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. 2025 Mar 27;17(3):98947.
doi: 10.4240/wjgs.v17.i3.98947.

Systematic review and meta-analysis comparing extraperitoneal and transperitoneal routes of colostomy-related complications

Adamu D Isah  1   2 , Xu Wang  3 , Zakari Shaibu  4 , Xiao Yuan  3 , Sheng-Chun Dang  5
Affiliations

Systematic review and meta-analysis comparing extraperitoneal and transperitoneal routes of colostomy-related complications

Adamu D Isah et al. World J Gastrointest Surg. .

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.

Keywords: Abdominoperineal resection; Colostomy; Extraperitoneal; Parastomal hernia; Transperitoneal.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Literature screening process.
Figure 2
Figure 2
Forest plot of operation time and blood loss. A: Operation time; B: Blood loss after laparoscopic approach. EPC: Extraperitoneal colostomy; TPC: Transperitoneal colostomy.
Figure 3
Figure 3
Forest plot of parastomal hernia after laparoscopic approach, stoma retraction, and parastomal hernia after open approach. A: Parastomal hernia after laparoscopic approach; B: Stoma retraction after laparoscopic approach; C: Parastomal hernia after open approach. EPC: Extraperitoneal colostomy; TPC: Transperitoneal colostomy.
Figure 4
Figure 4
Forest plot of prolapse and mucocutaneous separation. A: Prolapse; B: Mucocutaneous separation after laparoscopic approach. EPC: Extraperitoneal colostomy; TPC: Transperitoneal colostomy.
Figure 5
Figure 5
Forest plot of infection and edema. A: Infection; B: Edema after laparoscopic approach. EPC: Extraperitoneal colostomy; TPC: Transperitoneal colostomy.
Figure 6
Figure 6
Forest plot of necrosis and ischemia. A: Necrosis; B: Ischemia. EPC: Extraperitoneal colostomy; TPC: Transperitoneal colostomy.
Figure 7
Figure 7
Quality assessment of included studies. A: Graph depicting the risk of bias by presenting the authors’ assessments of each bias item as a percentage across all included studies; B: A summary of the bias assessments, detailing the authors' evaluations of each bias item for each study included in the review.
Figure 8
Figure 8
Funnel plot. A: Necrosis; B: Ischemia. OR: Odds ratio.
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