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

Wang FB, Pu YW, Zhong FY, Lv XD, Yang ZX, Xing CG - Saudi Med J (2015)

Bottom Line: A literature search of Medline, EMBASE, Cochrane database, and the Chinese Biomedical Literature Database (CBM) from the years 1990 to 2014 was performed.However, the other stoma-related complications were not significantly different between the 2 groups.Laparoscopic permanent sigmoid stoma creation through the extraperitoneal route should be the first choice after laparoscopic abdominoperineal resection. 

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, The Second Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province, China. E-mail. bing0789@163.com.

ABSTRACT

Objectives: 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.

Methods: 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.

Results: 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.

Conclusion: 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. 

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Analysis of controlled studies of EPC versus TPC in patients with rectal cancer. Outcome: operation time, 95% CI - 95% confidence interval, M-H - Mantel-Haenszel, df - degrees of freedom, OR - odds ratio, EPC - extraperitoneal colostomy after laparoscopic abdominoperineal resection surgery, TPC - transperitoneal colostomy after laparoscopic abdominoperineal resection surgery
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Figure 4: Analysis of controlled studies of EPC versus TPC in patients with rectal cancer. Outcome: operation time, 95% CI - 95% confidence interval, M-H - Mantel-Haenszel, df - degrees of freedom, OR - odds ratio, EPC - extraperitoneal colostomy after laparoscopic abdominoperineal resection surgery, TPC - transperitoneal colostomy after laparoscopic abdominoperineal resection surgery

Mentions: Four studies reported on the operation time, 2 studies focused on the entire operation time, and 2 studies focused on the time for the colostomy construction. Our analysis shows that there is no statistically significant difference regarding the length of the entire operation time (total 34 patients; heterogeneity: Chi2=4.84, p=0.36) (Figure 4). However, the time for colostomy construction via the extraperitoneal route using a laparoscopic approach is longer than the transperitoneal route (total 39 patients; heterogeneity: Chi2=0.85, p<0.00001) (Figure 5).


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

Wang FB, Pu YW, Zhong FY, Lv XD, Yang ZX, Xing CG - Saudi Med J (2015)

Analysis of controlled studies of EPC versus TPC in patients with rectal cancer. Outcome: operation time, 95% CI - 95% confidence interval, M-H - Mantel-Haenszel, df - degrees of freedom, OR - odds ratio, EPC - extraperitoneal colostomy after laparoscopic abdominoperineal resection surgery, TPC - transperitoneal colostomy after laparoscopic abdominoperineal resection surgery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4375691&req=5

Figure 4: Analysis of controlled studies of EPC versus TPC in patients with rectal cancer. Outcome: operation time, 95% CI - 95% confidence interval, M-H - Mantel-Haenszel, df - degrees of freedom, OR - odds ratio, EPC - extraperitoneal colostomy after laparoscopic abdominoperineal resection surgery, TPC - transperitoneal colostomy after laparoscopic abdominoperineal resection surgery
Mentions: Four studies reported on the operation time, 2 studies focused on the entire operation time, and 2 studies focused on the time for the colostomy construction. Our analysis shows that there is no statistically significant difference regarding the length of the entire operation time (total 34 patients; heterogeneity: Chi2=4.84, p=0.36) (Figure 4). However, the time for colostomy construction via the extraperitoneal route using a laparoscopic approach is longer than the transperitoneal route (total 39 patients; heterogeneity: Chi2=0.85, p<0.00001) (Figure 5).

Bottom Line: A literature search of Medline, EMBASE, Cochrane database, and the Chinese Biomedical Literature Database (CBM) from the years 1990 to 2014 was performed.However, the other stoma-related complications were not significantly different between the 2 groups.Laparoscopic permanent sigmoid stoma creation through the extraperitoneal route should be the first choice after laparoscopic abdominoperineal resection. 

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, The Second Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province, China. E-mail. bing0789@163.com.

ABSTRACT

Objectives: 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.

Methods: 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.

Results: 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.

Conclusion: 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. 

Show MeSH
Related in: MedlinePlus