Parastomal hernia after ileal conduit: Incidence, natural history and risk factors

Introduction Parastomal hernias are a challenging complication of digestive ostomies. Ileal‐conduit parastomal hernias after cystectomy have specific aspects. The aim of this study was to describe the incidence and natural history of ileal‐conduit parastomal hernias in order to guide their management, as well as to identify risk factors to prevent them. Patients and methods All consecutive patients undergoing cystectomy with a Bricker's ileal conduit in 3 academic centers were retrospectively identified. Data were collected regarding their medical history prior to cystectomy, the operation, the postoperative period, imaging results within 5 years of follow‐up, and the onset and timing of clinically or radiologically diagnosed ICPH. Results Among 577 patients included in the study, 115 (20.6%) developed an ICPH during the study period. Most patients did not present any symptom and the diagnosis was made at imaging in 74.8% of them. Most hernias were detected between 1 and 2 years after the cystectomy, with a mean time to diagnosis of 12.4 months. At multivariate analysis, overweight and obesity were independent risk factors for developing an ICPH (adjusted hazard ratio [aHR] 1.96; p = 0.046), while a trans‐rectus position of the ostomy was a significant protective factor (aHR 0.45; p = 0.011). Conclusions A PH develops in almost 20% of patients after ileal conduit urinary diversion, with a mean time of onset of 12.4 months. It is often a subclinical condition detected at medical imaging. Obesity increases the risk, while passing the ileal‐conduit through the rectus muscle can help to prevent it.