Preliminary Results of Extraperitoneal Rectus Abdominis Anterior Sigmoid Colostomy (ERASC) for Prevention of Parastomal Hernia Following Abdominoperineal Resection.

[INTRODUCTION] Among patients with rectal cancer undergoing abdominoperineal resection (APR), parastomal hernia (PSH) is the most common long-term complication. Although extraperitoneal colostomy (EPC) has been proposed as an effective surgical method to prevent PSH, its efficacy remains controversial. To effectively reduce the incidence of PSH after APR, we report a new surgical technique-extraperitoneal rectus abdominis anterior sigmoid colostomy (ERASC).

[OBJECTIVE] To preliminarily explore the feasibility of extraperitoneal rectus abdominis anterior sigmoid colostomy (ERASC) and its effectiveness in preventing parastomal hernia after abdominoperineal resection (APR).

[METHODS] A retrospective analysis was conducted on the clinical data of patients diagnosed with rectal cancer at the First Affiliated Hospital of Chongqing Medical University from 2022 to 2025, who underwent APR and ERASC. Operative duration, stoma-related complications, re-hospitalizations, and re-operations were recorded and preliminarily analyzed.

[RESULTS] A total of eight patients met the criteria (six males and two females). Two patients developed incomplete intestinal obstruction during the postoperative hospital stay, both of whom improved after conservative treatment. During a median follow-up of 501 days (IQR 338-618), no stoma-related complications (including but not limited to postoperative stoma obstruction, prolapse, or necrosis) were observed, and none of the eight patients developed a parastomal hernia.

[CONCLUSION] Extraperitoneal rectus abdominis anterior sigmoid colostomy (ERASC) has preliminarily demonstrated technical feasibility and long-term effectiveness in preventing PSH in this study.