Systematic review and meta-analysis comparing extraperitoneal and transperitoneal routes of colostomy-related complications.

BACKGROUND

Complications associated with stomas-including parastomal hernia (PSH), prolapse, mucocutaneous separation, and stoma retraction-provide considerable postoperative challenges for colostomy patients. Selecting between extraperitoneal colostomy (EPC) and transperitoneal colostomy (TPC) pathways is therefore essential for mitigating these complications.

AIM

To analyze the existing data regarding the efficacy of EPC compared to TPC in reducing stoma-related complications post-colostomy.

METHODS

PubMed, Google Scholar, EMBASE, MEDLINE, and the Cochrane Library were adopted to uncover pertinent papers in which EPC and TPC approaches were compared. We then conducted a meta-analysis using RevMan 5.4.1.

RESULTS

Both laparoscopic (Lap) and open approaches showed a reduced incidence of PSH in EPC relative to TPC ( < 0.00001 and = 0.02 respectively). In addition, Lap EPC depicted a lesser incidence of prolapse, mucocutaneous separation, and stoma retraction ( = 0.007, = 0.03, and = 0.01, respectively) compared to Lap TPC. However, EPC and TPC did not differ with respect to operation time, blood loss, edema, ischemia, necrosis, or infection after the LAP approach.

CONCLUSION

The extraperitoneal approach may provide benefits in minimizing some stoma-related problems such as PSH, prolapse, mucocutaneous separation, and stoma retraction after colostomy surgery.