Stoma-Site Specimen Extraction in Elective Minimally Invasive Colorectal Surgery: A Systematic Review and Meta-Analysis

Abstract

Background:

Minimally invasive colorectal surgery (MIS) offers reduced pain, faster bowel recovery, and shorter hospitalization compared with open surgery. In patients requiring a stoma, the stoma site can be used for specimen extraction, reducing the number of incisions. However, stoma-related complications, particularly parastomal hernia, may be increased. We synthesized evidence comparing stoma-site specimen extraction (SSE) with alternative extraction sites in MIS.

Methods:

A systematic review and meta-analyses were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches of PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and gray literature were performed (1990–2025). Eligible studies included adults undergoing elective laparoscopic or robotic colorectal surgery with SSE compared against midline or other extraction sites. Outcomes included stoma-related and nonstoma complications, perioperative parameters, and oncologic safety. Random-effect models were applied. Risk of bias was assessed using a modified Newcastle–Ottawa Scale. The study was prospectively registered with PROSPERO (CRD420251137576).

Results:

Eighteen studies comprising 5699 patients (SSE: 1363; midline: 539; other incisions: 3797) were included. Overall, stoma-related complication rates were comparable between groups (SSE versus midline: OR: 1.04, 95% confidence interval [CI]: 0.37–2.89; SSE versus others: OR: 1.13, 95% CI: 0.75–1.68). The risk of parastomal hernia did not differ significantly between SSE and comparators (SSE versus midline: OR: 2.67, 95% CI: 0.53–13.54; SSE versus others: OR: 1.36, 95% CI: 0.69–2.67). Non-stoma-related complications (OR: 0.96, 95% CI: 0.66–1.38) and readmission rates were also similar. Perioperative outcomes favored SSE, with shorter operative time (mean difference –22.6 minutes versus others) and earlier return of flatus.

Conclusions:

SSE is a safe and effective technique in MIS, offering perioperative benefits without increasing overall complication rates. Although parastomal hernia incidence was not significantly higher, vigilance is required, particularly in patients with permanent stomas. With appropriate case selection and meticulous closure, SSE represents a technique of MIS that reduces abdominal wall trauma while maintaining surgical safety.