Isah AD, Wang X, Shaibu Z, Yuan X, Dang SC. Systematic review and meta-analysis comparing extraperitoneal and transperitoneal routes of colostomy-related complications. World J Gastrointest Surg 2025; 17(3): 98947 [DOI: 10.4240/wjgs.v17.i3.98947]
Corresponding Author of This Article
Sheng-Chun Dang, Doctor, Professor, Surgeon, Department of General Surgery, The Affiliated Hospital of Jiangsu University, No. 438 Jiefang Road, Zhenjiang 212001, Jiangsu Province, China. dscgu@163.com
Research Domain of This Article
Surgery
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Adamu D Isah, Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
Adamu D Isah, Department of Radiation Oncology, Institute of Oncology, Affiliated Hospital, Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
Xu Wang, Xiao Yuan, Department of Radiation Oncology, Cancer Institute of Jiangsu University, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
Zakari Shaibu, School of Medicine, Jiangsu University, Zhenjiang 212013, Jiangsu Province, China
Sheng-Chun Dang, Department of General Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
Co-first authors: Adamu D Isah and Xu Wang.
Author contributions: Isah AD and Wang X contributed equally as co-first authors. Isah AD, Shaibu Z and Yuan X were responsible for data collection and manuscript preparation; Dang CS and Wang X critically revised the manuscript for significant intellectual content, ensuring the accuracy and integrity of the work. All authors reviewed and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sheng-Chun Dang, Doctor, Professor, Surgeon, Department of General Surgery, The Affiliated Hospital of Jiangsu University, No. 438 Jiefang Road, Zhenjiang 212001, Jiangsu Province, China. dscgu@163.com
Received: July 9, 2024 Revised: December 10, 2024 Accepted: January 17, 2025 Published online: March 27, 2025 Processing time: 229 Days and 4.5 Hours
Abstract
BACKGROUND
Complications associated with stomas—including parastomal hernia (PSH), prolapse, mucocutaneous separation, and stoma retraction—provide considerable postoperative challenges for colostomy patients. Selecting between extraperitoneal colostomy (EPC) and transperitoneal colostomy (TPC) pathways is therefore essential for mitigating these complications.
AIM
To analyze the existing data regarding the efficacy of EPC compared to TPC in reducing stoma-related complications post-colostomy.
METHODS
PubMed, Google Scholar, EMBASE, MEDLINE, and the Cochrane Library were adopted to uncover pertinent papers in which EPC and TPC approaches were compared. We then conducted a meta-analysis using RevMan 5.4.1.
RESULTS
Both laparoscopic (Lap) and open approaches showed a reduced incidence of PSH in EPC relative to TPC (P < 0.00001 and P = 0.02 respectively). In addition, Lap EPC depicted a lesser incidence of prolapse, mucocutaneous separation, and stoma retraction (P = 0.007, P = 0.03, and P = 0.01, respectively) compared to Lap TPC. However, EPC and TPC did not differ with respect to operation time, blood loss, edema, ischemia, necrosis, or infection after the LAP approach.
CONCLUSION
The extraperitoneal approach may provide benefits in minimizing some stoma-related problems such as PSH, prolapse, mucocutaneous separation, and stoma retraction after colostomy surgery.
Core Tip: The study provides an inclusive meta-analysis comparing extraperitoneal (EPC) and transperitoneal (TPC) routes in colostomy surgery, emphasizing significant reductions in parastomal hernia, prolapse, stoma retraction, and mucocutaneous separation with the EPC approach. Despite previous studies suggesting benefits, newer evidence from 1973 patients highlights methodological improvements and the inclusion of previously overlooked cohort studies. Findings indicate comparable operative outcomes between EPC and TPC routes, challenging previous assertions. The study underscores EPC's potential to enhance postoperative quality of life by minimizing specific complications.
