Analysis Of Effectiveness And Safety Of Extraperitoneal End Tunnel Colostomy Before The Posterior Rectus Sheath For Preventing Parastomal Hernia

Purpose: Parastomal hernia is one of the most important complications after colostomy.Because of its high incidence rate,many asymptomatic patients,difficult treatment after occurrence,and high recurrence rate,more attention is paid to preventing parastomal hernia.Extraperitoneal colostomy,a surgical technique is seen as an effective surgical technique in preventing parastomal hernia.Our institution combined the anatomical structure of the abdominal wall and related mechanical principles to improve the surgical technique—preserving the integrity of the posterior sheath of the rectus abdominis muscle as completely as possible.Make sure the posterior of stoma covered by the posterior sheath,and at the same time,the intestinal bowel of the stoma is distributed in the preperitoneal space,thereby reducing the occurrence of parastomal hernia,and this method is applied clinically.At the same time,we followed up and analyzed the occurrence of parastomal hernia after operations,exploring the effectiveness and safety of this modified surgical method(EETC)in preventing parastomal hernia.Analyzing the effectiveness and safety of extraperitoneal end tunnel colostomy for preventing parastomal hernia.Methods: This is a retrospective study,it had collected 68 patients who had underwent end colostomy which performed from June,2017 to December,2020 in our institution.Collecting basic information(age,gender,BMI,smoking history,diabetes history,hypertension),perioperative information(operation methods,operation time,making stoma methods,auxiliary examination,early postoperative-complications),and postoperative follow-up information(whether parastomal hernia occurred and other complications happened).Then,conducting statistical analysis to explore the effectiveness and safety of the extraperitoneal end tunnel colostomy surgical technique in parastomal hernia prevention.Results: Among the 68 patients included in the study,24(35.3%)received traditional colostomy and 44(64.7%)received extraperitoneal end tunnel colostomy before the rectus abdominis posterior sheath(hereinafter extraperitoneal tunnel colostomy or EETC for short).1.Among the risk factors for parastomal hernia,the colostomy operation methods(traditional colostomy and EETC)was significantly correlated with the occurrence of parastomal hernia.EETC could reduce the incidence rate of parastomal hernia than traditional colostomy.2.In the analysis of the effectiveness and safety of surgical methods,there were statistically significant differences in the incidence of postoperative edema and parastomal hernia.Compared with traditional colostomy technique,extraperitoneal tunnel colostomy can reduce the incidence of early postoperative complication –edema(P <0.01)and long-term complication-parastomal hernia(P <0.01);there was no significant difference in operation time between the two surgical techniques(P=0.27).Conclusion:1.Extraperitoneal end tunnel colostomy before the rectus abdominis posterior sheath could reduce the incidence rate of parastomal hernia2.EETC has not increase the surgical time and other early postoperative-complications of colostomy patients and also reduces the occurrence of other stoma-related complications,this modified surgical technique is safety.3.Extraperitoneal tunnel colostomy is more effective in preventing the occurrence of parastomal hernia no matter in principle analysis or the data supporting,and this is a supporting evidence of the safety and effective in this technique.