Application of extraperitoneal sigmoidostomy in laparoscopic abdominoperineal resection: A single center's 6-year experience

Abstract

Abstract Aim The aim of this study is to explore the safety and function of extraperitoneal sigmoidostomy for patients with rectal cancer who underwent laparoscopic abdominoperineal resection(LAPR). Methods In this study, we retrospectively analyzed the data from 37 patients who underwent LAPR with extraperitoneal sigmoidostomy and compared with the data from 46 patients who underwent LAPR with transperitoneal sigmoidostomy from January 2014 to January 2019. They were grouped into the intraperitoneal (Group A) and extraperitoneal sigmoidostomy (Group B) groups. Clinical data were collected and statistically analyzed. Results Patient demographics were similar in both groups. For LAPR with extraperitoneal sigmoidostomy group, the mean operation time was 155.8 ± 38.2min (range100-290 min), which is shorter than Group A (158.5 ± 32.4 min, range105-335 min), but with no significant difference. The mean time for the procedure of extraperitoneal sigmoidostomy in Group B was 22.4 ± 2.6 min (range 15–28 min). which is longer than Group A (17.1 ± 2.1 min, range 14–26 min), but with no significant difference. No significant difference was found in postoperative hospitalization between two groups (11.2 ± 3.4 days vs 12.2 ± 3.0 days, p = 0.17). The rate of PSH (2.7% (1/37) vs 19.6% (9/46), p = 0.02), stoma prolapse (0% (0/37) vs 13.0% (6/46), p = 0.03), intra-abdominal hernia (0%(0/37) vs 15.2%(7/46), p = 0.02) were significantly lower in Group B than Group A. The incidence of stoma edema in Group A was 15.2% (7/46). However, 13 of 37 patients in the Group B had stoma edema (35.1%(13/37), p = 0.04). The incidence of stoma stenosis, stoma retraction, and stoma ischemia was no statistically significant difference between two groups. Functions of stoma including stimulation of excrement, stimulating time for excrement, frequency of excrement, self-controlled ability of excrement, and regularity of excrement were better than those of the intraperitoneal sigmoidostomy group, and these differences were statistical significance (p = 0.002,0.001,<0.001,0.004,0.008,respectively), but there was no significant difference in shape (p = 0.062) and duration of excrement (p = 0.179) between two groups. Conclusion According to our study, LAPR with extraperitoneal sigmoidostomy procedure is safe and feasible and should be regarded as a standard procedure in LAPR for lower rectal cancer, which significantly reduced incidence of postoperative stoma-related complications, especially parastomal hernia, stoma prolapse and intra-abdominal hernia. In addition, extraperitoneal sigmoidostomy greatly improved patient's postoperative stoma function,especially stimulation of excrement and self-controlled ability of excrement.