Laparoscopic permanent sigmoid stoma creation through the extraperitoneal route versus transperitoneal route, [A meta-analysis of stoma-related complications]

ABSTRACT

To compare laparoscopic extraperitoneal colostomy with transperitoneal colostomy for construction of a permanent stoma by measuring the incidence of parastomal hernia, and other postoperative complications related to colostomy. The meta-analysis was carried out in the General Surgery Department of the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China in 2014. A literature search of Medline, EMBASE, Cochrane database, and the Chinese Biomedical Literature Database [CBM] from the years 1990 to 2014 was performed. The literature searches were carried out using medical subject headings and free-text words extraperitoneal colostomy, transperitoneal colostomy, laparoscopic extraperitoneal colostomy, rectal cancer, laparoscopic abdominoperineal resection, parastomal hernia, permanent stoma, and colostomy-related complications. Two different reviewers carried out the search and evaluated studies independently. One randomized controlled trial and 6 retrospective studies were included. A total of 378 patients [209 extraperitoneal colostomy and 169 transperitoneal colostomy] were identified. Our analysis showed that there was a significantly lower rate of parastomal hernia [odds ratio 0.10; 95% confidence interval 0.03-0.29, p<0.0001] in the extraperitoneal colostomy group. However, the other stoma-related complications were not significantly different between the 2 groups. Colostomy construction via the extraperitoneal route using a laparoscopic approach can largely reduce the incidence of parastomal hernia. Laparoscopic permanent sigmoid stoma creation through the extraperitoneal route should be the first choice after laparoscopic abdominoperineal resection