PD39-01 PROPHYLACTIC USE OF AN INTRAPERITONEAL ONLAY MESH DURING ILEAL CONDUIT URINARY DIVERSION FOR THE PREVENTION OF PARASTOMAL HERNIAS. INITIAL EXPERIENCE

Autor: Amir Akdam, Daniel Yaffe, Ilan Leibovitch, Itay Sternberg
Rok vydání: 2016
Předmět:
Zdroj: Journal of Urology. 195
ISSN: 1527-3792
0022-5347
DOI: 10.1016/j.juro.2016.02.1507
Popis: INTRODUCTION AND OBJECTIVES: Parastomal hernias develop in a quarter of patients within one year after cystectomy and ileal conduit urinary diversion (RC/IC) and half of patients within 2 years. Prophylactic placement of mesh during surgery has been described in colorectal surgery to be safe and effective. METHODS: Since October 2013, 20 consecutive patients underwent prophylactic placement of DynaMesh IPST during RC/IC at our institution. The last 30 consecutive patients treated with RC/IC prior to October 2013 were used as the control group. We compared patient characteristics, operative times and 90-day postoperative complications between the groups. Continuous variables were compared using the Mann-Whitney test and dichotomous variables were compared using Fisher’s exact test. RESULTS: Patient characteristics were similar between the groups. Seven of 20 patients in the DynaMesh group and 7 of 30 in the control group had additional procedures done at the time of RC/IC. Median operative times in patients without additional procedures were 301 minutes (IQR 229-474) and 283 (IQR 246-336) in the DynaMesh and control groups, respectively. This difference was not statistically significant (p1⁄40.06). Major complications occurred in 6 of 20 (30%) and 10 of 30 (33%) of patients in the DynaMesh and control groups, respectively. Minor complications were recorded in 10 of 20 (50%) and 16 of 30 (53%) patients in the DynaMesh and control groups, respectively. Both these differences, in major and minor complications, were not statistically significant (p1⁄40.77 and 0.78, respectively). None of the major complications were related to the placement of the mesh. With a median follow up of 13.5 months none of the patients needed removal of the mesh and none developed PSH. CONCLUSIONS: Our initial experience suggests that prophylactic placement of mesh during RC/IC for parastomal hernia prevention is effective, safe and does not elongate surgery considerably. A larger trial is needed to validate our results.
Databáze: OpenAIRE
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