Abstract
BackgroundIn patients who undergo low anterior rectal resection, the fashioning of a covering stoma (CS) is still controversial. In fact, a covering stoma (ileostomy or colostomy) is worsened by major complications related to the procedure, longer recovery time, necessity of a re-intervention under general anesthesia for stoma closure and poorer quality of life. The advantage of Ghost Ileostomy (GI) is that an ileostomy can be performed only when there is clinical evidence of anastomotic leakage, without performing further interventions with related complications when anastomotic leak is absent and therefore the procedure is not necessary. Moreover, in case of anastomotic dehiscence and necessity of delayed stoma opening, mortality and morbidity in patients with GI are comparable with the ones that occur in patients which had a classic covering stoma. On the other hand, is simple to think about the possible economic saving: avoiding an admission for performing the closure of the ileostomy, with all the costs connected (OR, hospitalization, post-operative period, treatment of possible complications) represents a huge saving for the hospital management and also raise the quality of life of the patients.MethodsIn this study we prospectively analyzed 20 patients who underwent anterior extra-peritoneal rectum resection for rectal carcinoma with TME and fashioning of GI realized with or without abdominal parietal split.ResultsIn the group of patients that received a GI without split laparotomy mortality was absent and in one case an anastomotic leak occurred. In the group of patients in which GI with split laparotomy was fashioned, one death occurred and there were one case of infection and one respiratory complication. Clinical follow-up was 12 months.ConclusionsThe use of different techniques for fashioning a GI do not present significant differences when they are performed by expert surgeons, but further evidence is needed with more randomized trials, in order to have more data supporting the clinical observation.
Highlights
In patients who undergo low anterior rectal resection, the fashioning of a covering stoma (CS) is still controversial
A covering stoma (CS) after low anterior rectal resection reduces the incidence of anastomotic leak and urgent re-intervention for complications related to colorectal anastomosis [2]
The leakage occurred in post-operative day 7 with findings of fecaloid material mixed with pus coming out from the peri-anastomotic drainage positioned during the surgical intervention
Summary
In patients who undergo low anterior rectal resection, the fashioning of a covering stoma (CS) is still controversial. A covering stoma (ileostomy or colostomy) is worsened by major complications related to the procedure, longer recovery time, necessity of a re-intervention under general anesthesia for stoma closure and poorer quality of life. A covering stoma (CS) after low anterior rectal resection reduces the incidence of anastomotic leak and urgent re-intervention for complications related to colorectal anastomosis [2]. The presence of defunctioning stoma has more advantages in the subgroup of patients that are at high risk of anastomotic leak: patients with low anastomosis or that previously underwent radio-chemotherapy [4]. The advantages of a CS are reduced by the stoma-related complications or by the necessity of a re-intervention for the closure of that stoma, with subsequent increase of costs and recovery time. The overall incidence of clinical leak is 8%, CS is confectioned and opened in 92% of cases, in the vaste majority of them, if analized retrospectively, with minimal or no clinical usefulness [5]
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