Extraperitonealization of the ileal conduit decreases the risk of parastomal hernia: A single-center, randomized clinical trial

Abstract

Parastomal hernia (PSH) is a common complication in patients receiving ileal conduit urinary diversion after radical cystectomy. In this randomized controlled clinical trial, we validate our previous finding that extraperitonealization of ileal conduit decreases incidence of PSH. In total, 104 consecutive patients undergoing radical cystectomy at Sun Yat-sen University Cancer Center are randomized 1:1 to receive either modified (extraperitonealized) ileal conduit (n = 52) or conventional ileal conduit (n = 52). Primary endpoint is incidence of radiological PSH during follow-up. Incidence of radiological PSH is lower in the modified group than in the conventional group (11.5% vs. 28.8%; p = 0.028) after a median follow-up of 32 months, corresponding to a hazard ratio of 0.374 (95% confidence interval: 0.145-0.965, p = 0.034) in the modified conduit group. The results support our previous finding that extraperitonealization of the ileal conduit is effective for reducing risk of PSH in patients receiving ileal conduit diversion.

Keywords: bladder cancer; ileal conduit; parastomal hernia; radical cystectomy; surgery; urinary diversion; urology.

Graphical abstract

Figure 1

Study flowchart

Figure 2

Cumulative incidence of radiological parastomal hernia (HR = 0.374, 95% CI: 0.145–0.965, p = 0.034) Estimated by the Kaplan-Meier method with confidence bands. CI, confidence interval; HR, hazard ratio.