# Preventing Parastomal Hernias After Radical Cystectomy with Ileal Conduit: A Systematic Review Regarding Surgical Prophylactic Techniques

## TL;DR

This paper reviews surgical techniques to prevent parastomal hernias after bladder removal surgery, finding that evidence is limited and more research is needed.

## Contribution

The study systematically evaluates the effectiveness of mesh and non-mesh techniques for preventing parastomal hernias after ileal conduit surgery.

## Key findings

- Clinical recurrence rates of parastomal hernias after mesh placement ranged from 0.0% to 11.1%.
- Non-mesh preventive strategies showed recurrence rates from 0.0% to 11.5%, with one trial showing positive effects.
- Current evidence is of low quality, and high-quality studies are needed to confirm the effectiveness of preventive techniques.

## Abstract

Background/Objective: Parastomal hernia (PSH) following radical cystectomy (RC) with ileal conduit represents a significant late complication. Preventive strategies have been described but are not yet routinely incorporated into clinical practice. We conducted a systematic review of the current literature to assess the efficacy of PSH preventive techniques for ileal conduit. Methods: A literature search of PubMed/MEDLINE, Scopus, CENTRAL, and Web of Science databases was conducted from 2010 to December 2024 following PRISMA guidelines. Inclusion criteria were patients undergoing RC with ileal conduit, evaluation of at least one PSH preventive strategy and reporting of PSH incidence or relevant postoperative outcomes. Eligible designs included RCTs and non-randomized cohort studies. Exclusion criteria included urinary diversions other than ileal conduit, non-bladder-related indications, non-extractable outcome data, and non-original publications. Results: Three randomized controlled trials (RCTs) and nine non-randomized studies were included in the analysis. Studies investigating both mesh and non-mesh preventive techniques were considered. Clinical PSH recurrence rates following mesh placement ranged from 0.0% to 11.1% among the included studies. RCTs using mesh placement reported conflicting conclusions regarding its protective effects. For non-mesh preventive strategies, clinical PSH recurrence rates ranged from 0.0% to 11.5%. The only RCT focusing on non-mesh approaches reported positive protective effects for the experimental group. All procedures were safe, with no significant increase in complication rates compared to conventional interventions. Conclusions: The low quality of current evidence prevents definitive conclusions regarding the protective effects of both mesh and non-mesh preventive approaches. High-quality evidence is needed to make conclusive statements on this topic. Patients at high risk for PSH development should be offered personalized preoperative counselling and the opportunity to participate in ongoing RCTs.