Risk factors of parastomal hernia in patients undergoing laparoscope radical cystectomy and ileal conduit diversion / 中华泌尿外科杂志

ABSTRACT

Objective To investigate the incidence rate of parastomal hernia (PH) among patients who have received laparoscope radical cystectomy and ileal conduit diversion and to discover the risk factors for PH.Methods Data of 162 patients who underwent surgery of laparoscope radical cystectomy and ileal conduit diversion for bladder cancer between Jan 2012 and Dec 2017 were studied.The patients who had suffered other tumors before surgery or without follow-up data were excluded.At last,148 patients were enrolled in this retrospective study.According to the occurrence of PH,the patients were divided into two groupsPH group and non-PH group.There were 21 patients (12 males and 9 females) in PH group.The mean age was (66.5 ± 8.6) years old,and mean body mass index (BMI) was (33.4 ± 5.2) kg/m2.11 patients with synchronous disease and 10 patients without synchronous disease before operation in PH group.Postoperative T stage ＜T3 in 17 cases,≥T3 in 4 cases.4 Cases received neoadjuvant chemotherapy and 5 cases received adjuvant chemotherapy.Tumor recurrence was found in 6 cases.16 cases had hypoproteinemia.Ileal conduit was made through abdominal incision in 9 cases,and 12 cases was made with laparoscopy.After the surgery,there was severe cough in 7 cases and abdominal distension in 7 cases.3 cases had previous abdominal operation,and 5 cases had history of glucocorticoid use.The mean size of the stoma was (3.0±0.6) cm.The mean length of the outflow tract was (11.2 ±1.3) cm.We did trans-rectus stoma in 4 cases,and para-rectus stoma in 17 cases.There were 127 patients (82 males and 45 females) in non-PH group.The mean age was (71.4 ±7.4) years,and the mean BMI was (28.8 ±4.1)kg/m2.60 patients with synchronous disease and 67 patients without.Postoperative T stage ＜ T3 in 96 cases,≥T3 in 31 cases.29 patients received neoadjuvant chemotherapy and 39 cases received adjuvant chemotherapy.Tumor recurrence was found in 38 cases.66 cases had hypoproteinemia.Ileal conduit was made through abdominal incision in 55 cases,under laparoscopy in 72 cases.There was severe cough in 34 cases and abdominal distension in 38 cases.21 cases had previous abdominal operation,and 35 cases had history of glucocorticoid use.The mean size of the stoma was (2.3 ± 0.4) cm.The mean length of the outflow tract was (12.2 ± 1.6) cm.4 cases had trans-rectus stoma,and 17 cases had para-rectus stoma.Postoperative rate of PH was estimated using the Kaplan-Meier methods.Chi-square test were used for the univariate analysis between group of PH and the normal one.Multivariate Logistic regression analysis was used to judge the independent risk factors of PH.Results Patients were followed up for 24 months.PH occurred in 21 cases,the 1,2,5 year cumulative incidence of PH was 9.9％,5.4％ and 16.7％ respectively.Clinical characteristics,including age at surgery (x2 =4.018,P =0.045),obesity (x2 =3.949,P =0.047),perioperative hypoproteinemia (x2 =4.279,P =0.039),chronic constipation(x2 =5.416,P =0.020),stoma location (x2 =6.464,P =0.011),stoma size (x2 =3.915,P =0.048),were significantly different between the PH group and the normal group (P ＜ 0.05).Multivariate Logistic regression analysis shows that obesity (OR =1.326,95％ CI =1.102-1.548,P =0.043),stoma location (OR =0.892,95 ％ CI =0.854-0.931,P =0.028),stoma size (OR =1.365,95％ CI =1.089-1.631,P =0.028) were the independent risk factors for PH.Conclusion We demonstrated that most of PH usually develop in 2 years after undergoing radical cystectomy with ileal conduit diversion.Obesity,stoma location and stoma size are independent risk factors.Preoperative counseling and preventative measures regarding PH formation should be emphasized,particularly in those patients with risk factors.