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Does ghost ileostomy have a role in the laparoscopic rectal surgery era? A randomized controlled trial

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Abstract

Background

Anastomotic leakage following anterior rectal resection is the most important and most commonly faced complication of laparoscopy and open surgery. To prevent this complication, the construction of a preventing stoma is usually adopted. It is not easy to decide whether to construct a protective stoma in patients with a medium risk of anastomotic leakage. In these patients, ghost ileostomy (GI), a pre-stage ileostomy that can be externalized and opened if needed, has proved useful. We conducted a prospective, randomized, controlled study to evaluate the advantages of GI in laparoscopic rectal resection.

Methods

All patients with surgical indications for laparoscopic rectal resection who were at medium risk for anastomotic leakage from January 2007 to January 2013 were included and were randomly divided in 2 groups. All of the patients were subjected to laparoscopic anterior rectal resection with the performance of GI (group A) or without the construction of any protective stoma (group B). The presence and severity of clinically evident postoperative anastomotic leakage and other postoperative complications and reinterventions were investigated.

Results

Of the 55 patients allocated to group A, 3 experienced anastomotic leakage compared with 4 in group B. The patients with GI experienced a lower severity of anastomotic leakage and shorter hospitalization compared with the patients in group B. None of the patients with GI and anastomotic leakage required laparotomy to treat the dehiscence.

Conclusions

The use of GI in laparoscopic rectal resections in patients at medium risk for anastomotic leakage was useful because it allowed for the avoidance of stoma creation in all of the patients, thus reducing the number of stomas performed, improving the quality of life of the patients and preserving, in most cases, the benefits gained by laparoscopy.

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References

  1. Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1:144–150

    CAS  PubMed  Google Scholar 

  2. Bonjer HJ, Hop WC, Nelson H, Sargent DJ, Lacy AM, Castells A, Guillou PJ, Thorpe H, Brown J, Delgado S, Kuhrij E, Haglind E, Pahlman L, Transatlantic Laparoscopically Assisted vs Open Colectomy Trials Study Group (2007) Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 142:298–303

    Article  PubMed  Google Scholar 

  3. Hazebroek EJ, Color Study Group (2002) COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Surg Endosc 16:949–953

    Article  CAS  PubMed  Google Scholar 

  4. Gonzalez-Contreras QH, de Tapia Cid Leon H, Rodriguez-Zentner HA, Castellanos-Juarez JC, Vega-Batista RR, Castaneda-Argaiz R (2008) Laparoscopic colorectal surgery: third level center experience. Rev Gastroenterol Mex 73:203–208

    CAS  PubMed  Google Scholar 

  5. Heald RJ, Leicester RJ (1981) The low stapled anastomosis. Br J Surg 68:333–337

    Article  CAS  PubMed  Google Scholar 

  6. Karanjia ND, Corder AP, Bearn P, Heald RJ (1994) Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 81:1224–1226

    Article  CAS  PubMed  Google Scholar 

  7. Laxamana A, Solomon MJ, Cohen Z, Feinberg SM, Stern HS, McLeod RS (1995) Long-term results of anterior resection using the double-stapling technique. Dis Colon Rectum 38:1246–1250

    Article  CAS  PubMed  Google Scholar 

  8. Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6:462–469

    Article  CAS  PubMed  Google Scholar 

  9. McGinn FP, Gartell PC, Clifford PC, Brunton FJ (1985) Staples or sutures for low colorectal anastomoses: a prospective randomized trial. Br J Surg 72:603–605

    Article  CAS  PubMed  Google Scholar 

  10. Mealy K, Burke P, Hyland J (1992) Anterior resection without a defunctioning colostomy: questions of safety. Br J Surg 79:305–307

    Article  CAS  PubMed  Google Scholar 

  11. Pakkastie TE, Luukkonen PE, Jarvinen HJ (1994) Anastomotic leakage after anterior resection of the rectum. Eur J Surg 160:293–297 discussion 299–300

    CAS  PubMed  Google Scholar 

  12. Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358

    Article  CAS  PubMed  Google Scholar 

  13. Alves A, Panis Y, Trancart D, Regimbeau JM, Pocard M, Valleur P (2002) Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg 26:499–502

    Article  PubMed  Google Scholar 

  14. Buchs NC, Gervaz P, Secic M, Bucher P, Mugnier-Konrad B, Morel P (2008) Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis 23:265–270

    Article  PubMed  Google Scholar 

  15. Park JS, Choi GS, Kim SH, Kim HR, Kim NK, Lee KY, Kang SB, Kim JY, Lee KY, Kim BC, Bae BN, Son GM, Lee SI, Kang H (2013) Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg 257:665–671

    Article  PubMed  Google Scholar 

  16. Shellito PC (1998) Complications of abdominal stoma surgery. Dis Colon Rectum 41:1562–1572

    Article  CAS  PubMed  Google Scholar 

  17. Thornton M, Joshi H, Vimalachandran C, Heath R, Carter P, Gur U, Rooney P (2011) Management and outcome of colorectal anastomotic leaks. Int J Colorectal Dis 26:313–320

    Article  PubMed  Google Scholar 

  18. Trencheva K, Morrissey KP, Wells M, Mancuso CA, Lee SW, Sonoda T, Michelassi F, Charlson ME, Milsom JW (2013) Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg 257:108–113

    Article  PubMed  Google Scholar 

  19. Volk A, Kersting S, Held HC, Saeger HD (2011) Risk factors for morbidity and mortality after single-layer continuous suture for ileocolonic anastomosis. Int J Colorectal Dis 26:321–327

    Article  PubMed  Google Scholar 

  20. Chude GG, Rayate NV, Patris V, Koshariya M, Jagad R, Kawamoto J, Lygidakis NJ (2008) Defunctioning loop ileostomy with low anterior resection for distal rectal cancer: should we make an ileostomy as a routine procedure? A prospective randomized study. Hepatogastroenterology 55:1562–1567

    CAS  PubMed  Google Scholar 

  21. Pata G, D’Hoore A, Fieuws S, Penninckx F (2009) Mortality risk analysis following routine vs selective defunctioning stoma formation after total mesorectal excision for rectal cancer. Colorectal Dis 11:797–805

    Article  CAS  PubMed  Google Scholar 

  22. Karanjia ND, Corder AP, Holdsworth PJ, Heald RJ (1991) Risk of peritonitis and fatal septicaemia and the need to defunction the low anastomosis. Br J Surg 78:196–198

    Article  CAS  PubMed  Google Scholar 

  23. Paun BC, Cassie S, MacLean AR, Dixon E, Buie WD (2010) Postoperative complications following surgery for rectal cancer. Ann Surg 251:807–818

    Article  PubMed  Google Scholar 

  24. Shiomi A, Ito M, Saito N, Hirai T, Ohue M, Kubo Y, Takii Y, Sudo T, Kotake M, Moriya Y (2011) The indications for a diverting stoma in low anterior resection for rectal cancer: a prospective multicentre study of 222 patients from Japanese cancer centers. Colorectal Dis 13:1384–1389

    Article  CAS  PubMed  Google Scholar 

  25. Vignali A, Fazio VW, Lavery IC, Milsom JW, Church JM, Hull TL, Strong SA, Oakley JR (1997) Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg 185:105–113

    Article  CAS  PubMed  Google Scholar 

  26. Cerroni M, Cirocchi R, Morelli U, Trastulli S, Desiderio J, Mezzacapo M, Listorti C, Esperti L, Milani D, Avenia N, Gulla N, Noya G, Boselli C (2011) Ghost Ileostomy with or without abdominal parietal split. World J Surg Oncol 9:92

    Article  PubMed Central  PubMed  Google Scholar 

  27. Gulla N, Trastulli S, Boselli C, Cirocchi R, Cavaliere D, Verdecchia GM, Morelli U, Gentile D, Eugeni E, Caracappa D, Listorti C, Sciannameo F, Noya G (2011) Ghost ileostomy after anterior resection for rectal cancer: a preliminary experience. Langenbeck’s Arch Surg 396:997–1007

    Article  Google Scholar 

  28. Mori L, Vita M, Razzetta F, Meinero P, D’Ambrosio G (2013) Ghost ileostomy in anterior resection for rectal carcinoma: is it worthwhile? Dis Colon Rectum 56:29–34

    Article  PubMed  Google Scholar 

  29. Sacchi M, Legge PD, Picozzi P, Papa F, Giovanni CL, Greco L (2007) Virtual ileostomy following TME and primary sphincter-saving reconstruction for rectal cancer. Hepatogastroenterology 54:1676–1678

    PubMed  Google Scholar 

  30. Sacchi M, Picozzi P, Di Legge P, Capuano L, Greco L, De Stefano M, Nicodemi S, Sacchi MC (2011) Virtual ileostomy following rectal cancer surgery: a good tool to avoid unusefull stomas? Hepatogastroenterology 58:1479–1481

    Article  PubMed  Google Scholar 

  31. Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, Holm T, Wong WD, Tiret E, Moriya Y, Laurberg S, den Dulk M, van de Velde C, Buchler MW (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147:339–351

    Article  PubMed  Google Scholar 

  32. Montedori A, Cirocchi R, Farinella E, Sciannameo F, Abraha I (2010) Covering ileo- or colostomy in anterior resection for rectal carcinoma. Cochrane Database Syst Rev 5:CD006878

    PubMed  Google Scholar 

  33. Bell SW, Walker KG, Rickard MJ, Sinclair G, Dent OF, Chapuis PH, Bokey EL (2003) Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg 90:1261–1266

    Article  CAS  PubMed  Google Scholar 

  34. Walker KG, Bell SW, Rickard MJ, Mehanna D, Dent OF, Chapuis PH, Bokey EL (2004) Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 240:255–259

    Article  PubMed Central  PubMed  Google Scholar 

  35. Chow A, Tilney HS, Paraskeva P, Jeyarajah S, Zacharakis E, Purkayastha S (2009) The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis 24:711–723

    Article  PubMed  Google Scholar 

  36. Lertsithichai P, Rattanapichart P (2004) Temporary ileostomy versus temporary colostomy: a meta-analysis of complications. Asian J Surg 27:202–210 discussion 211–202

    Article  PubMed  Google Scholar 

  37. Lindgren R, Hallbook O, Rutegard J, Sjodahl R, Matthiessen P (2011) What is the risk for a permanent stoma after low anterior resection of the rectum for cancer? A six-year follow-up of a multicenter trial. Dis Colon Rectum 54:41–47

    Article  PubMed  Google Scholar 

  38. Marquis P, Marrel A, Jambon B (2003) Quality of life in patients with stomas: the Montreux Study. Ostomy wound Manag 49:48–55

    Google Scholar 

  39. Dodgion CM, Neville BA, Lipsitz SR, Hu YY, Schrag D, Breen E, Greenberg CC (2013) Do older Americans undergo stoma reversal following low anterior resection for rectal cancer? J Surg Res 183:238–245

    Article  PubMed Central  PubMed  Google Scholar 

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Disclosures

Francesco Saverio Mari, Tatiana Di Cesare, Luciano Novi, Marcello Gasparrini, Giammauro Berardi, Giovanni Guglielmo Laracca, Andrea Liverani and Antonio Brescia declare no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea Hospital, School of Medicine and Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy

    Francesco Saverio Mari, Tatiana Di Cesare, Luciano Novi, Marcello Gasparrini, Giammauro Berardi, Giovanni Guglielmo Laracca, Andrea Liverani & Antonio Brescia

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  1. Francesco Saverio Mari
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  2. Tatiana Di Cesare
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  3. Luciano Novi
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Correspondence to Francesco Saverio Mari.

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Mari, F.S., Di Cesare, T., Novi, L. et al. Does ghost ileostomy have a role in the laparoscopic rectal surgery era? A randomized controlled trial. Surg Endosc 29, 2590–2597 (2015). https://doi.org/10.1007/s00464-014-3974-z

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  • DOI: https://doi.org/10.1007/s00464-014-3974-z

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