title: Circular Stapler-Assisted Extraperitoneal Colostomy in Laparoscopic Abdominoperineal Resection: a Single Surgeon Experience.
abstract: BACKGROUND
  Nowadays, laparoscopic abdominoperineal resection (LAPR) not only has the same oncologic safety of open surgery and but also has the common advantages of laparoscopic surgery. However, given the difficulty in operation and long operative time, laparoscopic extraperitoneal colostomy construction is rarely practiced and reported. In this study, we describe technique of extraperitoneal colostomy using circular stapler following LAPR and demonstrate its efficacy and safety.
  
  
  METHODS
  This is a retrospective analysis of prospectively maintained data of 42 patients who underwent LAPR with circular stapler-assisted extraperitoneal colostomy in our department between July 2011 and June 2014.
  
  
  RESULTS
  The mean time for extraperitoneal colostomy construction was 25 min (18-33 min). The mean operative time, estimated blood loss, postoperative gastrointestinal function recovery time, and duration of postoperative hospital stay were 160 min (115-225 min), 45 ml (10-250 ml), 33 h (26-45 h), and 8.6 days (6-13 days), respectively; 4.8 % of the patients had postoperative short-term complications. There were no stenosis, prolapse, and parastomal hernia observed in follow-up period. At 6 months after operation, 26 patients (62 %) claimed to be satisfied with their postoperative stool habits, 29 patients (69 %) had sensation to defecate per stoma, and 11 (26.2 %) patients had the ability to defer defecation for solid or liquid stool per stoma.
  
  
  CONCLUSIONS
  Circular stapler-assisted extraperitoneal colostomy is an easy, effective, and safe technique following LAPR and appears to minimize the occurrence of stomal complications and improve the quality of life for patients.
authors.affiliation: Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, Hubei Province, China, 430022.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, Hubei Province, China, 430022.
authors.forename: Jie
authors.initials: J
authors.lastname: Bai
authors.affiliation: Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, Hubei Province, China, 430022.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Shuai
authors.affiliation: Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, Hubei Province, China, 430022.
authors.forename: Weilong
authors.initials: W
authors.lastname: Chang
authors.affiliation: Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, Hubei Province, China, 430022.
authors.forename: Jinbo
authors.initials: J
authors.lastname: Gao
authors.affiliation: Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, Hubei Province, China, 430022.
authors.forename: Xinghua
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, Hubei Province, China, 430022.
authors.forename: Guobin
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, Hubei Province, China, 430022. tao_kaixiong@163.com.
authors.forename: Kaixiong
authors.initials: K
authors.lastname: Tao
mesh_terms: D000328:Adult; D000368:Aged; D003125:Colostomy; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011788:Quality of Life; D012189:Retrospective Studies; D017792:Surgical Stapling; D054047:Surgical Stomas
keywords: Circular stapler; Extraperitoneal colostomy; Laparoscopic abdominoperineal resection; Rectal cancer