Fredrik Liedberg1,2, Oskar Hagberg2,3, Firas Aljabery4, Truls Gårdmark5, Staffan Jahnson4, Tomas Jerlström6, Agneta Montgomery7, Amir Sherif8, Viveka Ströck9, Christel Häggström10,11, Lars Holmberg11,12. 1. Department of Urology Skåne University Hospital, Malmö, Sweden. 2. Institution of Translational Medicine, Lund University, Malmö, Sweden. 3. Regional Cancer Centre South, Region Skåne, Lund, Sweden. 4. Division of Urology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. 5. Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden. 6. Department of Urology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. 7. Institution of Clinical Sciences Malmö, Surgical Research Unit, Lund University, Lund, Sweden. 8. Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden. 9. Department of Urology, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 10. Department of Biobank Research, Umeå University, Umeå, Sweden. 11. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. 12. School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.
Abstract
BACKGROUND AND OBJECTIVE: To study the cumulative incidence and surgical treatment of midline incisional hernia (MIH) after cystectomy for bladder cancer. METHODS: In the nationwide Bladder Cancer Data Base Sweden (BladderBaSe), cystectomy was performed in 5646 individuals. Cumulative incidence MIH and surgery for MIH were investigated in relation to age, gender, comorbidity, previous laparotomy and/or inguinal hernia repair, operative technique, primary/secondary cystectomy, postoperative wound dehiscence, year of surgery, and period-specific mean annual hospital cystectomy volume (PSMAV). RESULTS: Three years after cystectomy the cumulative incidence of MIH and surgery for MIH was 8% and 4%, respectively. The cumulative incidence MIH was 12%, 9% and 7% in patients having urinary diversion with continent cutaneous pouch, orthotopic neobladder and ileal conduit. Patients with postoperative wound dehiscence had a higher three-year cumulative incidence MIH (20%) compared to 8% without. The corresponding cumulative incidence surgery for MIH three years after cystectomy was 9%, 6%, and 4% for continent cutaneous, neobladder, and conduit diversion, respectively, and 11% for individuals with postoperative wound dehiscence (vs 4% without). Using multivariable Cox regression, secondary cystectomy (HR 1.3 (1.0-1.7)), continent cutaneous diversion (HR 1.9 (1.1-2.4)), robot-assisted cystectomy (HR 1.8 (1-3.2)), wound dehiscence (HR 3.0 (2.0-4.7)), cystectomy in hospitals with PSMAV 10-25 (HR 1.4 (1.0-1.9)), as well as cystectomy during later years (HRs 2.5-3.1) were all independently associated with increased risk of MIH. CONCLUSIONS: The cumulative incidence of MIH was 8% three years postoperatively, and increase over time. Avoiding postoperative wound dehiscence after midline closure is important to decrease the risk of MIH.
BACKGROUND AND OBJECTIVE: To study the cumulative incidence and surgical treatment of midline incisional hernia (MIH) after cystectomy for bladder cancer. METHODS: In the nationwide Bladder Cancer Data Base Sweden (BladderBaSe), cystectomy was performed in 5646 individuals. Cumulative incidence MIH and surgery for MIH were investigated in relation to age, gender, comorbidity, previous laparotomy and/or inguinal hernia repair, operative technique, primary/secondary cystectomy, postoperative wound dehiscence, year of surgery, and period-specific mean annual hospital cystectomy volume (PSMAV). RESULTS: Three years after cystectomy the cumulative incidence of MIH and surgery for MIH was 8% and 4%, respectively. The cumulative incidence MIH was 12%, 9% and 7% in patients having urinary diversion with continent cutaneous pouch, orthotopic neobladder and ileal conduit. Patients with postoperative wound dehiscence had a higher three-year cumulative incidence MIH (20%) compared to 8% without. The corresponding cumulative incidence surgery for MIH three years after cystectomy was 9%, 6%, and 4% for continent cutaneous, neobladder, and conduit diversion, respectively, and 11% for individuals with postoperative wound dehiscence (vs 4% without). Using multivariable Cox regression, secondary cystectomy (HR 1.3 (1.0-1.7)), continent cutaneous diversion (HR 1.9 (1.1-2.4)), robot-assisted cystectomy (HR 1.8 (1-3.2)), wound dehiscence (HR 3.0 (2.0-4.7)), cystectomy in hospitals with PSMAV 10-25 (HR 1.4 (1.0-1.9)), as well as cystectomy during later years (HRs 2.5-3.1) were all independently associated with increased risk of MIH. CONCLUSIONS: The cumulative incidence of MIH was 8% three years postoperatively, and increase over time. Avoiding postoperative wound dehiscence after midline closure is important to decrease the risk of MIH.
Authors: Rebeccah B Baucom; William C Beck; Michael D Holzman; Kenneth W Sharp; William H Nealon; Benjamin K Poulose Journal: Am Surg Date: 2014-07 Impact factor: 0.688
Authors: Daniel C Edwards; David B Cahn; Madhu Reddy; Dana Kivlin; Aseem Malhotra; Tianyu Li; David Y T Chen; Rosalia Viterbo; Robert G Uzzo; Richard E Greenberg; Marc C Smaldone; Paul Curcillo; Alexander Kutikov Journal: Can J Urol Date: 2018-12 Impact factor: 1.344
Authors: Fredrik Liedberg; Oskar Hagberg; Firas Aljabery; Truls Gårdmark; Abolfazl Hosseini; Staffan Jahnson; Georg Jancke; Tomas Jerlström; Per-Uno Malmström; Amir Sherif; Viveka Ströck; Christel Häggström; Lars Holmberg Journal: BJU Int Date: 2019-04-22 Impact factor: 5.588