title: Does stoma site specimen extraction increase postoperative ileostomy complication rates?
abstract: Minimizing incisions has the potential to decrease hernia formation and wound complications following laparoscopic surgery. It is currently unknown if using the stoma site for specimen extraction affects outcomes. This study aims to evaluate the impact of stoma site extraction on postoperative complication rates in laparoscopic colorectal surgery.
  
  
  
  After IRB approval, a retrospective comparative review of 738 consecutive patients (405 M) who underwent laparoscopic colorectal surgery with ileostomy between January 2008 and December 2014 was performed. Patients who had a minimally invasive surgery that required an ileostomy were included. Patients were classified into two groups: stoma site extraction (SSE) or non-stoma site extraction (NSSE) and compared by body mass index (BMI), age, comorbidities, American Society of Anesthesiologists score, length of stay, estimated blood loss, parastomal complications, and hernia rate.
  
  
  
  The parastomal hernia rate was 10.1% for the SSE group (n = 14) and 4.2% for the NSSE group (n = 25) (p = 0.007). The need for additional surgeries was 7/139 (5.0%) for the SSE group and 27/599 (4.5%) for the NSSE group (p = 0.79). There was no difference in the hernia rate after stoma closure in either group. There was no difference in single incision laparoscopic surgery versus conventional laparoscopy or robotic-assisted laparoscopy on stoma site complications in patients with SSE. SSE, transfusion, and BMI >30 were found to be independent factors associated with increased stoma site complications.
  
  
  
  SSE does increase stoma site complications. SSE should be used with caution, or in conjunction with other techniques to reduce hernias in patients requiring a permanent stoma or with an elevated BMI. The increase in stoma site complications does not translate into additional surgeries or postoperative sequelae following stoma reversal and is a reasonable option in patients requiring a temporary stoma.
authors.affiliation: Department of Gastrointestinal Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.|Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave., A30, Cleveland, OH, 44195, USA.
authors.forename: Wanglin
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave., A30, Cleveland, OH, 44195, USA.
authors.forename: Cigdem
authors.initials: C
authors.lastname: Benlice
authors.affiliation: Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave., A30, Cleveland, OH, 44195, USA.
authors.forename: Luca
authors.initials: L
authors.lastname: Stocchi
authors.affiliation: Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave., A30, Cleveland, OH, 44195, USA.
authors.forename: Hermann
authors.initials: H
authors.lastname: Kessler
authors.affiliation: Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave., A30, Cleveland, OH, 44195, USA.
authors.forename: Emre
authors.initials: E
authors.lastname: Gorgun
authors.affiliation: Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave., A30, Cleveland, OH, 44195, USA. costedm@ccf.org.
authors.forename: Meagan
authors.identifier: 0000-0001-6825-0514
authors.initials: M
authors.lastname: Costedio
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D054047:Surgical Stomas
keywords: Colectomy; Colorectal surgery; Colostomy; Ileostomy; Laparoscopy; Parastomal hernia; Postoperative complications; Single incision laparoscopy; Specimen extraction