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).
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.
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.
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.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Marwan K, Staples MP, Thursfield V, Bell SW (2010) The rate of abdominoperineal resections for rectal cancer in the state of Victoria, Australia: a population-based study. Dis Colon Rectum 53:1645–1651
Tilney HS, Heriot AG, Purkayastha S, Antoniou A, Aylin P, Darzi AW, Tekkis PP (2008) A national perspective on the decline of abdominoperineal resection for rectal cancer. Ann Surg 247:77–84
Wibe A, Syse A, Andersen E, Tretli S, Myrvold HE, Soreide O, Norwegian Rectal Cancer G (2004) Oncological outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior vs. abdominoperineal resection. Dis Colon Rectum 47:48–58
Fujita S, Akasu T, Mizusawa J, Saito N, Kinugasa Y, Kanemitsu Y, Ohue M, Fujii S, Shiozawa M, Yamaguchi T, Moriya Y, Cancer Study Group of Japan Clinical Oncology G (2012) Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial. Lancet Oncol 13:616–621
Carne PW, Robertson GM, Frizelle FA (2003) Parastomal hernia. Br J Surg 90:784–793
Rubin MS, Schoetz DJ Jr, Matthews JB (1994) Parastomal hernia. Is stoma relocation superior to fascial repair? Arch Surg 129:413–418 discussion 418-419
Cheung MT, Chia NH, Chiu WY (2001) Surgical treatment of parastomal hernia complicating sigmoid colostomies. Dis Colon Rectum 44:266–270
Botet X, Boldo E, Llaurado JM (1996) Colonic parastomal hernia repair by translocation without formal laparotomy. Br J Surg 83:981
Berger D, Bientzle M (2007) Laparoscopic repair of parastomal hernias: a single surgeon’s experience in 66 patients. Dis Colon Rectum 50:1668–1673
LeBlanc KA, Bellanger DE (2002) Laparoscopic repair of paraostomy hernias: early results. J Am Coll Surg 194:232–239
Stelzner S, Hellmich G, Ludwig K (2004) Repair of paracolostomy hernias with a prosthetic mesh in the intraperitoneal onlay position: modified Sugarbaker technique. Dis Colon Rectum 47:185–191
Lian L, Wu XR, He XS, Zou YF, Wu XJ, Lan P, Wang JP (2012) Extraperitoneal vs. intraperitoneal route for permanent colostomy: a meta-analysis of 1,071 patients. Int J Colorectal Dis 27:59–64
Londono-Schimmer EE, Leong AP, Phillips RK (1994) Life table analysis of stomal complications following colostomy. Dis Colon Rectum 37:916–920
Hamada M, Ozaki K, Muraoka G, Kawakita N, Nishioka Y (2012) Permanent end-sigmoid colostomy through the extraperitoneal route prevents parastomal hernia after laparoscopic abdominoperineal resection. Dis Colon Rectum 55:963–969
Leroy J, Diana M, Callari C, Barry B, D’Agostino J, Wu HS, Marescaux J (2012) Laparoscopic extraperitoneal colostomy in elective abdominoperineal resection for cancer: a single surgeon experience. Colorectal Dis 14:e618–e622
Heiying J, Yonghong D, Xiaofeng W, Hang Y, Kunlan W, Bei Z, Jinhao Z, Qiang L (2014) A study of laparoscopic extraperitoneal sigmoid colostomy after abdomino-perineal resection for rectal cancer. Gastroenterol Rep (Oxf) 2:58–62
Wang FB, Pu YW, Zhong FY, Lv XD, Yang ZX, Xing CG (2015) Laparoscopic permanent sigmoid stoma creation through the extraperitoneal route versus transperitoneal route. A meta-analysis of stoma-related complications. Saudi Med J 36:159–163
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
American Society of Colon, Rectal Surgeons Committee Members, Wound Ostomy Continence Nurses Society Committee M (2007) ASCRS and WOCN joint position statement on the value of preoperative stoma marking for patients undergoing fecal ostomy surgery. J Wound Ostomy Continence Nurs 34:627–628
Nastro P, Knowles CH, McGrath A, Heyman B, Porrett TR, Lunniss PJ (2010) Complications of intestinal stomas. Br J Surg 97:1885–1889
Sohn YJ, Moon SM, Shin US, Jee SH (2012) Incidence and risk factors of parastomal hernia. J Korean Soc Coloproctol 28:241–246
Goligher JC (1958) Extraperitoneal colostomy or ileostomy. Br J Surg 46:97–103
Yamaguchi T, Kinugasa Y, Shiomi A, Sato S, Yamakawa Y, Kagawa H, Tomioka H, Mori K (2015) Learning curve for robotic-assisted surgery for rectal cancer: use of the cumulative sum method. Surg Endosc 29:1679–1685
Yamaguchi T, Kinugasa Y, Shiomi A, Tomioka H, Kagawa H, Yamakawa Y (2015) Robotic-assisted vs. conventional laparoscopic surgery for rectal cancer: short-term outcomes at a single center. Surg Today. doi:10.1007/s00595-015-1266-4
Yamaguchi T, Kinugasa Y, Shiomi A, Tomioka H, Kagawa H (2016) Robotic-assisted laparoscopic versus open lateral lymph node dissection for advanced lower rectal cancer. Surg Endosc 30:721–728
Janes A, Cengiz Y, Israelsson LA (2009) Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study. World J Surg 33:118–121 (discussion 122-113)
Pilgrim CH, McIntyre R, Bailey M (2010) Prospective audit of parastomal hernia: prevalence and associated comorbidities. Dis Colon Rectum 53:71–76
Mylonakis E, Scarpa M, Barollo M, Yarnoz C, Keighley MR (2001) Life table analysis of hernia following end colostomy construction. Colorectal Dis 3:334–337
Funahashi K, Suzuki T, Nagashima Y, Matsuda S, Koike J, Shiokawa H, Ushigome M, Arai K, Kaneko T, Kurihara A, Kaneko H (2014) Risk factors for parastomal hernia in Japanese patients with permanent colostomy. Surg Today 44:1465–1469
Hitoshi Hino, Tomohiro Yamaguchi, Yusuke Kinugasa, Akio Shiomi, Hiroyasu Kagawa, Yushi Yamakawa, Masakatsu Numata, Akinobu Furutani, Takuya Suzuki, and Kakeru Torii have no conflicts of interest or financial ties to disclose.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Hino, H., Yamaguchi, T., Kinugasa, Y. et al. Relationship between stoma creation route for end colostomy and parastomal hernia development after laparoscopic surgery. Surg Endosc 31, 1966–1973 (2017). https://doi.org/10.1007/s00464-016-5198-x
- Parastomal hernia
- Extraperitoneal route
- Transperitoneal route
- Laparoscopic surgery
- Abdominoperineal resection
- Hartmann procedure