title: Laparoscopic extraperitoneal colostomy in elective abdominoperineal resection for cancer: a single surgeon experience.
abstract: OBJECTIVE
  Parastomal herniation of end colostomies can be chronically debilitating for patients and a difficult problem to treat. To prevent parastomal hernia (PSH) formation an extraperitoneal 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 consecutive patients undergoing a laparoscopic abdominoperineal resection 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 to join the previously dissected paracolic gutter. The colon was exteriorized and the position was checked to ensure the absence of torsion or kinking.
  
  
  RESULTS
  Twenty-two patients underwent a standard laparoscopic abdominoperineal resection with total mesorectal excision. Colostomy was constructed extraperitoneally (EPC) or transperitoneally (TPC) in 12 and 10 patients respectively. There were five complications requiring operative intervention: two stomal necrosis and one surgical site infection in the TPC group and two 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.
  
  
  CONCLUSIONS
  Extraperitoneal laparoscopic colostomy showed a potential reduction of PSH in our series of patients.
authors.affiliation: IRCAD/EITS, Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France. joel.leroy@ircad.fr
authors.forename: J
authors.initials: J
authors.lastname: Leroy
authors.forename: M
authors.initials: M
authors.lastname: Diana
authors.forename: C
authors.initials: C
authors.lastname: Callari
authors.forename: B
authors.initials: B
authors.lastname: Barry
authors.forename: J
authors.initials: J
authors.lastname: D'Agostino
authors.forename: H-S
authors.initials: HS
authors.lastname: Wu
authors.forename: J
authors.initials: J
authors.lastname: Marescaux
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D003125:Colostomy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010537:Peritoneum / Q000601:surgery; D011183:Postoperative Complications / Q000473:pathology; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D054047:Surgical Stomas / Q000473:pathology