Literature selections curated by Lewis Flint, MD, FACS, and reviewed by the ACS Brief editorial board.
Study Compares Repairs of Biologic versus Synthetic Mesh for Parastomal Hernia Repair
Miller BT, Krpata DM, Petro CC, et al. Biologic vs Synthetic Mesh for Parastomal Hernia Repair. J Am Coll Surg. 2022, in press.
This study reported outcomes from a post hoc analysis of a randomized trial that compared repairs of parastomal hernias using biologic or synthetic mesh. The study assessed rates of surgical site occurrences necessitating procedural reintervention (SSOPI), reoperations, stoma-related adverse events, and hernia recurrence; patient-reported quality of life out to 2 years postoperatively also was determined. The study cohort included 108 patients, 53% who underwent procedures in which biologic mesh was used.
SSOPI occurred in 29.6% of patients with no significant difference in the two groups. Mesh erosion into the enclosed intestine was rare and similar in both groups. Hernia recurrence was observed in 27.8% of patients, again with no difference between groups. Quality of life was improved with both techniques.
The authors concluded that parastomal hernia repairs are associated with significant rates of complications and repair failure. Although improved quality of life is a significant benefit, counseling patients regarding risks of morbidity and hernia recurrence will be necessary.
Is There a Difference in 90-Day Mortality between Robot-Assisted Radical Cystectomy and Open Radical Cystectomy?
Catto JWF, Khetrapal P, Ricciardi F, et al. Effect of Robot-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion vs Open Radical Cystectomy on 90-Day Morbidity and Mortality among Patients with Bladder Cancer: A Randomized Clinical Trial. JAMA. May 15, 2022.
Maganty A, Herrel LA, Hollenbeck BK. Robotic Surgery for Bladder Cancer. JAMA. May 15, 2022.
James Catto, MB ChB, PhD, FRCS, and coauthors reported data from a randomized trial that compared recovery and morbidity in patients with non-metastatic bladder cancer who underwent robotic or open cystectomy. Each study group included 169 patients. The primary outcome was days alive and out of hospital in the first 3 postoperative months. This outcome was chosen because the benefits of robotic surgery are most likely to occur early after operation. Results were available for 317 patients. The primary outcome was 82 days for robotic cystectomy and 80 days for open cystectomy. Although this was a statistically significant difference, its clinical significance may be questioned. Blood loss and wound complications were lower after robotic procedures; as might be expected, operation duration was longer for robotic cystectomy. The postoperative quality of life was significantly better after robotic cystectomy.
In the accompanying editorial by Avinash Maganty, MD, and coauthors, the significant morbidity and mortality associated with open cystectomy was cited as a primary reason that surgeons are seeking alternative approaches. They emphasized that the choice of intracorporeal urinary diversion probably was a major contributor to lower morbidity and improved quality of life in the robotic group. They recommended additional trials to provide needed data supporting the value of robotic cystectomy.
