المؤلفون: Dewulf, Maxime, Pletinckx, Pieter, Nachtergaele, Femke, Muysoms, Filip

المصدر: British Journal of Surgery ; volume 108, issue Supplement_8 ; ISSN 0007-1323 1365-2168

مصطلحات موضوعية: Surgery

الوصف: Aim Parastomal hernia after radical cystectomy and ileal conduit urinary diversion is an underestimated and probably undertreated condition with significant impact on quality of life. However, its surgical treatment is challenging and prone to recurrence and complications. Literature on the subject is scarce and of poor quality, and the optimal surgical treatment of this condition remains to be determined. Material and Methods In this retrospective patient series, a prospectively maintained database was screened. Data from all patients undergoing surgical treatment for a parastomal hernia after cystectomy and ileal conduit urinary diversion in our center were collected. The incidence of local recurrence was defined as primary endpoint. The rate of in-hospital complications was defined as secondary endpoint. Results Between May 2016 and June 2020, 15 patients underwent minimally invasive repair of a parastomal hernia of an ileal conduit at our center. Almost half of the patients had a concomitant midline incisional hernia (7/15; 46,7%). The majority of patients were treated with robotic-assisted laparoscopic surgery (10/15; 66,7%). Median follow-up was 366 days. One patient developed a local recurrence of her parastomal hernia on day 66 postoperatively, this recurrence was treated with intraperitoneal mesh. Conclusions The minimally invasive surgical treatment of a parastomal hernia after ileal conduit urinary diversion poses specific perioperative challenges that require a broad surgical armamentarium and a tailored approach. This paper confirms the significant morbidity after this type of surgery and proposes a flow chart to standardize the choice of surgical technique, depending on the presence of a concomitant midline incisional hernia and perioperative findings.

الإتاحة: https://doi.org/10.1093/bjs/znab395.143Test
https://academic.oup.com/bjs/article-pdf/108/Supplement_8/znab395.143/41280936/znab395.143.pdfTest

المؤلفون: Muysoms, Filip, Dewulf, Maxime, Nachtergaele, Femke, Pletinckx, Pieter

المصدر: British Journal of Surgery ; volume 108, issue Supplement_8 ; ISSN 0007-1323 1365-2168

مصطلحات موضوعية: Surgery

الوصف: Aim Laparoscopic retro-rectus ventral hernia repair avoids the need for intra-peritoneal mesh placement and penetrating mesh fixation. The robotic platform facilitates the execution of this technique. Material and Methods From a prospective consecutive single center database all patients that underwent a robotic assisted trans-abdominal retro-rectus ventral hernia repair (rTARUP) via lateral single docking using a self-fixating mesh (ProGrip) were identified. Results Between September 2016 and December 2019, 203 patients were included. There were 89 (44%) umbilical hernias, 34 (17%) epigastric hernias and 80 (39%) incisional midline hernias. Patients had a mean BMI of 29 kg/m2. The mean hernia diameter was 3.2 cm and mainly located in zone M2-M3-M4 of the EHS classification. The mean operative time was 85 min (SD: 33 min) and all except one were clean operations. The self-fixating mesh was mostly 15 cm wide with a variable length between 15 and 30 cm. No intra-operative complications or conversions to open surgery. Intra-hospital complications were seen in 12 patients (6%) and one patient needed a reoperation for bleeding. The operation was performed in day care in 37% of patients and hospital stay was less than 24 hours in 80%. There were 6 readmissions within 30 days of surgery (3%). At 12 months clinical follow-up 3 patients were documented with a recurrence and 2 underwent an laparoscopic intra-peritoneal hernia repair. Due to COVID-19 restrictions a clinical follow-up was only possible in 73 % of patients and needs updating. Conclusions This case series reports favorable early clinical outcome of an innovative retro-rectus repair using the robotic platform.

الإتاحة: https://doi.org/10.1093/bjs/znab395.132Test
https://academic.oup.com/bjs/article-pdf/108/Supplement_8/znab395.132/41280616/znab395.132.pdfTest