The “virtual ileostomy” in elective colorectal surgery: is it useful?

Marrosu, Antonio; Serventi, Fernando; Pulighe, Fabio; Paliogiannis, Panagiotis; Attene, Federico; Sotgiu, Giovanni; Trignano, Mario

doi:10.1007/s10151-012-0964-9

Cited by 6 publications

(12 citation statements)

References 4 publications

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“…The protective stoma with ileum is not performed except in very few cases related to the comorbidity of the patients [47]. In this way, the virtual ileostomy can help to minimize the complications [50]. All authors of this series have confirmed that excessive pelvic adhesions or an inability to identify the rectal stump has led to conversion rates of 12.1% [4, 5, 8, 10–36].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Reversal of Hartmann’s Procedure: State of the Art 20 Years after the First Reported Case

Toro¹,

Ardiri

Mannino

et al. 2014

Gastroenterology Research and Practice

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Introduction. Aim of the present work is to review the literature to point out the role of laparoscopic reversal of Hartmann procedure. Material and Methods. Number of patients, age, sex, etiology, Hinchey classification, interval between procedure and reversal, position of the first trocars, mean operative time (min), number and causes of conversion, length of stay, mortality, complications, and quality of life were considered. Results. 238 males (52.4%) and 216 females (47.6%) between 38 and 67 years were analyzed. The etiology was diverticulitis in 292 patients (72.1%), carcinoma in 43 patients (10.6%), and other in 70 patients (17.3%). Only 7 articles (22.6%) reported Hinchey classification. The interval between initial procedure and reversal was between 50 and 330 days. The initial trocar was open positioned in 182 patients (43.2%) through umbilical incision, in 177 patients (41.9%) in right upper quadrant, and in 63 patients (14.9%) in colostomy site. The operative time was between 69 and 285 minutes. A total of 83 patients (12.1%) were converted and the causes were reported in 67.4%. The length of stay was between 3 and 12 days. 5 patients (0.7%) died. The complications concern 112 cases (16.4%). Conclusion. The laparoscopic Hartmann's reversal is safer and achieves faster positive results.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Reversal of Hartmann’s Procedure: State of the Art 20 Years after the First Reported Case

Toro¹,

Ardiri

Mannino

et al. 2014

Gastroenterology Research and Practice

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“…El estudio de Chen et al compara la técnica con TIAC y el estoma convencional en 41 pacientes. Los resultados obtenidos con el tubo de ileostomía revelan beneficio sobre la duración de la estancia postoperatoria (7 (RIC 7-9) vs 13 (RIC 13-15.25), p< 0.001), los costes sanitarios (6.5 (RIC 6.4-6.7) vs 11.35 (RIC 11.1-11.6), p < 0.001) y el intervalo hasta el cierre del estoma (34 (RIC 31-37) vs 95 (91)(92)(93)(94)(95)(96)(97)(98)(99), p < 0.001) con una diferencia estadísticamente significativa. Según los resultados expuestos no se objetivaron complicaciones asociadas al TIAC y no se identificaron diferencias significativas en las complicaciones más frecuentes, incluido el sangrado de la sutura, la fuga anastomótica, la estenosis anastomótica y la infección de herida entre los grupos [93].…”

Section: Tubo De Ileostomía Con Auto-cierre (Tiac)unclassified

“…Esta técnica, según los estudios publicados que avalan su efectividad, no disminuye la tasa de FA, pero sí disminuye el número de ileostomías temporales Además los autores aseguran que es una técnica segura, fácil de realizar y económica. Su uso apropiado requiere una sincronización precisa: el diagnóstico precoz de la dehiscencia de anastomosis mediante un drenaje perianastomótico o la obtención de imágenes (radiológicas o rectoscopia) y la exteriorización del asa ileal lo antes posible una vez se identifican los signos/síntomas sugestivos de dehiscencia [97].…”

Section: Técnicaunclassified

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Actualización sobre el estoma de protección tras resección anterior baja o ultrabaja por cáncer de recto. Revisión sistemática y nuevas tendencias.

Córdoba¹

2019

Arch. coloproctol.

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El estándar para el tratamiento del cáncer de recto es la resección anterior baja o ultrabaja con escisión total del mesorrecto. Técnicas cada vez menos invasivas unidas a un mayor interés por la preservación de esfínteres han llevado a realizar resecciones rectales con anastomosis cada vez más próximas al margen anal. Una de las complicaciones más importantes y más temidas por sus graves consecuencias es la fuga anastomótica. Con intención de prevenir la dehiscencia anastomótica o aliviar sus consecuencias se realizan tradicionalmente estomas derivativos tras la resección rectal con anastomosis de riesgo. Sin embargo el estoma de protección presenta morbilidad asociada, afecta a la calidad de vida del paciente, y precisa una nueva intervención para la reconstrucción del tránsito, que asocia a su vez una morbi-mortalidad significativa. Incluso uno de cada 4-6 estomas queda sin cerrar. Por todo ello el papel de los estomas de protección sigue siendo controvertido, sin encontrar respuestas con suficiente evidencia en la literatura. Este estudio tiene como objetivo hacer una revisión de la literatura para establecer el rol actual del estoma de protección. Además analizamos la corriente que boga por el cierre precoz del estoma (en los primeros 15 días tras la cirugía) y las alternativas a los estomas de protección tradicionales que han aparecido en los últimos años, como la ileostomía virtual, el tubo ileal y el dispositivo de derivación fecal.

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“…Since its first introduction, several authors have adopted the technique of ghost ileostomy and reported their respective results. [10][11][12][13][14] However, most of these previous reports were retrospective case series or case-control studies despite two prospective controlled studies and one randomised controlled trial (RCT) that compared ghost ileostomy with a no-stoma group. [15][16][17] A recent systematic review summarising the results of all previous studies regarding the ghost ileostomy concluded that it is a safe and effective alternative to routine ileostomy with a rate of exteriorisation of the ghost ileostomy of 10.5% and a rate of adverse events related to the ghost ileostomy of 2.1%.…”

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confidence: 99%

Ghost ileostomy versus conventional loop ileostomy in patients undergoing low anterior resection for rectal cancer (DRKS00013997): protocol for a randomised controlled trial

et al. 2020

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IntroductionAnastomotic leakage is the most important complication in colorectal surgery occurring in up to 20% after low anterior rectal resection. Therefore, a diverting ileostomy is usually created during low anterior resection to protect the anastomosis or rather to diminish the consequences in case of anastomotic leakage. The so-called virtual or ghost ileostomy is a pre-stage ostomy that can be easily exteriorised, if anastomotic leakage is suspected, in order to avoid the severe consequences of anastomotic leakage. On the other hand, an actual ileostomy can be avoided in patients, who do not develop anastomotic leakage.Methods and analysisThe GHOST trial is a randomised controlled pilot trial comparing ghost ileostomy with conventional loop ileostomy in patients undergoing low anterior resection with total mesorectal excision for rectal cancer. After screening for eligibility and obtaining informed consent, a total of 60 adult patients are included in the trial. Patients are intraoperatively randomised to the trial groups in a 1:1 ratio after assuring that none of the intraoperative exclusion criteria are present. The main outcome parameter is the comprehensive complication index as a measure of safety. Further outcomes include specific complications, stoma-related complications, complications of ileostomy closure, frequency of transformation of ghost ileostomy into conventional ileostomy, frequency of terminal ostomy creation, proportion of patients with an ostomy at 6 months after index surgery, anorectal function (Wexner score) and quality of life assessed by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and CR29 questionnaires. Follow-up for each individual patient will be 6 months.Ethics and disseminationThe GHOST trial has been approved by the Medical Ethics Committee of Heidelberg University (reference number S-694/2017). If the intervention proves to be safe, loop ileostomy could be spared in a large proportion of patients, thus also avoiding stoma-related complications and a second operation (ileostomy closure) with its inherent complications in these patients.Trial registration numberGerman Clinical Trials Registry (DRKS00013997); Universal Trial Number: U1111-1208-9742.

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The “virtual ileostomy” in elective colorectal surgery: is it useful?

Cited by 6 publications

References 4 publications

Laparoscopic Reversal of Hartmann’s Procedure: State of the Art 20 Years after the First Reported Case

Laparoscopic Reversal of Hartmann’s Procedure: State of the Art 20 Years after the First Reported Case

Actualización sobre el estoma de protección tras resección anterior baja o ultrabaja por cáncer de recto. Revisión sistemática y nuevas tendencias.

Ghost ileostomy versus conventional loop ileostomy in patients undergoing low anterior resection for rectal cancer (DRKS00013997): protocol for a randomised controlled trial

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