International Journal of Colorectal Disease

, Volume 27, Issue 1, pp 59–64 | Cite as

Extraperitoneal vs. intraperitoneal route for permanent colostomy: a meta-analysis of 1,071 patients

  • Lei Lian
  • Xian-Rui Wu
  • Xiao-Sheng He
  • Yi-Feng Zou
  • Xiao-Jian Wu
  • Ping Lan
  • Jian-Ping Wang
Original Article



Parastomal hernia is a common complication after colostomy construction. Whether an extraperitoneal route for colostomy creation can reduce the risk of parastomal hernia remains controversial.


A meta-analysis was performed to evaluate the value of extraperitoneal route in the prevention of parastomal hernia and other postoperative complications related to colostomy.

Data sources

A literature search of Medline, Embase, Ovid, and Cochrane databases from the years 1966 to 2010 was performed.

Study selection

Studies comparing extraperitoneal colostomy with intraperitoneal colostomy were identified.


Extraperitoneal colostomy was performed to prevent colostomy-related complications.

Main outcome measures

Data on the following outcomes were sought: incidence of postoperative colostomy complications including parastomal hernia, prolapse, and bowel obstruction.


Seven retrospective studies with a combined total of 1,071 patients (250 extraperitoneal colostomy and 821 intraperitoneal colostomy) were identified. There was a significantly lower rate of parastomal hernia (odds ratio, 0.41; 95% confidence interval, 0.23–0.73, p = 0.002) in the extraperitoneal colostomy group. However, the occurrences of bowel obstruction and prolapse were not significantly different between the two groups.


A limitation of the study lies on the meta-analysis of observational studies.


Extraperitoneal colostomy is associated with a lower rate of postoperative parastomal hernia as compared to intraperitoneal colostomy. Prospective randomized controlled trial is warranted to further determine the role of extraperitoneal route in the prevention of parastomal hernia.


Parastomal hernia Extraperitoneal colostomy Intraperitoneal colostomy Rectal cancer Colostomy-related complications Meta-analysis 


  1. 1.
    Alatise OI, Lawal OO, Adesunkanmi AK et al (2009) Surgical outcome of abdominoperineal resection for low rectal cancer in a Nigerian tertiary institution. World J Surg 33:233–239PubMedCrossRefGoogle Scholar
  2. 2.
    Tilney HS, Heriot AG, Purkayastha S et al (2008) A national perspective on the decline of abdominoperineal resection for rectal cancer. Ann Surg 247:77–84PubMedCrossRefGoogle Scholar
  3. 3.
    Wibe A, Syse A, Andersen E et al (2004) Oncological outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior vs. abdominoperineal resection. Dis Colon Rectum 47:48–58PubMedCrossRefGoogle Scholar
  4. 4.
    Carne PWG, Robertson GM, Frizelle FA (2003) Parastomal hernia. Br J Surg 90:784–793PubMedCrossRefGoogle Scholar
  5. 5.
    Koltun L, Benyamin N, Sayfan J (2000) Abdominal stoma fashioned by a used circular stapler. Dig Surg 17:118–119PubMedCrossRefGoogle Scholar
  6. 6.
    Londono-Schimmer EE, Leong APK, Phillips RKS (1994) Life table analysis of stomal complications following colostomy. Dis Colon Rectum 37:916–920PubMedCrossRefGoogle Scholar
  7. 7.
    Harshaw DH Jr, Gardner B, Vives A, Sundaram KN (1974) The effect of technical factors upon complications from abdominal perineal resections. Surg Gynecol Obstet 139:756–758PubMedGoogle Scholar
  8. 8.
    Marks CG, Ritchie JK (1975) The complications of synchronous combined excision of the rectum at St Mark’s hospital. Br J Surg 62:901–905PubMedCrossRefGoogle Scholar
  9. 9.
    von Smitten K, Husa A, Kyllonen L (1986) Long-term analysis of sigmoidostomy in patients with anorectal malignancy. Acta Chir Scand 152:211–213Google Scholar
  10. 10.
    Whittaker M, Goligher JC (1976) A comparison of the results of extraperitoneal and intraperitoneal techniques for construction of terminal iliac colostomies. Dis Colon Rectum 19:342–344PubMedCrossRefGoogle Scholar
  11. 11.
    Goligher J (1984) Surgery of the anus, colon and rectum, 5th edn. Bailli`ere Tindall, London, pp 703–704Google Scholar
  12. 12.
    Moisidis E, Curiskis JI, Brooke-Cowden GL (2000) Improving the reinforcement of parastomal tissues with Marlex mesh: laboratory study identifying solutions to stomal aperture distortion. Dis Colon Rectum 43:55–60PubMedCrossRefGoogle Scholar
  13. 13.
    Martin L, Foster G (1996) Parastomal hernia. Ann R Coll Surg Engl 78:81–84PubMedGoogle Scholar
  14. 14.
    Goligher JC (1958) Extraperitoneal colostomy or ileostomy. Br J Surg 46:97–103PubMedCrossRefGoogle Scholar
  15. 15.
    Hamada M, Nishioka Y, Nishimura T et al (2008) Laparoscopic permanent sigmoid stoma creation through the extraperitoneal route. Surg Laparosc Endosc Percutan Tech 18:483–485PubMedCrossRefGoogle Scholar
  16. 16.
    Souba WW, Fink MP, Jurkovich GJ et al (2007) ACS surgery: principles & practice, 6th edn. WebMD Professional Publishing, New YorkGoogle Scholar
  17. 17.
    Gordon PH, Nivatvongs S (1999) Principles and practice of surgery for the colon, rectum, and anus, 2nd edn. Quality Medical Publishing, Inc., St. Louis, Part III, p. 1146Google Scholar
  18. 18.
    Gordon PH, Nivatvongs S (2007) Principles and practice of surgery for the colon, rectum, and anus, 3rd edn. Informa Healthcare USA, Inc., New York, Part III, p. 1045Google Scholar
  19. 19.
    Ding WX, Yang P, Deng JZ, Cheng LQ, Liao S (2007) Comparative study of colostomy in the laparoscopic-assisted abdominoperineal resection. Zhonghua Wei Chang Wai Ke Za Zhi 10:326–328PubMedGoogle Scholar
  20. 20.
    Hwang YF, Chen SS, Liou TY, Wang HM, Hsu H (1990) Complications of colostomies and colostomy closure. Gaoxiong Yi Xue Ke Xue Za Zhi 6:276–282PubMedGoogle Scholar
  21. 21.
    Gendall KA, Raniga S, Kennedy R, Frizelle FA (2007) The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum 50:2223–2237PubMedCrossRefGoogle Scholar
  22. 22.
    Shellito PC (1998) Complications of abdominal stoma surgery. Dis Colon Rectum 41:1562–1572PubMedCrossRefGoogle Scholar
  23. 23.
    Pearl RK (1989) Parastomal hernias. World J Surg 13:569–572PubMedCrossRefGoogle Scholar
  24. 24.
    Abcarian H (1995) Peristomal hernias. In: Wexner SD, Vernava AM (eds) Clinical decision making in colorectal surgery. Igaku-Shoin, New York, pp 449–452Google Scholar
  25. 25.
    Devlin HB (1983) Peristomal hernia. In: Dudley H (ed) Operative surgery volume 1: alimentary tract and abdominal wall, 4th edn. Butterworths, London, pp 441–443Google Scholar
  26. 26.
    Leslie D (1984) The parastomal hernia. Surg Clin N Am 64:407–415PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Lei Lian
    • 1
  • Xian-Rui Wu
    • 1
  • Xiao-Sheng He
    • 1
  • Yi-Feng Zou
    • 1
  • Xiao-Jian Wu
    • 1
  • Ping Lan
    • 1
  • Jian-Ping Wang
    • 1
  1. 1.Department of Colorectal Surgery, The Sixth Affiliated Hospital (Gastrointestinal Hospital)Sun Yat-sen UniversityGuangzhouPeople’s Republic of China

Personalised recommendations