The same rate of parastomal hernia reparations in the different approaches to colostomy

Abstract Backgrounds Parastomal hernias are common with permanent colostomies and result in complications. This study aimed to compare the rate of parastomal hernia reparations in the different approaches to colostomy after abdominoperineal resection for rectal cancer and to further investigate the risk factors for parastomal hernia formation in patients with permanent colostomies. Methods Consecutive rectal cancer patients who underwent abdominoperineal resection from June 2014 to July 2020 in West China Hospital were divided into the extraperitoneal group and transperitoneal group according to their surgical approach for permanent colostomies. The impact of different approaches to colostomy on parastomal hernia reparations was determined by comparing a group of patients receiving an extraperitoneal route to colostomy with a group receiving transperitoneal. Potential variables were evaluated first with univariate and then multivariate analyses to identify the risk factors for the formation of parastomal hernia. Results In total, 202 subjects in the transperitoneal group and 103 in the extraperitoneal group attended the follow-up visit with a median follow-up period of 33 (25th–75th percentiles, 17–46) months. Clinically and radiologically detectable parastomal hernias were present in 76 of 202 (37.6%) and 14 of 103 (13.6%) subjects in the transperitoneal and extraperitoneal groups during the follow-up period (p<0.01). Besides, 10 of 76 (13.1%) subjects in the transperitoneal group and 2 of 14 (14.3%) subjects in the extraperitoneal group underwent a parastomal hernia operation during the follow-up (p = 0.82). In addition, the transperitoneal approach of colostomy (p = 0.002), older age (p<0.001), and higher BMI (p = 0.013) were identified as independent risk factors for the occurrence of parastomal hernia. Conclusions Extraperitoneal colostomy decreased the rate of detectable parastomal hernias but didn’t reduce the rate of surgical reparation of parastomal hernias.