Parastomal hernia occurs in 17% of patients with ileal conduit and recurrence following hernia repair occurs in 27-50% of cases. Strattice™ mesh is a porcine derived tissue matrix which is used in hernia repair as an alternative to synthetic mesh. The introduction of Strattice™ mesh has been reported to have better surgical outcomes when used in colorectal practice, with a reduction in hernia recurrence, whilst increasing the incidence of post-operative seroma. We have reviewed the outcomes of Strattice™ mesh use in the repair of ileal conduit related parastomal hernias to see if there benefits of using it translates into urological practice.

We retrospectively reviewed the notes of all 57 patients (39 female and 18 male) with a mean age of 56 years (range 33-78) with ileal conduits having repair of hernia with Strattice™ mesh in our department, at University College London Hospital, between January 2012 and September 2017. Data was collected on patient demographics, type of hernia repair (incisional or parastomal), and possible mesh related complications including; seroma, conduit obstruction and hernia recurrence. The parastomal hernia repairs were performed by 4 consultant surgeons, utilising excision of a stoma sized circle from the mesh with conduit pull through and intra-peritoneal lateral mesh fixation to the anterior abdominal wall.

Of the 57 patients with ileal conduits having Strattice™ mesh hernia repair in this time period, 34 had incisional hernia repair (mean age 60 years, range 41-77, 9 men) and 23 had parastomal hernia repair (mean age 54 years, range 33-71, 6 men). 

Of the patients (23 patients) with complications following parastomal hernia repair where Strattice™ mesh was used, 30% (7 patients) developed conduit obstruction at the level of the mesh, 9% (2 patients) had stomal retraction with shortening and subsequent obstruction of their conduit, 26% (6 patients) had a recurrence of parastomal hernia on follow up, and 4% (1 patient) developed post-operative seroma.

39% of patients (9 out of 23 patients) who underwent parastomal hernia repair with Strattice™ mesh developed obstructive complications on post-operative follow up. Although in the colorectal setting, the use of this mesh has been reported to reduce rates of hernia recurrence, our review showed a 26% (6 out of 23 patients) recurrence rate of parastomal hernias in patients with ileal conduits.

The rate of obstructive complications and recurrence of hernia is higher than expected when using Strattice™ mesh to repair parastomal hernias in patients with ileal conduits. This warrants further prospective studies into the use of this new technology, as obstruction of ileal conduits and parastomal hernias can cause a negative impact on patients quality of life and their health. It may be that the successes seen in parastomal hernia repair with the use of Strattice™ mesh are at the expense of obstructive complications, which will need to be taken into consideration when planning for surgery.