Early postoperative outcomes of intraperitoneal funnel mesh for parastomal hernia prevention in robotic radical cystectomy: A retrospective feasibility study.

Abstract

Introduction: Although robotic and open cystectomies have similar parastomal hernia (PSH) rates, the robotic approach offers perioperative advantages. PSH nevertheless remains a clinically and economically significant complication, and evidence on prophylactic mesh use in robot-assisted radical cystectomy (RARC) with ileal conduit (IC) formation is limited. This feasibility study reports short-term outcomes following mesh insertion, focusing on postoperative complications, including mesh-related infection and ileus.

Methods: This retrospective, single-center, observational cohort study evaluates the use of prophylactic funnel mesh made of polyvinylidene fluoride (PVDF) during RARC with IC formation through a comprehensive assessment. This technique has been implemented routinely within our center.

Results: From August 2023 to September 2024, 22 consecutive patients (41% of females) underwent RARC with IC formation. One robotic cystectomy was for a benign cause, whereas seven patients had bladder cancer stage T1, 11 - T2, 2 - T3, and 1 - T4. The average operating time was 310 ± 61 min. Perioperatively, 23% of patients had a Clavien-Dindo Class ≤2 ileus. After a median follow-up of 16 months, there was 1 (4.5%) clinical/radiological instance of PSH (Clavien-Dindo Class 3b) and 1 (4.5%) instance of mesh-related infection (Clavien-Dindo Class 2).

Conclusions: Placement of PVDF funnel mesh during RARC with IC formation appears feasible and was associated with a low rate of mesh-related complications in this series. Although only one PSH occurred during short-term follow-up, these results should be interpreted cautiously, given the small sample size and limited duration. Longer-term evaluation is required to determine the true effectiveness of this approach in preventing PSH.