Management and outcomes profiles of parastomal hernia after radical cystectomy and ileal conduit urinary diversion: a systematic review

IntroductionParastomal hernia following radical cystectomy and ileal conduit urinary diversion (ICPH) is a prevalent postoperative complication which needed a unified scheme for proper management. This review provided a comprehensive summary of the data regarding the occurrence, risk factors, surgical approaches, mesh placement, postoperative complications, and recurrence rates of ICPH, with the aim of offering valuable insights for the standardized management of ICPH.MethodsSystematic literature search was conducted up to November 2024 using databases including MEDLINE and Elsevier, supplemented by manual screening of relevant journals and reference lists. Data extraction focused on incidence, risk factors, surgical approaches, and postoperative outcomes.ResultsA total of 30 studies were included, including 18 retrospective studies and 12 cases. And 3 additional systematic reviews were integrated to extract data concerning the incidence and risk factors of ICPH. The pooled ICPH incidence of 4 studies was 14.36%. Main risk factors included fascial defects >= 24 mm, obesity, and female sex. In the choice of surgical approach, minimally invasive techniques dominated (169/367,52%). The most frequently reported methods were the Keyhole (149/328, 45%) and Sugarbaker (113/328, 35%) techniques. In terms of mesh placement, the choice of most cases intraperitoneal placement. The most prevalent postoperative complication was urinary system complications (n = 14). Most of the complications were Clavien-Dindo grade 2 (40/68,59%). Recurrence rates varied widely (0-47%), with Keyhole-associated recurrence up to 52% versus 12.5% for Sugarbaker.ConclusionICPH is a clinical complication that deserves the attention of surgeons. Mesh repair is the current mainstream method. Although there are various surgical methods for mesh repair, each has its own advantages and disadvantages, and a large number of clinical studies are still needed to provide the optimal solution. In addition, the effectiveness of prophylactic mesh placement remains controversial.