A Meta-analysis Of The Effects Of Different Stomatal Options On The Development Of Parastomal Hernia

Background:With the development of laparoscopic surgery in the last century,after decades of development,has gradually become the preferred means of colorectal surgery,laparoscopic surgery also can increase the likelihood of patients with low rectal cancer confirmed anal part,but there are still some patients due to low tumor site cannot protect anal postoperative line of permanent colostomy colon in Miles,or because of preoperative chemoradiotherapy(CRT)anastomotic leakage risk factors related to the distal colon and rectum resection patients,male patients and the patients with anastomotic level is low,the line of performing a temporary bypass patients are more and more.However,parastomal hernia is a common complication after enterostomy.Although most parastomal hernias are asymptomatic,the surgical effect is often not very satisfactory when patients have strangulation and necrosis.At the same time,whether laparoscopic surgery will affect the incidence of parastomal hernia is still controversial.Objective:To compare the incidence of parastomal hernia between laparoscopic surgery and open surgery,and the incidence of parastomal hernia caused by different stomal routes,through a meta-analysis.Methods:Foreign databases such as PubMed,Embase and Web of Science were searched to collect literatures on risk factors of parastomal hernia published between January 2000 and August 2020.Data were extracted and analyzed in terms of articles on parastomal hernia after laparoscopic surgery and open surgery as well as articles on the stoma route.The main measures included surgical method,stomy route,gender,age,BMI,etc.Results:Nine of the 15 included studies reported the number of patients with parastomal hernias after laparoscopic and open surgery,respectively.Using a random-effects model,the incidence of parastomal hernias due to traditional open surgery was lower than laparoscopic surgery(OR=1.80,95%CI=1.08--3.01,P=0.02).Nine of the 15 included studies involving 1123 patients who underwent an epitoneal stomy using a fixed-effect model showed that patients who underwent an epitoneal stomy were less likely to end up with a parastomal hernia than those who underwent a traditional epitoneal stomy(OR=0.35,95%CI=0.22-0.56,P<0.0001).Conclusion:The incidence of parastomal hernias after laparoscopic enterostomy is higher in patients undergoing enterostomy than in patients undergoing traditional open surgery;In patients undergoing enterostomy,the incidence of parastostomal hernias after peritoneal surgery is lower than after extraperitoneal surgery;Among patients undergoing enterostomy,the risk of parastomal hernia increases with age and body mass index.