Comparison between the Extraperitoneal Route with the Transperitoneal Route for the Permanent Colostomy: A Meta-Analysis with Rcts and Systematic Review

AimTo assess the efficacy of extraperitoneal colostomy(EPC) in the prevention of stoma-related complications.BackgroundTransperitoneal colostomy (TPC) is still a widely used surgical approach. However, TPC has been reported with highly incidence of stoma-related complications, like parastomal hernia, stomal retraction, stomal prolapse.The purpose of EPC is to prevent these complications. But it is still lack of evidence-based basis.Material and methodsMEDLINE, 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. Revman 5.4 was performed in the meta-analysis.ResultsA total of 5 RCTs were eligible in this study. Compared with TPC, EPC group had lower incidence in Parastomal Hernia (RR, 0.14; 95% CI, 0.04–0.52, P=0.003, I2=0%), Stomal Prolapse (RR, 0.27; 95% CI, 0.08–0.95, P=0.04, I2=0%) and a higher rate of defaecation Sensation (RR, 3.51; 95% CI, 2.47–5.0, P＜0.00001, I2=37%). No statistical difference was observed in Stoma Retraction, Colostomy Construction Time, Stoma Ischemia, and Necrosis.ConclusionAn extraperitoneal colostomy is associated with a lower rate of postoperative complication compared to transperitoneal colostomy. Randomized controlled trial meta-analysis showed better results in permanent colostomy after abdominoperineal resection.

Modified technique of extraperitoneal colostomy without incision of the posterior rectus sheath

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.