Laparoscopic Permanent Sigmoid Stoma Creation Through the Extraperitoneal Route

Abstract

About 50% of patients who have a permanent stoma experience some degree of parastomal hernia formation. To prevent this complication, the extraperitoneal route is considered to be more effective than the transperitoneal route in the case of open colorectal surgery. This technique also has superiority in avoiding postoperative intestinal obstruction. Although laparoscopic surgery for rectal cancer has not been proved to be as safe as open surgery by a randomized-controlled trial, some studies have shown the equality of long-term results with laparoscopic low anterior resection and laparoscopic abdominoperineal resection. It is anticipated that cases of laparoscopic abdominoperineal resection will increase in the near future. However, a laparoscopic technique for creation of a permanent stoma has hardly been discussed. Most operative procedures for laparoscopic stoma creation have been performed with transperitoneal route, which may cause parastomal hernia and/or intestinal obstruction. This report describes a laparoscopic technique for permanent sigmoid stoma creation through the extraperitoneal approach.

Parastomal hernia. A study of the French federation of ostomy patients

“…This goal was not realized but the authors noted an incidental decrease in the incidence of PSH. A laparoscopic version of this technique has been described [14][15][16]; • the size of the parietal orifice seems be crucial [17]. A prospective study showed that the rate of PSH was directly proportional to the diameter in millimeters of the orifice.…”

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

“…We applied this technique to laparoscopic APRs as reported previously. 9 Open surgery for APR presents a risk of not only parastomal hernia, but also incisional hernia. On the other hand, because laparoscopic surgery for APR presents a minimal risk of incisional hernia, its application would be beneficial in preventing abdominal herniation.…”

“…In group A, the stoma was created through the extraperitoneal route according to our previously reported technique. 9 In brief, a circular opening of the skin was created with a scalpel (diameter, 25 mm) at the site that had been marked preoperatively by the stoma therapist. The fascia was then incised in a crosswise direction approximately 2 finger widths in length.…”

“…9 However, this procedure was more time consuming, especially in patients with obesity, in comparison with the transperitoneal route. Furthermore, we do not have any evidence on whether the use of the extraperitoneal route can prevent parastomal hernia in laparoscopic surgery.…”

Risk factors for parastomal hernia in Japanese patients with permanent colostomy

“…Hamada et al [22, 23] reported the usefulness of and the proper technique for extraperitoneal colostomy in laparoscopic APR, although the risk factors for hernia formation were not described. Extraperitoneal colostomy may be recommended for patients undergoing laparoscopic APR.…”