Incidence of intestinal obstruction after sigmoid extraperitoneal colostomy combined with pelvic peritoneal closure in abdominoperineal resection for low rectal cancer.

Objective: To investigate the efficacy of laparoscopic sigmoid extraperitoneal colostomy combined with pelvic peritoneal closure in abdominoperineal resection for low rectal cancer.

Methods: We retrospectively analyzed the clinical data of 162 patients with low rectal cancer, who underwent laparoscopic abdominoperineal resection from January 2015 to January 2019 at the Affiliated Peace Hospital of Changzhi Medical College. Extraperitoneal stoma construction was performed in 98 patients (study group), while 64 patients (control group) underwent the procedure without suturing the pelvic peritoneum. All patients were followed up for 24 months postoperatively. The outcome measures were intra- and postoperative conditions and short- and long-term postoperative complications.

Results: The patients in both groups successfully underwent laparoscopic surgery, and no conversion to laparotomy was required. The operation time (165.93 ± 24.91 vs 159.75 ± 21.60), intraoperative blood loss (120.71 ± 49.16 vs 120.63 ± 45.63), flatus elimination time (55.14 ± 10.67 vs 53.1 ± 10.53), and degree of cancer differentiation did not differ statistically between the two groups (P > 0.05). However, the pelvic peritoneal closure time (10.16 ± 1.98 vs 0.00), ostomy time (24.17 ± 2.26 vs 20.61 ± 2.0), and postoperative hospital stay duration (14.43 ± 2.49 vs 16.19 ± 3.50) showed statistically significant differences (P < 0.05). A comparison of the incidence of short-term complications between the two groups showed that intestinal obstruction occurred in three patients in the study group and eight patients in the control group, with a statistically significant difference (P < 0.05); however, the incidence of other complications did not differ statistically between the two groups (P > 0.05). Moreover, comparing the long-term complications revealed no significant differences in the incidence of intestinal obstruction and perineal hernia between the two groups (P > 0.05). Long-term complications were reported in two patients in the study group (extraperitoneal stoma approach) and nine patients in the control group (intraperitoneal stoma approach), with a statistically significant difference (P < 0.05).

Conclusion: Sigmoid extraperitoneal colostomy with pelvic peritoneal closure in abdominoperineal resection for low rectal cancer is safe and feasible. This approach can effectively reduce the postoperative incidence of intestinal obstruction, hospital stay duration, and stomal complications.