TY - JOUR
T1 - Laparoscopic extraperitoneal colostomy has a lower risk of parastomal hernia and bowel obstruction than transperitoneal colostomy
AU - Ota, Emi
AU - Yamaguchi, Tomohiro
AU - Nagasaki, Toshiya
AU - Fukuoka, Hironori
AU - Mukai, Toshiki
AU - Hiyoshi, Yukiharu
AU - Konishi, Tsuyoshi
AU - Akiyoshi, Takashi
AU - Fukunaga, Yosuke
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022/6
Y1 - 2022/6
N2 - 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.
AB - 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.
KW - Bowel obstruction
KW - Extraperitoneal route
KW - Laparoscopic colostomy
KW - Parastomal hernia
KW - Transperitoneal route
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U2 - 10.1007/s00384-022-04187-7
DO - 10.1007/s00384-022-04187-7
M3 - Article
C2 - 35606659
AN - SCOPUS:85130551456
SN - 0179-1958
VL - 37
SP - 1429
EP - 1437
JO - International Journal of Colorectal Disease
JF - International Journal of Colorectal Disease
IS - 6
ER -