Comparison between the Extraperitoneal Route with the Transperitoneal Route for the Permanent Colostomy: A Meta-Analysis with Rcts and Systematic Review

AimTo assess the efficacy of extraperitoneal colostomy(EPC) in the prevention of stoma-related complications.BackgroundTransperitoneal colostomy (TPC) is still a widely used surgical approach. However, TPC has been reported with highly incidence of stoma-related complications, like parastomal hernia, stomal retraction, stomal prolapse.The purpose of EPC is to prevent these complications. But it is still lack of evidence-based basis.Material and methodsMEDLINE, EMBASE, Web of Science, Scopus, MOOSE, Pubmed, Google Scholar, Baidu Scholar, and the Cochrane Library were searched to conduct a systematic review and meta-analysis with RCTs. Revman 5.4 was performed in the meta-analysis.ResultsA total of 5 RCTs were eligible in this study. Compared with TPC, EPC group had lower incidence in Parastomal Hernia (RR, 0.14; 95% CI, 0.04–0.52, P=0.003, I2=0%), Stomal Prolapse (RR, 0.27; 95% CI, 0.08–0.95, P=0.04, I2=0%) and a higher rate of defaecation Sensation (RR, 3.51; 95% CI, 2.47–5.0, P＜0.00001, I2=37%). No statistical difference was observed in Stoma Retraction, Colostomy Construction Time, Stoma Ischemia, and Necrosis.ConclusionAn extraperitoneal colostomy is associated with a lower rate of postoperative complication compared to transperitoneal colostomy. Randomized controlled trial meta-analysis showed better results in permanent colostomy after abdominoperineal resection.

Internal hernia of the stomach through the lateral space of the colostomy: a case report

An 81-year-old woman had undergone laparoscopic abdominoperineal resection for rectal cancer. A permanent colostomy was created through an intraperitoneal route. Three months after the surgery, the patient presented with lower abdominal pain and vomiting. Computed tomography showed gastric incarceration through the lateral space of the lifted sigmoid colostomy. Although the herniated stomach was reduced by nasogastric tube decompression, the patient experienced a recurrence of gastric hernia shortly thereafter. A laparoscopic operation was performed, and a new colostomy was constructed through an extraperitoneal route. The patient had no hernia recurrence during the 20 months of follow-up after the operation. Gastric internal hernia associated with colostomy can occur as a rare complication. Although reduction of the incarcerated stomach is possible by nasogastric tube decompression, surgical repair of the hernia may be the optimal management to prevent recurrence.

Surgical Anatomy of the Retroperitoneal Spaces, Part V: Surgical Applications and Complications

Knowledge of the surgical anatomy of the retroperitoneum is crucial for surgery of the retroperitoneal organs. Surgery is essential for treatment of retroperitoneal pathologies. The list of these diseases is extensive and comprises acute and chronic inflammatory processes (abscess, injury, hematoma, idiopathic fibrosis), metastatic neoplasms, and primary neoplasms from fibroadipose tissue, connective tissue, smooth and striated muscle, vascular tissue, somatic and sympathetic nervous tissue, extraadrenal chromaffin tissue, and lymphatic tissue. The retroperitoneum can be approached and explored by several routes, including the transperitoneal route and the extraperitoneal route. The retroperitoneal approach to the iliac fossa is used for ectopic renal transplantation. Safe and reliable primary retroperitoneal access can be performed for laparoscopic exploration. The anatomic complications of retroperitoneal surgery are the complications of the organs located in several compartments of the retroperitoneal space. Complications may arise from incisions to the somatic wall, somatic nerves, blood and lymphatic vessels, lymph nodes, visceral autonomous plexuses, and neighboring splanchna.