Abstract
Introduction: Parastomal herniation of end colostomies can be chronically debilitating for patients and a difficult problem to treat. To prevent parastomal hernia (PSH) formation an extra-peritoneal colostomy (EPC) approach has been developed in open colorectal surgery and some studies have suggested a potential advantage to this approach. Here we describe our technique of laparoscopic extraperitoneal stoma formation and present our experience to date.
Methods: We performed a retrospective analysis of all consecutive patients undergoing a Laparoscopic Abdomino-Perineal Resection (LAPR) between March 1999 and March 2011. We performed the EPC technique as follows: under laparoscopic guidance, a smooth tip instrument was used to gently separate the peritoneum from the posterior aponeurotic plane to create an extraperitoneal tunnel running from the skin incision to the left flank of the abdominal cavity and join the previously dissected paracolic gutter. The colon was exteriorised and the position checked to ensure the absence of torsion or kinking.
Results: Twenty-two patients underwent a standard LAPR with total mesorectal excision (TME). Colostomy was constructed extra-peritoneally (EPC) or trans-peritoneally (TPC) in 12 and 10 patients respectively. There were 5 complications requiring operative intervention: 2 stomal necrosis and 1 surgical site infection in the TPC group and 2 small bowel occlusions in the EPC group. Four patients from the TPC group developed PSH at 24, 36, 48 and 72 months respectively while there were no cases of PSH in the EPC group.
Conclusion: Extra peritoneal laparoscopic colostomy showed a potential reduction of PSH in our series of patients.
© 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland
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