title: Permanent end-sigmoid colostomy through the extraperitoneal route prevents parastomal hernia after laparoscopic abdominoperineal resection.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  We examined the effects of the extraperitoneal route for stoma creation to prevent parastomal hernia after laparoscopic abdominoperineal resection for rectal neoplasms.
  
  
  METHODS
  This is a study of a retrospective cohort.
  
  
  METHODS
  Data on a total 37 consecutive patients who underwent abdominoperineal resection 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.
  
  
  METHODS
  The main outcome measures were the rate of parastomal hernia determined through CT and clinical examinations in the 2 groups.
  
  
  RESULTS
  In Group A, 1 case was diagnosed as having a parastomal hernia, whereas, in Group B, 5 cases were diagnosed by CT examination as having a parastomal hernia; the difference in incidence between the 2 groups was significant (p = 0.0305). Furthermore, 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).
  
  
  CONCLUSIONS
  : This study was limited by its nonrandomized retrospective design.
  
  
  CONCLUSIONS
  Group B developed parastomal hernia more frequently within a significantly shorter period. A permanent sigmoid colostomy created through the extraperitoneal route can prevent the incidence of parastomal hernia after laparoscopic abdominoperineal resection.
authors.affiliation: Department of General and Digestive Surgery, Kochi Health Sciences Center, Kochi-city, Kochi, Japan.
authors.forename: Madoka
authors.initials: M
authors.lastname: Hamada
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Ozaki
authors.forename: Genya
authors.initials: G
authors.lastname: Muraoka
authors.forename: Naoya
authors.initials: N
authors.lastname: Kawakita
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nishioka
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D012809:Colon, Sigmoid / Q000601:surgery*; D003125:Colostomy / Q000009:adverse effects / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006555:Hernia, Ventral / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D010535:Laparoscopy; D008223:Lymphoma / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D054047:Surgical Stomas / Q000009:adverse effects*