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Isah AD, Wang X, Shaibu Z, Yuan X, Dang SC. Systematic review and meta-analysis comparing extraperitoneal and transperitoneal routes of colostomy-related complications. World J Gastrointest Surg 2025; 17:98947. [PMID: 40162385 PMCID: PMC11948114 DOI: 10.4240/wjgs.v17.i3.98947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 12/10/2024] [Accepted: 01/17/2025] [Indexed: 02/24/2025] Open
Abstract
BACKGROUND Complications associated with stomas-including parastomal hernia (PSH), prolapse, mucocutaneous separation, and stoma retraction-provide considerable postoperative challenges for colostomy patients. Selecting between extraperitoneal colostomy (EPC) and transperitoneal colostomy (TPC) pathways is therefore essential for mitigating these complications. AIM To analyze the existing data regarding the efficacy of EPC compared to TPC in reducing stoma-related complications post-colostomy. METHODS PubMed, Google Scholar, EMBASE, MEDLINE, and the Cochrane Library were adopted to uncover pertinent papers in which EPC and TPC approaches were compared. We then conducted a meta-analysis using RevMan 5.4.1. RESULTS Both laparoscopic (Lap) and open approaches showed a reduced incidence of PSH in EPC relative to TPC (P < 0.00001 and P = 0.02 respectively). In addition, Lap EPC depicted a lesser incidence of prolapse, mucocutaneous separation, and stoma retraction (P = 0.007, P = 0.03, and P = 0.01, respectively) compared to Lap TPC. However, EPC and TPC did not differ with respect to operation time, blood loss, edema, ischemia, necrosis, or infection after the LAP approach. CONCLUSION The extraperitoneal approach may provide benefits in minimizing some stoma-related problems such as PSH, prolapse, mucocutaneous separation, and stoma retraction after colostomy surgery.
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Affiliation(s)
- Adamu D Isah
- Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
- Department of Radiation Oncology, Institute of Oncology, Affiliated Hospital, Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Xu Wang
- Department of Radiation Oncology, Cancer Institute of Jiangsu University, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Zakari Shaibu
- School of Medicine, Jiangsu University, Zhenjiang 212013, Jiangsu Province, China
| | - Xiao Yuan
- Department of Radiation Oncology, Cancer Institute of Jiangsu University, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Sheng-Chun Dang
- Department of General Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
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Higuchi A, Numata M, Saeki H, Izukawa S, Nukada S, Iguchi K, Uchiyama M, Okamoto H, Atsumi Y, Kato A, Kazama K, Suzuki S, Katayama Y, Numata K, Sawazaki S, Tamagawa H, Sugano N, Godai T, Mushiake H, Shinoda S, Matsumoto S, Rino Y, Saito A, Shiozawa M. The safety of laparoscopic extraperitoneal colostomy in the introductory phase: A prospective observational study by the Kanagawa Yokohama Colorectal Cancer Study Group (KYCC) 1804. Surg Today 2025:10.1007/s00595-025-03020-2. [PMID: 40140016 DOI: 10.1007/s00595-025-03020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 01/11/2025] [Indexed: 03/28/2025]
Abstract
PURPOSE To assess the incidence of parastomal hernia in the introductory phase following laparoscopic extraperitoneal colostomy. METHODS The subjects of this observational study were 30 patients who underwent laparoscopic extraperitoneal sigmoid colostomy between April 2019 and November 2020. We evaluated the incidence of parastomal hernia over 2 years and the time required for stoma creation. RESULTS Parastomal hernia was diagnosed in five patients (17.2%), which was a higher incidence than that reported previously (0-13.3%). An exploratory analysis using the LASSO logistic regression model identified obesity (body mass index ≥25 kg/m2) and postoperative wound dehiscence as risk factors for parastomal hernia. The mean stoma creation time was 23.6 min, with >80% of cases completed within 30 min. CONCLUSION Laparoscopic extraperitoneal colostomy can be adopted successfully, even in centers without prior experience. However, the incidence of parastomal hernia in this study was slightly higher than reported previously. Obese patients had longer stoma creation times and a higher incidence of parastomal hernia.
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Affiliation(s)
- Akio Higuchi
- Department of Gastrointestinal Surgery, Yokohama Minami Kyousai Hospital, 1-21-1 Mutsuurahigashi, Kanazawa-ku, Yokohama City, Kanagawa, 236-0037, Japan
| | - Masakatsu Numata
- Department of Gastroenterological Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho Minami-ku, Yokohama City, Kanagawa, 232-0024, Japan.
| | - Hiroyuki Saeki
- Department of Gastrointestinal Surgery, Yokohama Minami Kyousai Hospital, 1-21-1 Mutsuurahigashi, Kanazawa-ku, Yokohama City, Kanagawa, 236-0037, Japan
| | - Shota Izukawa
- Department of Gastroenterological Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho Minami-ku, Yokohama City, Kanagawa, 232-0024, Japan
| | - Suguru Nukada
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama City, Kanagawa, 241-8515, Japan
| | - Kenta Iguchi
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama City, Kanagawa, 241-8515, Japan
| | - Mamoru Uchiyama
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama City, Kanagawa, 241-8515, Japan
| | - Hironao Okamoto
- Department of Surgery, Hiratsuka Kyousai Hospital, 9-11 Oiwake, Hiratsuka-shi, Kanagawa, 254-0047, Japan
| | - Yosuke Atsumi
- Department of Gastroenterological Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho Minami-ku, Yokohama City, Kanagawa, 232-0024, Japan
| | - Aya Kato
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama City, Kanagawa, 236-0004, Japan
| | - Keisuke Kazama
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama City, Kanagawa, 236-0004, Japan
| | - Shinsuke Suzuki
- Department of Surgery, Fujisawa Shonandai Hospital, 2345 Takakura, Fujisawa-shi, Kanagawa, 252-0802, Japan
| | - Yusuke Katayama
- Department of Surgery, Japanese Red Cross Hadano Hospital, 1-1, Tatenodai, Hadano-shi, Kanagawa, 257-0017, Japan
| | - Koji Numata
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama City, Kanagawa, 236-0004, Japan
| | - Sho Sawazaki
- Department of Surgery, Miura Municipal Hospital, 1-1, Shiroyama-cho, Miura-shi, Kanagawa, 238-0298, Japan
| | - Hiroshi Tamagawa
- Department of Gastrointestinal Surgery, Yokohama Minami Kyousai Hospital, 1-21-1 Mutsuurahigashi, Kanazawa-ku, Yokohama City, Kanagawa, 236-0037, Japan
| | - Nobuhiro Sugano
- Department of Surgery, Hiratsuka Kyousai Hospital, 9-11 Oiwake, Hiratsuka-shi, Kanagawa, 254-0047, Japan
| | - Teni Godai
- Department of Surgery, Fujisawa Shonandai Hospital, 2345 Takakura, Fujisawa-shi, Kanagawa, 252-0802, Japan
| | - Hiroyuki Mushiake
- Department of Surgery, Saiseikai Yokohamashi Nanbu Hospital, 3-2-10, Konandai, Konan-ku, Yokohama City, Kanagawa, 234-0054, Japan
| | - Satoru Shinoda
- Department of Biostatistics, School of Medicine, Yokohama City University, 3-9 Fukuura Kanazawa-ku, Yokohama City, Kanagawa, 236-0004, Japan
| | - Satomi Matsumoto
- Department of Gastrointestinal Surgery, Yokohama Minami Kyousai Hospital, 1-21-1 Mutsuurahigashi, Kanazawa-ku, Yokohama City, Kanagawa, 236-0037, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama City, Kanagawa, 236-0004, Japan
| | - Aya Saito
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama City, Kanagawa, 236-0004, Japan
| | - Manabu Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama City, Kanagawa, 241-8515, Japan
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Aubert M, Buscail E, Duchalais E, Cazelles A, Collard M, Charleux-Muller D, Jeune F, Nuzzo A, Pellegrin A, Theuil L, Toutain A, Trilling B, Siproudhis L, Meurette G, Lefevre JH, Maggiori L, Mege D. Management of adult intestinal stomas: The 2023 French guidelines. J Visc Surg 2024; 161:106-128. [PMID: 38448363 DOI: 10.1016/j.jviscsurg.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
AIM Digestive stoma are frequently performed. The last French guidelines have been published twenty years ago. Our aim was to update French clinical practice guidelines for the perioperative management of digestive stoma and stoma-related complications. METHODS A systematic literature review of French and English articles published between January 2000 and May 2022 was performed. Only digestive stoma for fecal evacuation in adults were considered. Stoma in children, urinary stoma, digestive stoma for enteral nutrition, and rare stoma (Koch, perineal) were not included. RESULTS Guidelines include the surgical landmarks to create digestive stoma (ideal location, mucocutaneous anastomosis, utility of support rods, use of prophylactic mesh), the perioperative clinical practice guidelines (patient education, preoperative ostomy site marking, postoperative equipment, prescriptions, and follow-up), the management of early stoma-related complications (difficulties for nursing, high output, stoma necrosis, retraction, abscess and peristomal skin complications), and the management of late stoma-related complications (stoma prolapse, parastomal hernia, stoma stenosis, late stoma retraction). A level of evidence was assigned to each statement. CONCLUSION These guidelines will be very useful in clinical practice, and allow to delete some outdated dogma.
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Affiliation(s)
- Mathilde Aubert
- Department of Digestive Surgery, hôpital Timone, Aix Marseille University, AP-HM, Marseille, France
| | - Etienne Buscail
- Digestive Surgery Department, hôpital Rangueil, Toulouse, France
| | | | - Antoine Cazelles
- Digestive Surgery Department, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - Maxime Collard
- Digestive Surgery Department, hôpital Saint-Antoine, AP-HP, Sorbonne université, 75012, Paris, France
| | | | - Florence Jeune
- Digestive Surgery Department, hôpital Saint-Louis, AP-HP, Paris, France
| | - Alexandre Nuzzo
- Digestive Surgery Department, hôpital Beaujon, AP-HP, Paris, France
| | | | | | - Amandine Toutain
- Digestive Surgery Department, hôpital Saint-Louis, AP-HP, Paris, France
| | | | | | | | - Jérémie H Lefevre
- Digestive Surgery Department, hôpital Saint-Antoine, AP-HP, Sorbonne université, 75012, Paris, France
| | - Léon Maggiori
- Digestive Surgery Department, hôpital Saint-Louis, AP-HP, Paris, France
| | - Diane Mege
- Department of Digestive Surgery, hôpital Timone, Aix Marseille University, AP-HM, Marseille, France.
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Fu YY, Ma Y, Zhang CK, Sun LH, Tang D, Wang W, Wang DR. The clinical applications of D-type parastomal hernia repair surgery. Hernia 2024; 28:427-434. [PMID: 38170300 DOI: 10.1007/s10029-023-02924-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/27/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE This study investigated the use of a modified laparoscopic repair of paraostomy hernia technique, called "D-Type parastomal hernia repair surgery" which combines abdominal wall and extraperitoneal stoma reconstruction, in patients with parastomal hernia (PSH) following colorectal stoma surgery. The aim was to determine whether D-type parastomal hernia repair surgery is a promising surgical approach compared to the traditional laparoscopic repair technique (Sugarbaker method) for patients with PSH. METHODS PSH patients were selected and retrospectively divided into two groups: the study group underwent D-type parastomal hernia repair, while the control group underwent laparoscopic Sugarbaker repair. Clinical data from both groups were analyzed. RESULT Compared to control group (n = 68), the study group undergoing D-type stoma lateral hernia repair had significant increase in total operative time (98.82 ± 12.37 min vs 124.61 ± 34.99 min, p < 0.001). The study group also showed better postoperative stoma bowel function scores in sensory ability, frequency of bowel movements, and clothing cleanliness without a stoma bag (p = 0.037, 0.001, 0.002). The treatment cost was significantly higher in the control group (3899.97 ± 260.00$ vs 3215.91 ± 230.03$, p < 0.001). The postoperative recurrence rate in the control group was 26.4%, while in the study group, it was 4.3%, with a significant statistical difference (p = 0.024). In terms of long-term postoperative complications, the study group had an overall lower incidence compared to the control group (p = 0.035). Other parameters showed no significant differences between the two groups. CONCLUSION The study suggests that D-type parastomal hernia repair surgery is a safe and feasible procedure. Compared to traditional surgery, it can reduce the recurrence of lateral hernia, improve postoperative stoma bowel function, and save medical resources.
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Affiliation(s)
- Y Y Fu
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
- Medical College of Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, China
| | - Y Ma
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, China
- Nanjing University, Nanjing, 210093, China
| | - C K Zhang
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
- Medical College of Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, China
| | - L H Sun
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
- Medical College of Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, China
- The Fourth People's Hospital of Taizhou City, Taizhou, 225300, China
| | - D Tang
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
- Medical College of Yangzhou University, Yangzhou, 225001, China
- Department of Gastrointestinal Surgery, Northern Jiangsu Peoples's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
| | - W Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu Peoples's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.
| | - D R Wang
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China.
- Medical College of Yangzhou University, Yangzhou, 225001, China.
- Department of Gastrointestinal Surgery, Northern Jiangsu Peoples's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China.
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Dai M, Furuya-Kanamori L, Syed A, Lin L, Wang Q. An empirical comparison of the harmful effects for randomized controlled trials and non-randomized studies of interventions. Front Pharmacol 2023; 14:1064567. [PMID: 37025494 PMCID: PMC10070801 DOI: 10.3389/fphar.2023.1064567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/28/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction: Randomized controlled trials (RCTs) are the gold standard to evaluate the efficacy of interventions (e.g., drugs and vaccines), yet the sample size of RCTs is often limited for safety assessment. Non-randomized studies of interventions (NRSIs) had been proposed as an important alternative source for safety assessment. In this study, we aimed to investigate whether there is any difference between RCTs and NRSIs in the evaluation of adverse events. Methods: We used the dataset of systematic reviews with at least one meta-analysis including both RCTs and NRSIs and collected the 2 × 2 table information (i.e., numbers of cases and sample sizes in intervention and control groups) of each study in the meta-analysis. We matched RCTs and NRSIs by their sample sizes (ratio: 0.85/1 to 1/0.85) within a meta-analysis. We estimated the ratio of the odds ratios (RORs) of an NRSI against an RCT in each pair and used the inverse variance as the weight to combine the natural logarithm of ROR (lnROR). Results: We included systematic reviews with 178 meta analyses, from which we confirmed 119 pairs of RCTs and NRSIs. The pooled ROR of NRSIs compared to that of RCTs was estimated to be 0.96 (95% confidence interval: 0.87 and 1.07). Similar results were obtained with different sample size subgroups and treatment subgroups. With the increase in sample size, the difference in ROR between RCTs and NRSIs decreased, although not significantly. Discussion: There was no substantial difference in the effects between RCTs and NRSIs in safety assessment when they have similar sample sizes. Evidence from NRSIs might be considered a supplement to RCTs for safety assessment.
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Affiliation(s)
- Minhan Dai
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Luis Furuya-Kanamori
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QL, Australia
| | - Asma Syed
- Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar
| | - Lifeng Lin
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
| | - Qiang Wang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Qiang Wang,
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Bhatia M, Singhal T, Kostadinov D. Letter to the editor for "Laparoscopic extraperitoneal colostomy has a lower risk of parastomal hernia and bowel obstruction than transperitoneal colostomy". Int J Colorectal Dis 2022; 37:2255-2256. [PMID: 36068356 DOI: 10.1007/s00384-022-04250-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Mohit Bhatia
- Department of General & Colorectal Surgery, PRUH, King's College, Orpington, London, UK.
| | - Tarun Singhal
- Department of General & Colorectal Surgery, PRUH, King's College, Orpington, London, UK
| | - Danko Kostadinov
- Department of General & Colorectal Surgery, PRUH, King's College, Orpington, London, UK
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Li Z, Tian L, Liu R, Zheng B, Wang B, Zhao X, Quan P, Qiu J. A technique for laparoscopic extraperitoneal colostomy with an intact posterior sheath of rectus. BMC Surg 2022; 22:239. [PMID: 35725604 PMCID: PMC9210575 DOI: 10.1186/s12893-022-01686-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022] Open
Abstract
Regardless of the advances in surgical techniques, parastomal hernia is still an inevitable complication for many patients with low rectal cancer undergoing abdominal perineal resection (APR). Extraperitoneal colostomy (EPC) seems to be a effective method to reduce the risk of parastomal hernia. We propose a new approach to simplify and standardize laparoscopic EPC to make this operation easy to perform. We used the technique of laparoscopic TEP groin hernia repair to produce an extraperitoneal tunnel, which can not only facilitate precise visualization of the extraperitoneal tunnel but also utilize the intact posterior rectus abdominis sheath as biologic materials to maintain soft-tissue augmentation, with a satisfactory result. With laparoscopy, we can create adequate space without insufficient dissection of the extraperitoneal tunnel while avoiding damage to the retrorectus sheath. At the time of writing, we had performed this method in four patients, without any complications. This technique is effective at preventing parastomal hernia without extra costs.
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Affiliation(s)
- Zeyu Li
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, People's Republic of China
| | - Lifei Tian
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, People's Republic of China
| | - Ruiting Liu
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, People's Republic of China
| | - Bobo Zheng
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, People's Republic of China
| | - Ben Wang
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, People's Republic of China
| | - Xu Zhao
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, People's Republic of China
| | - Pan Quan
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, People's Republic of China
| | - Jian Qiu
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, People's Republic of China.
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Laparoscopic extraperitoneal colostomy has a lower risk of parastomal hernia and bowel obstruction than transperitoneal colostomy. Int J Colorectal Dis 2022; 37:1429-1437. [PMID: 35606659 DOI: 10.1007/s00384-022-04187-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Several studies indicate that an extraperitoneal colostomy can prevent the development of a parastomal hernia (PSH) as compared to a transperitoneal colostomy. However, the clinical value of laparoscopic extraperitoneal colostomy, and its influence on bowel obstruction and PSH remain unclear. The present study aimed to clarify the impact of laparoscopic extraperitoneal colostomy on the development of a PSH and bowel obstruction. METHODS This study included 327 consecutive patients who underwent laparoscopic abdominoperineal resection or Hartmann's procedure between January 2013 and December 2019 after fulfilling selection criteria. The incidence of a PSH (Clavien-Dindo classification ≥ grade I) and bowel obstruction (≥ grade IIIa) in the transperitoneal and extraperitoneal route groups were analyzed using univariate and multivariate analysis. RESULTS The patients were classified into transperitoneal (n = 222) and extraperitoneal (n = 105) route groups. The patient characteristics, except for body mass index and operative time, were comparable between the groups. A PSH and bowel obstruction occurred more frequently in the transperitoneal than in the extraperitoneal route group (17.1% vs. 1.9% and 15.3% vs. 6.7%, respectively; p < 0.01 and p = 0.03, respectively). The multivariate analysis showed that age ≥ 70 years, body mass index ≥ 22.4 kg/m2, and a transperitoneal route were independent risk factors for the development of a PSH, and a transperitoneal route was an independent risk factor for bowel obstruction. CONCLUSIONS The transperitoneal route was identified as a risk factor for the development of both a PSH and bowel obstruction after laparoscopic abdominoperineal resection or Hartmann's procedure.
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Luo J, Singh D, Zhang F, Yang X, Zha X, Jiang H, Yang L, Yang H. Comparison of the extraperitoneal and transperitoneal routes for permanent colostomy: a meta-analysis with RCTs and systematic review. World J Surg Oncol 2022; 20:82. [PMID: 35279174 PMCID: PMC8918274 DOI: 10.1186/s12957-022-02547-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
Aim To assess the efficacy of extraperitoneal colostomy (EPC) in preventing stoma-related complications. Background Transperitoneal colostomy (TPC) is a widely used surgical approach. However, TPCs have been reported to have increased risks of stoma-related complications, such as parastomal hernias, stomal retraction, and stomal prolapse. The purpose of EPC is to reduce these complications. However, there is still a lack of evidence-based studies. Materials and methods MEDLINE, EMBASE, Web of Science, Scopus, MOOSE, PubMed, Google Scholar, Baidu Scholar, and the Cochrane Library were searched to conduct a systematic review and meta-analysis with RCTs. The meta-analysis was performed with RevMan 5.4 software. Results This study included 5 eligible RCTs. Compared with the TPC group, the EPC group had lower incidence rates of parastomal hernias (RR, 0.14; 95% CI, 0.04–0.52, P = 0.003, I2 = 0%) and stomatal prolapse (RR, 0.27; 95% CI, 0.08–0.95, P = 0.04, I2 = 0%), but a higher rate of defecation sensation (RR, 3.51; 95% CI, 2.47–5.0, P < 0.00001, I2 = 37%). No statistically significant differences were observed in stoma retraction, colostomy construction time, stoma ischemia, or stoma necrosis. Conclusion Extraperitoneal colostomies are associated with lower rates of postoperative complications than transperitoneal colostomies. A randomized controlled trial meta-analysis found that permanent colostomies after abdominoperineal resection resulted in better outcomes.
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Akamoto S, Imura S, Fujiwara Y, Habu K, Konishi Y, Fukuhara T, Nakagawa K. Extraperitoneal colostomy in robotic surgery for rectal cancer using a tip-up fenestrated grasper. Asian J Endosc Surg 2021; 14:636-639. [PMID: 33084208 DOI: 10.1111/ases.12880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/23/2020] [Accepted: 10/01/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although extraperitoneal colostomy could reduce the risk for parastomal hernia formation, it is often technically demanding to dissect the extraperitoneal route laparoscopically. Here, we demonstrate our original surgical technique for extraperitoneal tunneling using a robotic instrument. MATERIALS AND SURGICAL TECHNIQUE After total mesorectal excision (TME) and before specimen retrieval, the edge of the outer leaf of the parietal peritoneum was elevated by the grasper in the left hand and the tip-up fenestrated grasper (Tip-Up) in the right hand. The extraperitoneal tissue was opened using the scissor forceps (right hand). Then, extraperitoneal tunneling (inner tunnel) was performed using a Tip-Up with a width of approximately 4 cm that could reach adjacent to the lateral border of the abdominal rectus muscle. A round incision was made at a preoperatively marked site on the skin. The anterior rectal sheath was cut in a cruciate fashion. The abdominal rectus muscle was split, and then the posterior rectus sheath was cut longitudinally not just below the stoma marking site but also at a slant on the lateral side. The peritoneum was dissected with care to avoid opening the peritoneum. The outer side of the tunnel was broken through to the inner tunnel using an easy blunt dissection with two fingers. Kelly forceps were introduced through the extraperitoneal tunnel along with the fingers, and the stump of the sigmoid colon was grasped and exteriorized through this tunnel. DISCUSSION Robotic retroperitoneal tunneling using a Tip-Up is easy and useful for preventing parastomal hernia.
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Affiliation(s)
- Shintaro Akamoto
- Department of Surgery, Sumitomo Besshi Hospital, Niihama-shi, Japan
| | - Shin Imura
- Department of Surgery, Sumitomo Besshi Hospital, Niihama-shi, Japan
| | - Yuta Fujiwara
- Department of Surgery, Sumitomo Besshi Hospital, Niihama-shi, Japan
| | - Kyosuke Habu
- Department of Surgery, Sumitomo Besshi Hospital, Niihama-shi, Japan
| | - Yusuke Konishi
- Department of Surgery, Sumitomo Besshi Hospital, Niihama-shi, Japan
| | - Tetsuji Fukuhara
- Department of Surgery, Sumitomo Besshi Hospital, Niihama-shi, Japan
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Liao X, Li X, Cheng J, Zhang Y, Ding K, Li X. Extraperitoneal colostomy after laparoscopic abdominoperineal resection using a cannula for tunnel creation through a trocar port. Surg Endosc 2021; 36:3178-3182. [PMID: 34160698 DOI: 10.1007/s00464-021-08621-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Extraperitoneal colostomy (EPC) after laparoscopic abdominoperineal resection (APR) remains a challenge for surgeons. This study aims to summarize our laparoscopic EPC method and assess its effects versus a transperitoneal colostomy (TPC) for patients with rectal tumors. METHODS A total of 133 patients with rectal cancer treated with laparoscopic APR between May 2009 and May 2020 were retrospectively reviewed. The clinical data, including demographics, comorbidities, tumor stage, colostomy duration, and complications were compared between the EPC group and the TPC group. RESULTS The EPC group included 83 patients whose extraperitoneal tunnels were created using a cannula through a trocar port, and the TPC group included 50 patients whose stomata were formed traditionally. There were no differences in colostomy time [(23.1 ± 6) min vs. (21.4 ± 4) min, P = 0.078], number of parastomal dermatitis patients (5 vs. 2, P = 0.916), or number of stomal stenoses (1 vs. 1, P = 0.715) between the EPC and TPC groups. No cases of parastomal hernia developed in the EPC group, whereas 4 patients were diagnosed with a parastomal hernia; the difference between the two groups was statistically significant (P = 0.036). CONCLUSIONS Laparoscopic EPC have a lower incidence of parastomal hernia than TPC. It is easy and inexpensive to create an extraperitoneal tunnel using a cannula through a trocar port.
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Affiliation(s)
- Xiaofeng Liao
- Department of General Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China
| | - Xiaoyun Li
- Department of General Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China
| | - Jun Cheng
- Department of General Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China
| | - Yongkang Zhang
- Department of General Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China
| | - Ke Ding
- Department of General Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China
| | - Xiaogang Li
- Department of General Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China.
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12
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Zhang T, Yang D, Sun G, Zhang D. Modified technique of extraperitoneal colostomy without incision of the posterior rectus sheath. Sci Rep 2021; 11:2857. [PMID: 33536513 PMCID: PMC7859403 DOI: 10.1038/s41598-021-82626-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/14/2021] [Indexed: 11/24/2022] Open
Abstract
Extraperitoneal colostomy is a widely used technique during abdominoperineal resection (APR) operation for lower rectal cancer. This technique has been reported to be effective to prevent the postoperative parastomal hernia in some retrospective studies, however, there is still a certain incidence of parastomal hernia. A modification of the extraperitoneal colostomy technique is described in this paper that keeps posterior rectal sheath intact instead of having a conventional incision, to further reduce the risk of parastomal hernia. Until now, this modified technique has been performed in 15 patients, no occurrence of parastomal hernia was observed.
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Affiliation(s)
- Tao Zhang
- Department of Colorectal and Hernia Surgery, The Fourth Affiliated Hospital of China Medical University, 4# Chong-shan East Road, Shenyang, Liaoning, China
| | - Daye Yang
- Department of Colorectal and Hernia Surgery, The Fourth Affiliated Hospital of China Medical University, 4# Chong-shan East Road, Shenyang, Liaoning, China
| | - Gongping Sun
- Department of Colorectal and Hernia Surgery, The Fourth Affiliated Hospital of China Medical University, 4# Chong-shan East Road, Shenyang, Liaoning, China
| | - Dewei Zhang
- Department of Colorectal and Hernia Surgery, The Fourth Affiliated Hospital of China Medical University, 4# Chong-shan East Road, Shenyang, Liaoning, China.
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13
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Li C, Qin X, Yang Z, Guo W, Huang R, Wang H, Wang H. A nomogram to predict the incidence of permanent stoma in elderly patients with rectal cancer. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:342. [PMID: 33708969 PMCID: PMC7944294 DOI: 10.21037/atm-21-29] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Creation of a temporary diverting stoma during rectal cancer surgery is used widely to prevent undesirable outcomes related to anastomotic leakage (AL). The transition from temporary stoma (TS) to permanent stoma (PS) is a frequent outcome. Elderly patients may have a greater probability of PS. We aimed to identify risk factors of PS and developed a nomogram to predict the rate of PS for elderly patients. Methods We enrolled elderly patients (≥70 years) who underwent rectal cancer surgery with a TS between January 2014 and December 2017 at our hospital. We divided patients into two groups: a TS group and a PS group. We then identified the risk factors for PS and developed a nomogram to predict the possibility of PS. Results Of the 278 elderly patients who received a diverting stoma, 220 (79.14%) eventually underwent stoma reversal, and 58 (20.86%) had PS. The proportion of males in the PS group was significantly higher than that of the TS group (P=0.048). Univariate and multivariate analysis showed that American Society of Anesthesiologists (ASA) score (P<0.001), laparotomy (P=0.004), AL (P<0.001), and tumor recurrence (P<0.001) were significantly correlated with PS. These four factors were included to construct the nomogram. The consistency index of the nomogram was 0.833 and the model yielded an area under the curve of 0.833. Conclusions ASA score (≥3), laparotomy, AL, and tumor recurrence were independent risk factors for PS in elderly patients. Our nomogram exhibited moderate predictive ability.
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Affiliation(s)
- Chuangkun Li
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiusen Qin
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zifeng Yang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wentai Guo
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rongkang Huang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huaiming Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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14
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Shen Y, Yang T, Gu C, Wei M, Meng W, Wang Z. Is colostomy with extraperitoneal approach appropriate for patients with bowel obstruction? A call to introduce standard indications. ANZ J Surg 2021; 91:E614-E616. [PMID: 33497501 DOI: 10.1111/ans.16606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Yu Shen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tinghan Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chaoyang Gu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mingtian Wei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wenjian Meng
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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15
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Yasukawa D, Aisu Y, Kimura Y, Takamatsu Y, Kitano T, Hori T. Internal Hernia Associated with Colostomy After Laparoscopic Surgery for Rectal Malignancy: A Report of 3 Thought-Provoking Cases. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1488-1494. [PMID: 30546005 PMCID: PMC6302771 DOI: 10.12659/ajcr.912676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 09/24/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Colostomy creation via intraperitoneal route is often performed during laparoscopic Hartmann's operation or abdominoperineal resection (APR). Herein, we report 3 rare cases of internal hernia associated with colostomy (IHAC). CASE REPORT The first case involved a 70-year-old man with IHAC after laparoscopic APR. Laparoscopy revealed the small intestine passed through a defect between the lifted sigmoid colon and left lateral abdominal wall in a cranial-to-caudal direction. The dislocated bowel with ischemic change was restored to its normal position and the lateral defect was covered with lateral peritoneum and greater omentum. The second case involved a 75-year-old man with IHAC after laparoscopic APR. Intraperitoneal findings were similar to those in the first case, except for the size of the lateral defect. This defect was too large for primary closure or patching; therefore, no surgical repair was performed. Unfortunately, this led to IHAC recurrence and creation of a new colostomy via extraperitoneal route. The third case involved an 85-year-old man with acute peritonitis resulting from IHAC after laparoscopic Hartmann's operation. Surgery revealed incarcerated bowels forming a closed loop and a perforation in the lifted sigmoid colon. The perforated colon was compressed by the dilated herniated bowel. The resected sigmoid colon showed perforation at the ulcer, which was shown on pathology to be caused by ischemia. CONCLUSIONS IHAC can lead not only to ischemia of strangulated bowel, but also to secondary damage to the lifted colon. During laparoscopic Hartmann's operation or APR, the colostomy should be created via extraperitoneal route to avoid IHAC.
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Affiliation(s)
- Daiki Yasukawa
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yuki Aisu
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yusuke Kimura
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yuichi Takamatsu
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Taku Kitano
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Tomohide Hori
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
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Stomal construction: Technical tricks for difficult situations, prevention and treatment of post-operative complications. J Visc Surg 2018; 155:41-49. [DOI: 10.1016/j.jviscsurg.2017.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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17
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Wang P, Liang J, Zhou H, Wang Z, Shi L, Zhou Z. Extraperitoneal sigmoidostomy: a surgical approach with less complications and better functions for abdominoperineal resection of rectal cancer. Int J Colorectal Dis 2018; 33:41-46. [PMID: 29147773 DOI: 10.1007/s00384-017-2931-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study is to explore the safety and function of extraperitoneal sigmoidostomy for patients with rectal cancer who underwent abdominoperineal resection. METHODS We systematically reviewed records of patients with rectal cancer who underwent abdominoperineal resection and extraperitoneal or intraperitoneal sigmoidostomy from January 2010 to December 2014 at our department. They were grouped into the extraperitoneal (group A) and intraperitoneal sigmoidostomy (group B) groups. Clinical data were collected and statistically analyzed. RESULTS A total of 231 consecutive cases were included: 108 cases in group A and 123 in group B. Patient demographics were similar in both groups. Group A was associated with less time for sigmoidostomy (19.6 ± 2.8 vs. 27.0 ± 4.5 min, p < 0.001), shorter postoperative hospitalization (6.4 ± 1.3 vs. 6.9 ± 1.6 days, p = 0.036), less incidence of stoma-related complications (p = 0.002) and less possibility of re-operation related to stomal complications (p = 0.037). Functions of stoma including stimulation of excrement, stimulating time for excrement, frequency of excrement, self-controlled ability of excrement, and regularity of excrement were all better than those in group B patients (p < 0.001, < 0.001, 0.018, 0.004, and 0.001, respectively). Patients in group A had less psychological problems including anxiety (p = 0.008), depression (p = 0.045), and impaired social interaction (p = 0.010). CONCLUSIONS Extraperitoneal sigmoidostomy is associated with shorter operative duration and postoperative hospitalization and has fewer complications and better outcome for abdominoperineal resection of rectal cancer, and patients also had less psychological problems.
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Affiliation(s)
- Peng Wang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jianwei Liang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Haitao Zhou
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Zheng Wang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lei Shi
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhixiang Zhou
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Wang P, Su H, Liang J, Wang Z, Zhou Z, Zhou H. The Longtan Modification: An Effective and Economical Surgical Innovation for Parastomal Hernia Post-Intraperitoneal Sigmoidostomy. J Laparoendosc Adv Surg Tech A 2017; 28:459-463. [PMID: 29028454 DOI: 10.1089/lap.2017.0423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study was designed to introduce a new surgical innovation, referred to as the "Longtan modification," for cases with parastomal hernia (PSH) following intraperitoneal sigmoidostomy, and to assess the safety and feasibility of this procedure. METHODS Between January 2013 and June 2016, a total of 26 consecutive cases with PSH successfully underwent this procedure. The patient demographics, surgical outcomes, stoma-related complications, and the stoma function were collected and analyzed. RESULTS Mean diameter of the hernia ring was 7.6 cm, mean operation time was 94.2 minutes, and mean intraoperative blood loss was 18.0 mL. The mean period of postoperative hospitalization was 4.4 days while the mean hospitalization cost was only $3,750 USD. There were no severe complications such as postoperative hemorrhage, ischemic necrosis, peritoneal infection, or intestinal obstruction, although one case suffered from postoperative infection at the site of incision. None of the cases had a recurrence of PSH during the follow-up period. In addition, the stoma functioned efficiently and appropriately following the Longtan modification. CONCLUSION Overall, the Longtan modification appears to be an effective and economical surgical innovation for cases with PSH following intraperitoneal sigmoidostomy.
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Affiliation(s)
- Peng Wang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Su
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianwei Liang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Wang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhixiang Zhou
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haitao Zhou
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Affiliation(s)
- J Barbieux
- Service de chirurgie générale, digestive et endocrine, IRCAD-IHU, université de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
| | - O Perotto
- Service de chirurgie générale, digestive et endocrine, IRCAD-IHU, université de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - J Leroy
- Service de chirurgie générale, digestive et endocrine, IRCAD-IHU, université de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
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Hino H, Yamaguchi T, Kinugasa Y, Shiomi A, Kagawa H, Yamakawa Y, Numata M, Furutani A, Suzuki T, Torii K. Relationship between stoma creation route for end colostomy and parastomal hernia development after laparoscopic surgery. Surg Endosc 2016; 31:1966-1973. [PMID: 27553802 DOI: 10.1007/s00464-016-5198-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 08/17/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The therapeutic benefits of extraperitoneal colostomy with laparoscopic surgery remain unclear. The aim of this study was to investigate the relationship between the route for stoma creation with laparoscopic surgery and stoma-related complications, especially parastomal hernia (PSH). METHODS From January 2007 to March 2015, a total of 59 patients who underwent laparoscopic abdominoperineal resection or Hartmann procedure were investigated. Patient demographic and treatment characteristics, including stoma-related complications, were analyzed retrospectively. RESULTS Transperitoneal and extraperitoneal colostomy were performed in 29 and 30 patients, respectively. Median follow-up duration was 21 months (range: 2-95). Patient demographic and treatment characteristics were comparable between the transperitoneal group (TPG) and the extraperitoneal group (EPG). PSH developed in 12 (41 %) patients in TPG, and 4 (13 %) patients in EPG (p = 0.020). The incidence of other stoma-related complications and non-stoma-related complications did not differ significantly between TPG and EPG. No patient characteristics except for transperitoneal route for stoma creation were associated with PSH development. CONCLUSIONS The extraperitoneal route for stoma creation is associated with a significantly lower incidence of PSH development after laparoscopic surgery. Whenever possible, extraperitoneal colostomy should be recommended, even with laparoscopic surgery.
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Affiliation(s)
- Hitoshi Hino
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Tomohiro Yamaguchi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Yusuke Kinugasa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hiroyasu Kagawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yushi Yamakawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Masakatsu Numata
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Akinobu Furutani
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Takuya Suzuki
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Kakeru Torii
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
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Systematic Review and Meta-Analysis of Extraperitoneal Versus Transperitoneal Colostomy for Preventing Parastomal Hernia. Dis Colon Rectum 2016; 59:688-95. [PMID: 27270522 DOI: 10.1097/dcr.0000000000000605] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Parastomal hernia remains a frequent problem after constructing a colostomy. Current research mainly focuses on prophylactic mesh placement as an addition to transperitoneal colostomies. However, for constructing a colostomy, either an extraperitoneal or transperitoneal route can be chosen. OBJECTIVE The aim of this meta-analysis was to investigate which technique results in lower parastomal hernia rates in patients undergoing end colostomy. DATA SOURCES A meta-analysis was conducted according to Preferred Items for Reporting of Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. Embase, MEDLINE, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, Cochrane, PubMed, and Google Scholar databases were searched. The study protocol was registered in the International Prospective Register of Systematic Reviews database. STUDY SELECTION Studies comparing extraperitoneal and transperitoneal colostomies were included. Only studies written in English were included. The quality of studies and risk of bias were assessed using the Cochrane risk-of-bias tool. The quality of nonrandomized studies was assessed using the Newcastle-Ottawa Scale. INTERVENTION The intervention was colostomy formation. MAIN OUTCOME MEASURES The main outcome measure was parastomal hernia incidence. Secondary outcome measures were stoma prolapse, stoma necrosis, and operating time. RESULTS Of 401 articles found, a meta-analysis was conducted of 10 studies (2 randomized controlled trials and 8 retrospective studies) composed of 1048 patients (347 extraperitoneal and 701 transperitoneal). Extraperitoneal colostomy led to significantly lower parastomal hernia rates (22 of 347 (6.3%) for extraperitoneal versus 125 of 701 (17.8%) for transperitoneal; risk ratio = 0.36 (95% CI, 0.21-0.62); I = 26%; p < 0.001) and significantly lower stoma prolapse rates (2 of 185 (1.1%) for extraperitoneal versus 13 of 179 (7.3%) for transperitoneal; risk ratio = 0.21 (95% CI, 0.06-0.73); I = 0%; p = 0.01). Differences in stoma necrosis were not significant. Operating time data were insufficient to analyze. LIMITATIONS Most of the studies were nonrandomized, and some were not recent publications. CONCLUSIONS Although the majority of studies included were retrospective, extraperitoneal colostomy was observed to lead to a lower rate of parastomal hernia and stoma prolapse.
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