Back to 2026 Abstracts
Re-Evaluating Prophylactic Mesh in Radical Cystectomy: No Reduction in Parastomal Hernia Formation
Adam Cole, MD1, Maya Eldin, MD, MPH1, Randie White, MD2, Evelyn James, MPH1, Jeffery Howard, MD, PhD1, Stephen Ryan, MD1, Matthew Hayn, MD1, Jesse Sammon, DO1.
1Maine Medical Center, Portland, ME, USA, 2Vanderbilt, Nashville, TN, USA.
BACKGROUND: Parastomal hernia (PH) is a common complication after ileal conduit creation during radical cystectomy (RC). The benefit of prophylactic mesh placement in reducing PH remains unclear. This study evaluated whether prophylactic mesh decreases PH rates after RC.
METHODS: We identified 277 patients who underwent RC with ileal conduit diversion at a single institution using a prospectively maintained database. A subset received prophylactic mesh at the time of conduit creation. Only patients with adequate postoperative CT imaging for PH assessment were included. Fascial opening size was compared using the Mann-Whitney U test, and multivariable logistic regression identified independent predictors of PH.
RESULTS: Baseline characteristics were similar between groups. Of 277 patients (median follow-up 18 months), 80 (29%) received mesh. PH developed in 71 patients (26%), with no difference between mesh and non-mesh groups (25% vs 27%, p = 0.58). Patients with PH had significantly larger fascial openings (p < .001), though opening size did not differ by mesh use (p = .111). Mesh placement was not associated with reduced PH risk (OR 0.79, p = .5) or need for repair (OR 0.68, p = .3). Higher body mass index and fascial openings >25 mm were independently associated with PH (both p < .001), while an open surgical approach was protective (OR 0.34, p = .003).
CONCLUSIONS: Prophylactic mesh placement during RC with ileal conduit was not associated with reduced PH incidence or smaller fascial openings. Routine use of prophylactic mesh is not supported for PH prevention.
Back to 2026 Abstracts
