Parastomal Hernia After Robot-assisted Cystectomy and Ileum Conduit: Incidence, Risk or Protective Factors and Outcomes of Minimal-invasive Hernia Repair-systematic Review

Abstract Background and aims: Incidence of and risk factors for parastomal hernia after robot-assisted (RA) cystectomy with ileum conduit (IC) are not well established. The aims of this systematic review were to summarize the literature 1) on the incidence of parastomal hernia after RA cystectomy and IC reconstruction; 2) on risk or protective factors associated with the development of parastomal hernias after RA cystectomy and IC reconstruction; and 3) on outcomes of minimal invasive parastomal hernia repair in patients with IC. Methods we conducted literature searches in Medline, EMBASE, and CINHAL up to April 2025 without language restriction. Two independent assessors evaluated eligibility and quality of the included study. Due to high heterogeneity, meta-analysis was not attempted. Results out of 368 records, 11 and 2 papers provided information on the incidence of parastomal hernia and on risk factors, respectively. For the outcome of minimal invasive IC hernia repair, 7 studies were included. Most studied presented high risk of bias and the incidence rate varied widely across studies. Similar findings were observed for hernia recurrence after minimal invasive hernia repair. Conclusion A relevant proportion of patients may experience parastomal hernia of IC after RA-cystectomy, however incidence figures varied widely. Information on factors influencing the development of parastomal hernia after RA cystectomy is essentially lacking. Finally, the evidence on the outcome of minimal invasive hernia repair in IC patients is very limited both in terms of quantity and of quality. There is urgent need to address the knowledge gaps detected by this systematic review. Cooperation to achieve prospective multicentre designs with adequate sample size and systematic follow-up methods would be crucial factors to generate the high-quality data required to develop evidence-based strategies to prevent parastomal hernias.