Permanent End-Sigmoid Colostomy Through the Extraperitoneal Route Prevents Parastomal Hernia After Laparoscopic Abdominoperineal Resection

BACKGROUND:The prevalence of a paracolostomy hernia has been reported to be from 10% to 50%, with serious impairment of the quality of life and sometimes life-threatening morbidity in some cases. Most essential in avoiding the need for further treatment of an end-sigmoid colostomy is prevention of a...

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Veröffentlicht in:Diseases of the colon & rectum 2012-09, Vol.55 (9), p.963-969
Hauptverfasser: Hamada, Madoka, Ozaki, Kazuhide, Muraoka, Genya, Kawakita, Naoya, Nishioka, Yutaka
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Sprache:eng
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Zusammenfassung:BACKGROUND:The prevalence of a paracolostomy hernia has been reported to be from 10% to 50%, with serious impairment of the quality of life and sometimes life-threatening morbidity in some cases. Most essential in avoiding the need for further treatment of an end-sigmoid colostomy is prevention of a parastomal hernia. OBJECTIVE:We examined the effects of the extraperitoneal route for stoma creation to prevent parastomal hernia after laparoscopic abdominoperineal resection for rectal neoplasms. DESIGN:This is a study of a retrospective cohort. SETTING AND PATIENTS:Data on a total 37 consecutive patients who underwent abdominoperineal resection from March 2005 to December 2010 in Kochi Health Sciences Center were examined retrospectively in this study. Group A included 22 patients whose stoma was created through the extraperitoneal route, and group B included 15 patients whose stoma was created through the transperitoneal route. MAIN OUTCOME MEASURES:The main outcome measures were the rate of parastomal hernia determined through CT and clinical examinations in the 2 groups. RESULTS:In Group A, 1 case was diagnosed as having a parastomal hernia, whereas, in Group B, 5 cases were diagnosed by CT examination as having a parastomal hernia; the difference in incidence between the 2 groups was significant (p = 0.0305). Furthermore, median duration of the follow-up period between the latest CT examination and the primary operation was 722 days in group A, which was significantly longer than that in group B (442 days) (p = 0.001). LIMITATIONS:This study was limited by its nonrandomized retrospective design. CONCLUSION:Group B developed parastomal hernia more frequently within a significantly shorter period. A permanent sigmoid colostomy created through the extraperitoneal route can prevent the incidence of parastomal hernia after laparoscopic abdominoperineal resection.
ISSN:0012-3706
1530-0358
DOI:10.1097/DCR.0b013e31825fb5ff