Parastomal Hernia After Laparoscopic Abdominoperineal Resection Can Be Prevented By Creating End Sigmoid Colostomy Through the Extraperitoneal Route

Madoka Hamada, MD, Genya Muraoka, MD, Naoya Kawakita, MD, Kazuhide Ozaki, MD, Yasuo Fukui, MD, Yutaka Nishioka, MD, Toshitatsu Taniki, MD, Tadashi Horimi, MD. Kochi Health Sciences Center


The prevalence of a paracolostomy hernia has been reported to be from 10% to 50%, with serious impairment of the quality of life and sometimes life-threatening morbidity in some cases. Most essential in avoiding the need for further treatment of an end sigmoid colostomy is prevention of a parastomal hernia. We examined the effects of the extraperitoneal route for stoma creation to prevent parastomal hernia after laparoscopic abdominoperineal resection (APR) for rectal neoplasms.
Patients and Methods
Data on a total 37 consecutive patients who underwent APR from March 2005 to December 2010 in Kochi Health Sciences Center were examined retrospectively in this study. Group A included 22 patients whose stoma was created through the extraperitoneal route and Group B included 15 patients whose stoma was created through the transperitoneal route.We compared the incidence of parastomal hernia determined through CT and clinical examinations between the two groups.
In Group A, one case was diagnosed as having a parastomal hernia, while in Group B, 6 cases were diagnosed by CT examination as having a parastomal hernia with CT examination; the difference in incidence between the two groups was significant (p<0.001). Futhermore, median duration of the follow-up period between the latest CT examination and the primary operation was 722 days in Group A, which was significantly longer than that in Group B (442 days) (p=0.001). Group B developed parastomal hernia more frequently within a significantly shorter period.
A permanent sigmoid colostomy created through the extraperitoneal route can prevent incidence of the parastomal hernia after laparoscopic APR. Our results support Sugarbaker technique for the treatment of parastomal hernia at the end sigmoid colostomy.

Session Number: Poster – Poster Presentations
Program Number: P294
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