The Assessment of the Incidence of Parastomal Hernia in End Colostomy Patients Using Lateral Pararectal Approach versus Transrectal Approach; A Retrospective Comparative Study
Authors: Akhnokh Samy Gamil , Ayoub Bishoy Refaat Ragheb , Mansour Kirollos Rady Mourad 
Published: November 2024

Abstract

Background
A colostomy is a surgical procedure by which a stoma is constructed through exteriorization of the large intestine. A colostomy can be a loop colostomy or an end colostomy. Para-stomal hernia (PSH) is the most frequent late complication in patients with a stoma, but its true incidence is still difficult to determine. Since various surgical approaches for stoma placement in cancer colon represents major conflict and may be associated with complications, comparing the lateral pararectal with the transrectal stoma position with regard to parastomal herniation, stoma-related morbidity and quality of life was highlighted as a main point of interest.

Objective
To compare lateral pararectal and transrectal stoma placement regarding the incidence rate of parastomal hernia and other stoma complications.

Methods
This retrospective comparative study was conducted at tertiary care hospital at Ain Shams University hospitals from March 2023 till August 2023 and performed on total 50 patients who cases that had undergone end colostomy in Ain Shams University hospitals from January 2020 to January 2022 through either transrectal or pararectal approach regarding incidence of parastomal hernia.

Results
There was no significant difference between the studied groups regarding baseline demographic (age, sex and BMI) (p values = 0.245, 0.821, 0.578) respectively. Regarding risk factors of hernias, our study results revealed that chronic constipation was the most common risk factor (80%), followed by smoking (66%) and respiratory co-morbidities (28%). Colorectal cancer was the most common cause of surgical indication with no statistically significant differences among the study groups as regards the surgical indications (Colorectal cancer resection, Diverticular resection, IBD and Ischemic colitis) (p values = 0.715, 0.645, 0.913, 0.413) respectively. The presence of a parastomal hernia was confirmed in 21 patients (42%), 14 males and 7 females. In all these patients, clinical examination showed a parastomal mass in the upright position and while making a voluntary increase in abdominal pressure. The mass remained in 10 patients after returning to the prone position. The position of the colostomy, determined by means of clinical examination, was transrectal in 21 patients (42%), pararectal in 24 (48%). Colostomy position was doubtful in 5 (10%) cases; using CT it was possible to establish that the colostomy was in a transrectal position in four of these patients and pararectal in one. The position of the colostomy, therefore, was pararectal in 25 (50%) of the 50 patients studied and transrectal in 25 (50%). There were no statistically significant differences among the study groups as regards the postoperative complications (stoma prolapse, retraction, SSI, stoma stenosis and operative revision).

Conclusion
Creating colostomies away from the lateral edge of the rectus abdominis muscle i.e., at a “para-rectus” position is associated with a lower risk of having para-stomal hernia and is as effective as, if not better, creating those stomas at the “trans-rectus” site.