WTP4.1 Can Deep Stomal Fixation and Extraperitoneal Stoma Creation Improve Stoma Morbidity? Systematic Review and Meta-Analysis

Abstract

Abstract Aim This systematic review evaluates the efficacy and safety of two operative techniques: deep stomal fixation (fixation of stoma to the sheath of abdominal wall muscles and/or peritoneum) and extraperitoneal approach of stoma creation. Method PubMed, Medline, Cochrane, and Google Scholar were searched for studies comparing stoma fixation to the sheath and/or peritoneum to the conventional skin-only fixation and extraperitoneal to transperitoneal approaches of stoma formation. Clinical endpoints included parastomal hernia (PSH), stoma prolapse, retraction and associated adverse effects. Results 2 randomised and 2 retrospective studies investigated deep stomal fixation. There was no statistically significant benefit of this technique in terms of PSH (OR 1.19, P=0.82), prolapse (OR 0.62, P=0.53) or retraction (OR 1.16, P=0.80). Some technical difficulties on stoma reversal were reported in one of the studies. As for extraperitoneal stoma creation, 2 randomised and 8 retrospective studies compared it to the conventional transperitoneal approach. A statistically notable reduction in PSH was identified in extraperitoneal stomas (OR 0.29, P=0.004). This technique showed statistically insignificant reduction in prolapse (OR 0.74, P=0.53) and retraction (OR 0.48, P=0.36). There was no significant difference in operative time (MD 3.45, P=0.71) or the associated risk of small bowel obstruction (OR 0.68, P=0.57). Conclusion Stoma fixation to the abdominal muscle sheath and/or peritoneum does not lower stomal complications, and conversely it may make stoma reversal technically challenging. Extraperitoneal approach minimises PSH occurrence with no remarkable adverse effects; yet more randomised trials are required for further evaluation.