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Laparoscopic extraperitoneal colostomy has a lower risk of parastomal hernia and bowel obstruction than transperitoneal colostomy

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A Correspondence to this article was published on 06 September 2022

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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Acknowledgements

The authors would like to thank Editage for the English language editing and Dr. Takashi Sakamoto for his statistical help.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

    Emi Ota, Tomohiro Yamaguchi, Toshiya Nagasaki, Toshiki Mukai, Yukiharu Hiyoshi, Takashi Akiyoshi & Yosuke Fukunaga

  2. Department of Gastroenterology, Yokohama City University, Kanagawa, Japan

    Hironori Fukuoka

  3. Department of Colon and Rectal Surgery, The University of Texas M.D. Anderson Cancer Center, Huston, TX, USA

    Tsuyoshi Konishi

Authors
  1. Emi Ota
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  2. Tomohiro Yamaguchi
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  9. Yosuke Fukunaga
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Contributions

Emi Ota, Tomohiro Yamaguchi, and Yosuke Fukunaga contributed to the conception and design of the study, acquisition, analysis, and interpretation of the data, and drafting and critically revising the manuscript for important intellectual content. Toshiya Nagasaki, Hironori Fukuoka, Toshiki Mukai, Yukiharu Hiyoshi, Tsuyoshi Konishi, and Takashi Akiyoshi contributed to the acquisition of data and critical revision of the manuscript for important intellectual content. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Tomohiro Yamaguchi.

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Ethical approval

This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the IRB of the Cancer Institute Hospital who approved the study (protocol no.2018–1109).

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The authors declare no competing interests.

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Ota, E., Yamaguchi, T., Nagasaki, T. et al. Laparoscopic extraperitoneal colostomy has a lower risk of parastomal hernia and bowel obstruction than transperitoneal colostomy. Int J Colorectal Dis 37, 1429–1437 (2022). https://doi.org/10.1007/s00384-022-04187-7

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