ileal conduit urinary diversion. New research from the Fox Chase Cancer Center, presented at the American Urological Association’s (AUA) Annual Meeting, provides evidence supporting the use of partially absorbable synthetic, non-biologic parastomal mesh to mitigate this risk.
The research indicates that the application of this mesh to reinforce the abdominal wall significantly reduces the incidence of parastomal hernias, without leading to a notable increase in infections or stenosis. “We found that placing the mesh did not result in a significant increase in infections or stenosis,” stated Dr. Tamir Sholklapper, the study’s first author and a resident at the center. “Most importantly, patients did not develop debilitating hernias around their stoma sites.”
Traditionally performed in bladder cancer patients or those with non-functioning bladders, cystectomy reroutes urine through a section of the intestine, exiting the body through an abdominal stoma. Around 25% of these patients develop parastomal hernias, which can vary in severity and may require further surgery.
Earlier European trials indicated that partially absorbable synthetic mesh could lower parastomal hernia occurrences, but real-world application was limited. Other trials with biologic mesh showed less promising results, creating confusion among surgeons.
The Fox Chase team, under the leadership of Sameer Patel, MD, FACS, Chief of the Division of Plastic and Reconstructive Surgery, has been using the partially absorbable mesh following the European findings. Data from 43 patients at Fox Chase showed that only three (7%) developed a parastomal hernia, with two being asymptomatic and detected through imaging only.
“At the end of the day, having only one patient with a clinical parastomal hernia is almost unheard of, especially when we typically expect a 25% rate,” Sholklapper noted, highlighting the low complication rates, including just one case of stomal stenosis and no infections. “This study underscores that, in a real-world setting, the same partially absorbable mesh used in the European trial can be a game-changer for clinical practice in the United States,” Sholklapper added.
The findings, featured in the study “Very Low Rate of Parastomal Hernia Using Partially Absorbable Macroporous Mesh for Prophylactic Reinforcement in Ileal Conduit Urinary Diversion: A Collaborative Approach Between Urology and Plastic/Reconstructive Surgery,” were presented at the AUA meeting in Las Vegas from April 26-29.
