A technique for laparoscopic extraperitoneal colostomy with an intact posterior sheath of rectus

Li, Zeyu; Tian, Lifei; Liu, Ruiting; Zheng, Bin; Wang, Ben; Zhao, Xu; Qiu, Jian

doi:10.1186/s12893-022-01686-w

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…In addition, EPC was associated with a lower incidence of stomal prolapse than TPC. In the current literature, several modified surgical techniques regarding EPC have been described (6,7,18,19). From a theoretical point of view, EPC is associated with more evenly spread forces of the ab- dominal wall (pressure and tension), compared with the transperitoneal method, where these forces are concentrated on one created defect through all layers of the abdominal wall.…”

Section: Discussionmentioning

confidence: 99%

Surgical Methods for Minimizing the Incidence of Paracolostomy Hernias

Popov,

Pavlov,

Arabadzhiev

et al. 2023

SSM

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INTRODUCTION: Regardless of the advances in surgical techniques, parastomal hernia continues to be a frequent and serious complication after colostomy construction. The outcomes after surgical treatment are often not satisfactory, and the recurrence rate is high. AIM:The study aims to present modern surgical methods for the prevention of paracolostomy hernias. MATERIALS AND METHODS:The study included 77 patients with formed colostomies in the Clinic of Surgery of Alexandrovska University Hospital during the period from 2017 to 2022, analyzed with a follow-up period of at least six months. Group A includes 35 patients whose stoma was constructed by the extraperitoneal route. Group B consists of 42 patients with the traditional transperitoneal technique. In addition, 2 patients in whom synthetic mesh was used to treat and prevent paracolostomy hernia are reported. RESULTS:In group A only one patient was diagnosed with parastomal hernia, while in group B there were 9. The difference between the two groups was found to be statistically significant (p<0.05). In the cases where a prophylactic synthetic mesh was utilized, no complications we observed. CONCLUSION: Improving surgical techniques for preventing paracolostomy hernias is crucial, as they represent an inevitable complication, in most cases, after colostomy formation. The results of the conducted study as well as the available literature data highlight the benefits of methods such as the extraperitoneal route for stoma construction and the prophylactic use of synthetic meshes.

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Section: Discussionmentioning

confidence: 99%

Surgical Methods for Minimizing the Incidence of Paracolostomy Hernias

Popov,

Pavlov,

Arabadzhiev

et al. 2023

SSM

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“…Definitive fixation of the rectum is postulated to occur with the mesh in the early post-operative phase, and then being driven by posterior fibrosis in the midto late phases. Using a resorbable (biological) mesh may protect the patients from erosions caused by non-resorbable meshes observed with the Ripstein and Orr-Loygue procedures [11,12].…”

Section: Robotic Mesh Rectopexy For Rectal Prolapse: the Geneva Techn...mentioning

confidence: 99%

Laparoscopic retroperitoneal end colostomy creation – A video vignette

Gordeev,

Belenkaya,

Lukmonov

et al. 2023

Colorectal Disease

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“…Zhang et al 8 recommended entering the extraperitoneal space from the lateral edge of the posterior rectus sheath, thus keeping posterior rectus sheath intact. Li et al 9 used the technique of laparoscopic total extraperitoneal groin hernia repair to produce an extraperitoneal tunnel to facilitate precise visualization of the extraperitoneal space. Based on our experience, we have proposed a modified approach for extraperitoneal space entering from the arcuate line of the posterior rectus sheath.…”

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confidence: 99%

Modified Approach for Extraperitoneal Colostomy Creation in Laparoscopic Abdominoperineal Resection

Zhang,

Li,

Cheng

et al. 2023

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Parastomal hernia is a major long-term complication after abdominoperineal resection. Extraperitoneal colostomy has been proposed as an effective step for parastomal hernia prevention but it has not been widely used as it is technically-demanding and time-consuming. We proposed a modified approach for extraperitoneal colostomy creation by entering the extraperitoneal space through the arcuate line of the posterior rectus sheath. OBJECTIVE: To evaluate the safety, difficulty and efficacy for long-term parastomal hernia prevention of the modified approach for extraperitoneal colostomy creation compared with conventional transperitoneal colostomy approach. DESIGN: This was a retrospective evaluation of a surgical and video database. SETTINGS: This was a single-institution retrospective study. PATIENTS: Clinical data of 74 patients who underwent laparoscopic abdominoperineal resection surgery from January 2019 to January 2020 in the Department of General Surgery, Qilu Hospital of Shandong University were retrospectively reviewed. MAIN OUTCOME MEASURES: Baseline characteristics, time required for colostomy creation (from skin incision to colostomy maturation), perioperative complications, and long-term colostomy-related complications were compared. RESULTS: Baseline characteristics did not differ between the 2 approaches. The body mass index level ranged from 19.5 to 29.4 kg/m 2 for patients undergoing extraperitoneal approach. Time required for colostomy creation [22 (21-25) min for extraperitoneal vs. 23 (21-25) min for transperitoneal, p = 0.861] were comparable between the two approaches. The cumulative incidence of parastomal hernia was significantly greater with transperitoneal colostomy than extraperitoneal colostomy at 2 and 3 years postoperatively (16.2% vs. 0, p = 0.025, and 21.6% vs. 0, p = 0.005). The rest perioperative complications and long-term colostomy-related complications did not differ between the two approaches. LIMITATIONS: This study is limited by its retrospective design and small sample size. CONCLUSIONS: The modified approach for extraperitoneal colostomy creation is safe, technically simple and effective for long-term parastomal hernia prevention in patients with a body mass index of 19.5 - 29.4 kg/m 2.

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A technique for laparoscopic extraperitoneal colostomy with an intact posterior sheath of rectus

Cited by 3 publications

References 19 publications

Surgical Methods for Minimizing the Incidence of Paracolostomy Hernias

Surgical Methods for Minimizing the Incidence of Paracolostomy Hernias

Laparoscopic retroperitoneal end colostomy creation – A video vignette

Modified Approach for Extraperitoneal Colostomy Creation in Laparoscopic Abdominoperineal Resection

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