title: Laparoscopic permanent sigmoid stoma creation through the extraperitoneal route versus transperitoneal route. A meta-analysis of stoma-related complications.
abstract: OBJECTIVE
  To compare laparoscopic extraperitoneal colostomy with transperitoneal colostomy for construction of a permanent stoma by measuring the incidence of parastomal hernia, and other postoperative complications related to colostomy.
  
  
  METHODS
  The meta-analysis was carried out in the General Surgery Department of the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China in 2014. A literature search of Medline, EMBASE, Cochrane database, and the Chinese Biomedical Literature Database (CBM) from the years 1990 to 2014 was performed. The literature searches were carried out using medical subject headings and free-text words: extraperitoneal colostomy, transperitoneal colostomy, laparoscopic extraperitoneal colostomy, rectal cancer,  laparoscopic abdominoperineal resection, parastomal hernia, permanent stoma, and colostomy-related complications. Two different reviewers carried out the search and evaluated studies independently.
  
  
  RESULTS
  One randomized controlled trial and 6 retrospective studies were included. A total of 378 patients (209 extraperitoneal colostomy and 169 transperitoneal colostomy) were identified. Our analysis showed that there was a significantly lower rate of parastomal hernia (odds ratio 0.10; 95% confidence interval 0.03-0.29, p&lt;0.0001) in the extraperitoneal colostomy group. However, the other stoma-related complications were not significantly different between the 2 groups.
  
  
  CONCLUSIONS
  Colostomy construction via the extraperitoneal route using a laparoscopic approach can largely reduce the incidence of parastomal hernia. Laparoscopic permanent sigmoid stoma creation through the extraperitoneal route should be the first choice after laparoscopic abdominoperineal resection.
authors.affiliation: Department of General Surgery, The Second Affiliated Hospital, Soochow University, Suzhou, Jiangsu Province, China. E-mail. bing0789@163.com.
authors.forename: Feng-Bing
authors.initials: FB
authors.lastname: Wang
authors.forename: Yu-Wei
authors.initials: YW
authors.lastname: Pu
authors.forename: Feng-Yun
authors.initials: FY
authors.lastname: Zhong
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Lv
authors.forename: Zhi-Xue
authors.initials: ZX
authors.lastname: Yang
authors.forename: Chun-Gen
authors.initials: CG
authors.lastname: Xing
mesh_terms: D012809:Colon, Sigmoid / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D010537:Peritoneum / Q000601:surgery*; D054047:Surgical Stomas