Surgical repair of parastomal hernia after Bricker procedure: consecutive experience of a tertiary center

Background: Parastomal hernia (PH) is the most frequent surgical complication after radical cystectomy with ileal conduit urinary diversion (Bricker's procedure). There are few studies that specifically assess results of PH repairs after Bricker. The aim of this study was to review our experience of surgical repair of PH after Bricker. Methods: We retrospectively reviewed the medical files of a consecutive series of 23 patients (13 male, 10 females; median age 67) who underwent PH repair after Bricker's procedure between 2014 and 2020. Demographic characteristics, intraoperative data, postoperative complications and follow-up were collected. Pre et post CT imaging was specifically reviewed by a radiologist to confirm the PH stage and the CT follow-up according to the Moreno-Matias classification. Data are presented as median and ranges. Results: Preoperatively, all patients suffered from Moreno-Matias type III PH. 16 patients (70%) underwent Sugarbaker repair and 7 (30%) a “sandwich” technique combining Sugarbaker and keyhole repairs. 16 patients (70%) underwent laparoscopic repair (2 conversions). 9 patients underwent a repair of a midline incisional hernia during the same procedure. 4 patients developed severe (> Clavien 3a) complications (two 3b and two IVa). Median hospital stay was 4 days (1-25). Two patients required Bricker reoperation, one for acute ileal conduit ischemia due to peroperative vascular lesion, and one for mesh migration. One patient developed early recurrence after Sugarbacker repair due to mesh migration, and all other patients (n=22, 95.6%) did not develop clinical recurrence at follow-up. Within the no clinical recurrence group (n=22), 20 patients underwent at least one abdominal CT during the follow-up (median 36 months; 1-92). Two asymptomatic Moreno-Matias type Ia recurrences were detected on CT. Conclusions: This significant series confirm that repair of PH after Bricker is a challenging procedure that may be performed by minimal invasive techniques with intraperitoneal meshes and should be performed in experienced centres.