Extraperitoneal vs. intraperitoneal route for permanent colostomy: a meta-analysis of 1,071 patients

Background Parastomal hernia is a common complication after colostomy construction. Whether an extraperitoneal route for colostomy creation can reduce the risk of parastomal hernia remains controversial. Objective A meta-analysis was performed to evaluate the value of extraperitoneal route in the prevention of parastomal hernia and other postoperative complications related to colostomy. Data sources A literature search of Medline, Embase, Ovid, and Cochrane databases from the years 1966 to 2010 was performed. Study selection Studies comparing extraperitoneal colostomy with intraperitoneal colostomy were identified. Intervention Extraperitoneal colostomy was performed to prevent colostomy-related complications. Main outcome measures Data on the following outcomes were sought: incidence of postoperative colostomy complications including parastomal hernia, prolapse, and bowel obstruction. Results Seven retrospective studies with a combined total of 1,071 patients (250 extraperitoneal colostomy and 821 intraperitoneal colostomy) were identified. There was a significantly lower rate of parastomal hernia (odds ratio, 0.41; 95% confidence interval, 0.23-0.73, p=0.002) in the extraperitoneal colostomy group. However, the occurrences of bowel obstruction and prolapse were not significantly different between the two groups. Limitations A limitation of the study lies on the meta-analysis of observational studies. Conclusion Extraperitoneal colostomy is associated with a lower rate of postoperative parastomal hernia as compared to intraperitoneal colostomy. Prospective randomized controlled trial is warranted to further determine the role of extraperitoneal route in the prevention of parastomal hernia.