Systematic Review and Meta-Analysis of Extraperitoneal Versus Transperitoneal Colostomy for Preventing Parastomal Hernia.
BACKGROUND
Parastomal hernia remains a frequent problem after constructing a colostomy. Current research mainly focuses on prophylactic mesh placement as an addition to transperitoneal colostomies. However, for constructing a colostomy, either an extraperitoneal or transperitoneal route can be chosen.


OBJECTIVE
The aim of this meta-analysis was to investigate which technique results in lower parastomal hernia rates in patients undergoing end colostomy.


METHODS
A meta-analysis was conducted according to Preferred Items for Reporting of Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. Embase, MEDLINE, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, Cochrane, PubMed, and Google Scholar databases were searched. The study protocol was registered in the International Prospective Register of Systematic Reviews database.


METHODS
Studies comparing extraperitoneal and transperitoneal colostomies were included. Only studies written in English were included. The quality of studies and risk of bias were assessed using the Cochrane risk-of-bias tool. The quality of nonrandomized studies was assessed using the Newcastle-Ottawa Scale.


METHODS
The intervention was colostomy formation.


METHODS
The main outcome measure was parastomal hernia incidence. Secondary outcome measures were stoma prolapse, stoma necrosis, and operating time.


RESULTS
Of 401 articles found, a meta-analysis was conducted of 10 studies (2 randomized controlled trials and 8 retrospective studies) composed of 1048 patients (347 extraperitoneal and 701 transperitoneal). Extraperitoneal colostomy led to significantly lower parastomal hernia rates (22 of 347 (6.3%) for extraperitoneal versus 125 of 701 (17.8%) for transperitoneal; risk ratio = 0.36 (95% CI, 0.21-0.62); I = 26%; p < 0.001) and significantly lower stoma prolapse rates (2 of 185 (1.1%) for extraperitoneal versus 13 of 179 (7.3%) for transperitoneal; risk ratio = 0.21 (95% CI, 0.06-0.73); I = 0%; p = 0.01). Differences in stoma necrosis were not significant. Operating time data were insufficient to analyze.


CONCLUSIONS
Most of the studies were nonrandomized, and some were not recent publications.


CONCLUSIONS
Although the majority of studies included were retrospective, extraperitoneal colostomy was observed to lead to a lower rate of parastomal hernia and stoma prolapse.
1 Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands 2 Department of Neuroscience, Erasmus University Medical Center, Rotterdam, the Netherlands 3 Department of Surgery, Havenziekenhuis, Rotterdam, the Netherlands.
Leonard F
LF
Kroese
Gijs H J
GH
de Smet
Johannes
J
Jeekel
Gert-Jan
GJ
Kleinrensink
Johan F
JF
Lange
D003125:Colostomy / Q000379:methods*; D006801:Humans; D000069290:Incisional Hernia / Q000517:prevention & control*; D010537:Peritoneum / Q000601:surgery*; D054047:Surgical Stomas; D016896:Treatment Outcome