Investigation of Mortality and Morbidity In Patients Associated With Low Anterior Resection and Ghost Ileostomy
-
Mohammad Sadegh Fazeli
,
Amirpasha Ebrahimi
,
Behnam Behboudi
,
Ehsan Sobhanian
,
Zahra Moghimi
,
Ehsan Sadeghian
,
Mohammad Reza Keramati
,
Amir Keshvari
,
Seyed Mohsen Ahmadi Tafti
,
Haleh Pak
,
Sahar zafarmandi
,
Mehran Ebrahimi
,
Ali sobhanian
,
Yasaman Rahimi
,
Alireza Kazemeini
Abstract
Background: Ghost ileostomy is a new invented method that use in patients with low ant resection and colorectal anastomose. Ghost ileostomy can be used instead of converting stoma. CS (converting stoma) is critical after low rectal resection procedures due to its anastomosis leakage preventing role, especially in patients who are at higher risk but its complications are non-negligible. We approached a study of Ghost ileostomy to identify its probable post operation morbidity and mortality. The purpose of this study was to assess the prevalence of some Post operation morbidity such as anastomose bleeding or hematoma, prolong ileus, pulmonary emboly, intra abdominal abscess, wound site infection and other complications.
Methods: 26 patients with low ant resection and colorectal anastomosis due to colon cancer without any risk factor between 2013 and 2014 were selected. Checking of anastomosis leakage after 10-14 days post operation was analyzed to assess the prevalence of anastomosis leakage and compare post operation morbidity and mortality.
Results: The mean age of cases was 55 years (40 to 65). 16 (61.5%) were male and 10 (38.5%) female. average BMI is 23.7 and all of the patient are in the normal range. Our mortality rate was negative. 2 patients (0.076%) suffered from prolong ileus and one patient (0.038%) had wound site infection. Other post operation morbidities such as anastomose bleeding or hematoma, pulmonary emboly, intra abdominal abscess were negative. We had no any stoma related morbidity and also no any anastomosis morbidity.
Conclusion: Anastomosis leakage is the most complication in colorectal surgeries. Diverting stoma can decrease complications of anastomosis leakage but there is no evidence of its preventing role. By using ghost ileostomy we can manage selective loop ileostomy and the complications will be reduced. The most reliable way for anastomosis leakage diagnosis is surgeon's suspicion. Converting stoma that use for preventing anastomosis leakage, has significant complications by its own. As the anastomosis leakage does not have a high prevalence we can use ghost ileostomy to reduce the complications and improving quality of life.
1.Gullà 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. Ghost ileostomy after anterior resection for rectal cancer: a preliminary experience. Langenbecks Arch Surg. 2011 Oct;396(7):997-1007.
2.Chude GG, Rayate NV, Patris V, et al. Defunctioning loop ilcostomy with low anterior resection for distal rectal cancer: should we make an ileostomy as a routine procedure? A prospective randomized study. Hepato Gastroenterol 2008;55:1562–7.
3.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.
4. Salvadalena G. Incidence of complications of the stoma and peristomal skin among individuals with colostomy, ileostomy, and urostomy: a systematic revicw. J Wound Ostomy Continence Nurs 2008;35:596–607.
5.Eberl T, Jagoditsch M, Klingler A, et al. Risk factors for anastomotic leakage after resection for rectal cancer. Am J Surg 2008;196:592–8.
6. Park JJ, Del Pino A, Orsay CP, Nelson RL, Pearl RK, Cintron JR et al (1999) Stoma complications: the Cook County Hospital experience. Dis Colon Rectum 42:1575-1580.
7.Gooszen AW, Geelkerken RH, Hermans J, Lagaay MB, Gooszen HG (1998) Temporary decompression after colorectal surgery: randomized comparison of loop ileostomy and loop colostomy. Br J Surg 85:76–79.
8.O Toole GC, Hyland JM, Grant DC, Barry MK (1999) Defunctioning loop ileostomy: a prospective audit. J Am Coll Surg 188:6-9.
9.Kairaluoma M, Rissanen H, Kultti V, Mecklin JP, Kellokumpu 1(2002) Outcome of temporary stomas. A prospective study of temporary intestinal stomas constructed between 1989 and 1996. Dig Surg 19:45–51.
10.Kaiser AM, Israclit S, Klaristenfeld D, Selvindoss P, Vukasin P, Ault G et al (2008) Morbidity of ostomy takedown. J Gastrointest Surg 12:437–441.
11.Enker WE, Merchant N, Cohen AM, Lanouette NM, Swallow C, Guillem J et al (1999) Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg 230:544–552, discussion 52-4,
12.Law WL, Chu KW (2004) Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg 240:260–268.
13.de la Quintana Jimenez P, Pastor Juan C, Prados Herrero I, Perez Lopez C, Gonzalez Fuentes M, de Mena Casaseca C et al (2010) A prospective, longitudinal, multicenter, cohort quality-of-life evaluation of an intensive follow-up program for patients with a stoma. Ostomy/Wound Management 56:44–52.
14.Bertram P, Junge K, Schachtrupp A, Götze C, Kunz D, Schumpelick V. Pcritoneal release of TNFalpha and IL-6 after elective colorectal surgery and anastomotic leakage. J Invest Surg 2003; 16: 65-69 [PMID: 12746189)
15.Mori L, Vita M, Razzetta F, Meinero P, D'Ambrosio G. Ghost ileostomy in anterior resection for rectal carcinoma: is it worthwhile? Dis Colon Rectum. 2013 Jan;56(1):29-34.
16. Bruce J, Krukowski ZH, Al-Khairy G, Russell EM, Park KG. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 2001; 88: 1157-1168 [PMID: 11531861 DOI: 10.1046/j.0007-1323.2001.01829.x)
17.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, Büchler MW. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery: 2010; 147: 339-351 [PMID: 20001450 DOI:..1016/j.surg.2009.10.012)
18.Hyman N, Manchester TL, Osler T, Burs B, Cataldo PA. Anastomotic leaks after intestinal anastomosis: it's later than you think. Ann Surg 2007; 245: 254-258 (PMID: 17245179 DOI: 10.1097/01.sla.0000225083.27182.85)
19.Matthiessen P, Strand I, Jansson K, Tõmquist C, Andersson M, Rutegård J, Norgren L. Is carly detection of anastomotic leakage possible by intraperitoneal microdialysis and intraperitoneal cytokines after anterior resection of the rectum for cancer? Dis Colon Rectum 2007; 50: 1918-1927 [PMID: 17763907 DOI: 10.1007/s10350-007-9023-4)
20.Herwig R, Glodny B, Kühle C, Schlüter B, Brinkmann OA, Strasser H, Senninger N, Winde G. Early identification of peritonitis by peritoneal cytokine measurement. Dis Colon Rectum 2002; 45: 514-521 (PMID: 12006934 DOI: 10.1007/s10350-001-6231-2]
21.Yamamoto T, Umegae S, Matsumoto K, Saniabadi AR. Peritoneal cytokines as early markers of peritonitis following surgery for colorectal carcinoma: a prospective study. Cytokine 2011; 53: 239-242 (PMID: 21075004 DOI: 10.1016/j.cyto.2010.10.006]
22.Moore AK, Esquibel KA, Thal W. Ostomy options for clients with ileostomies. Gastroenterol Nurs 2008;31:418–20.
23.Buchs NC, Gervaz P, Secic M, et al. Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis 2008;23:265–70.
24. Alves A, Panis Y, Pocard M, Regimbeau JM, Valleur P. Management of anastomotic leakage after nondiverted large bowel resection. J Am Coll Surg 1999; 189: 554-559 (PMID:10589591]
25.Platell C, Barwood N, Dorfinann G, Makin G. The incidence of anastomotic leaks in patients undergoing colorectal surgery. Colorectal Dis 2007; 9: 71-79 (PMID: 17181849 DOI: 10.1111/j.1463-1318.2006.01002.x]
26.Ellebaek Pedersen M, Qvist N, Bisgaard C, Kelly U, Bernhard A, Moller Pedersen S. Paritoneal microdialysis. Early diagnosis of anastomotic leakage after low anterior resection for rectosigmoid cancer. Scand J Surg 2009;98: 148-154 (PMID 19919919)
27.Vheeler JM1, Gilbert JM. Controlled intraoperative water testing of left-sided colorectal anastomoscs: are ileostomies avoidable? Ann R Coll Surg Engl 1999; 81: 105-108 [PMID: 10361966)
28.Yalin R, Aktan AO, Yeğen C, Döşlüoğlu H, Okboy N. Importance of testing stapled rectal anastomoses with air. Eur J Surg 1993; 159: 49-51 (PMID: 5095507]
29.Ishihara S, Watanabe T. Nagawa H. Intraoperative colonoscopy for stapled anastomosis in colorectal surgery. Surg Today 2008; 38: 1063-1065 (PMID: 1$958570 DOI: 10.10071 SOOS95-007-3740-01
30.Smith S, McGechin W, Kozol RA, Giles D. The efficacy of intraoperative methylene blue Cncias to assess the integrity of a colonic anastomiosis. BUC Surg 2007; 7: 15 (PMID: 17683526 DOI: 10.1186/1471-2482-7-15)
31.Griffith CD, Hardcastle JD. Intraoperative testing of anastomotic integrity after stapled anterior resection for cancer. J R Coll Surg Edinb 1990; 35: 106-109 (PMID: 2355372)
32.Sahanoue Y', Nakao K, Shoji Y, Yanayi II, Kusunoki /1, Utsunomiya J. Intraoperative colonoscopy. Surg Embosc 1993; 7; 84-97 (PMID: 8156374)
33.Lanthaler M, Bicbl M, Mittermair R, Ofner D, Nchoda H. Intraoperative colonoscopy for anastomosis assessment in laparoscopically assisted left-sided colon rescction: is it worthwhilc? J laparocndosc Adv Surg Tech A 2008; 18: 27-31(PMID: 18266570 DOI: 10.1089/ap.2007.0058]
34.Li VK, Wcxner SD, Pulido N, Wang H, Jin HY, Weiss EG, Nogcuras JJ, Sands DR. Use of routine intraoperative en-doscopy in elective laparoscopic colorcctal surgery: can it further avoid anastomotic failure? Surg Endosc 2009; 23: 2459-2465 (PMID: 19301071 DOI: 10.1007/s00464-009-0416-4]
35.Shamiych A, Szabo K, Ulf Wayand W, Zchctner J. Intraoperative endoscopy for the assessment of circular-stapled anastomosis in laparoscopic colon surgery. Surg Laparosc Endosc Percutan Tech 2012; 22: 65-67 [PMID: 22318063 DOI: 10.1097/SLE.Ob013e3182401c20]
36.Ambrosctti P, Robert J, Mathey P, Rohner A. Left-sided colon and colorectal anastomoscs: Doppler ultrasound as an aid to assess bowel vascularization. A prospective cvaluation of 200 consecutive clective cases. Int J Colorectal Dis 1994; 9:211-214 [PMID: 7876727)
2.Chude GG, Rayate NV, Patris V, et al. Defunctioning loop ilcostomy with low anterior resection for distal rectal cancer: should we make an ileostomy as a routine procedure? A prospective randomized study. Hepato Gastroenterol 2008;55:1562–7.
3.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.
4. Salvadalena G. Incidence of complications of the stoma and peristomal skin among individuals with colostomy, ileostomy, and urostomy: a systematic revicw. J Wound Ostomy Continence Nurs 2008;35:596–607.
5.Eberl T, Jagoditsch M, Klingler A, et al. Risk factors for anastomotic leakage after resection for rectal cancer. Am J Surg 2008;196:592–8.
6. Park JJ, Del Pino A, Orsay CP, Nelson RL, Pearl RK, Cintron JR et al (1999) Stoma complications: the Cook County Hospital experience. Dis Colon Rectum 42:1575-1580.
7.Gooszen AW, Geelkerken RH, Hermans J, Lagaay MB, Gooszen HG (1998) Temporary decompression after colorectal surgery: randomized comparison of loop ileostomy and loop colostomy. Br J Surg 85:76–79.
8.O Toole GC, Hyland JM, Grant DC, Barry MK (1999) Defunctioning loop ileostomy: a prospective audit. J Am Coll Surg 188:6-9.
9.Kairaluoma M, Rissanen H, Kultti V, Mecklin JP, Kellokumpu 1(2002) Outcome of temporary stomas. A prospective study of temporary intestinal stomas constructed between 1989 and 1996. Dig Surg 19:45–51.
10.Kaiser AM, Israclit S, Klaristenfeld D, Selvindoss P, Vukasin P, Ault G et al (2008) Morbidity of ostomy takedown. J Gastrointest Surg 12:437–441.
11.Enker WE, Merchant N, Cohen AM, Lanouette NM, Swallow C, Guillem J et al (1999) Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg 230:544–552, discussion 52-4,
12.Law WL, Chu KW (2004) Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg 240:260–268.
13.de la Quintana Jimenez P, Pastor Juan C, Prados Herrero I, Perez Lopez C, Gonzalez Fuentes M, de Mena Casaseca C et al (2010) A prospective, longitudinal, multicenter, cohort quality-of-life evaluation of an intensive follow-up program for patients with a stoma. Ostomy/Wound Management 56:44–52.
14.Bertram P, Junge K, Schachtrupp A, Götze C, Kunz D, Schumpelick V. Pcritoneal release of TNFalpha and IL-6 after elective colorectal surgery and anastomotic leakage. J Invest Surg 2003; 16: 65-69 [PMID: 12746189)
15.Mori L, Vita M, Razzetta F, Meinero P, D'Ambrosio G. Ghost ileostomy in anterior resection for rectal carcinoma: is it worthwhile? Dis Colon Rectum. 2013 Jan;56(1):29-34.
16. Bruce J, Krukowski ZH, Al-Khairy G, Russell EM, Park KG. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 2001; 88: 1157-1168 [PMID: 11531861 DOI: 10.1046/j.0007-1323.2001.01829.x)
17.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, Büchler MW. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery: 2010; 147: 339-351 [PMID: 20001450 DOI:..1016/j.surg.2009.10.012)
18.Hyman N, Manchester TL, Osler T, Burs B, Cataldo PA. Anastomotic leaks after intestinal anastomosis: it's later than you think. Ann Surg 2007; 245: 254-258 (PMID: 17245179 DOI: 10.1097/01.sla.0000225083.27182.85)
19.Matthiessen P, Strand I, Jansson K, Tõmquist C, Andersson M, Rutegård J, Norgren L. Is carly detection of anastomotic leakage possible by intraperitoneal microdialysis and intraperitoneal cytokines after anterior resection of the rectum for cancer? Dis Colon Rectum 2007; 50: 1918-1927 [PMID: 17763907 DOI: 10.1007/s10350-007-9023-4)
20.Herwig R, Glodny B, Kühle C, Schlüter B, Brinkmann OA, Strasser H, Senninger N, Winde G. Early identification of peritonitis by peritoneal cytokine measurement. Dis Colon Rectum 2002; 45: 514-521 (PMID: 12006934 DOI: 10.1007/s10350-001-6231-2]
21.Yamamoto T, Umegae S, Matsumoto K, Saniabadi AR. Peritoneal cytokines as early markers of peritonitis following surgery for colorectal carcinoma: a prospective study. Cytokine 2011; 53: 239-242 (PMID: 21075004 DOI: 10.1016/j.cyto.2010.10.006]
22.Moore AK, Esquibel KA, Thal W. Ostomy options for clients with ileostomies. Gastroenterol Nurs 2008;31:418–20.
23.Buchs NC, Gervaz P, Secic M, et al. Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis 2008;23:265–70.
24. Alves A, Panis Y, Pocard M, Regimbeau JM, Valleur P. Management of anastomotic leakage after nondiverted large bowel resection. J Am Coll Surg 1999; 189: 554-559 (PMID:10589591]
25.Platell C, Barwood N, Dorfinann G, Makin G. The incidence of anastomotic leaks in patients undergoing colorectal surgery. Colorectal Dis 2007; 9: 71-79 (PMID: 17181849 DOI: 10.1111/j.1463-1318.2006.01002.x]
26.Ellebaek Pedersen M, Qvist N, Bisgaard C, Kelly U, Bernhard A, Moller Pedersen S. Paritoneal microdialysis. Early diagnosis of anastomotic leakage after low anterior resection for rectosigmoid cancer. Scand J Surg 2009;98: 148-154 (PMID 19919919)
27.Vheeler JM1, Gilbert JM. Controlled intraoperative water testing of left-sided colorectal anastomoscs: are ileostomies avoidable? Ann R Coll Surg Engl 1999; 81: 105-108 [PMID: 10361966)
28.Yalin R, Aktan AO, Yeğen C, Döşlüoğlu H, Okboy N. Importance of testing stapled rectal anastomoses with air. Eur J Surg 1993; 159: 49-51 (PMID: 5095507]
29.Ishihara S, Watanabe T. Nagawa H. Intraoperative colonoscopy for stapled anastomosis in colorectal surgery. Surg Today 2008; 38: 1063-1065 (PMID: 1$958570 DOI: 10.10071 SOOS95-007-3740-01
30.Smith S, McGechin W, Kozol RA, Giles D. The efficacy of intraoperative methylene blue Cncias to assess the integrity of a colonic anastomiosis. BUC Surg 2007; 7: 15 (PMID: 17683526 DOI: 10.1186/1471-2482-7-15)
31.Griffith CD, Hardcastle JD. Intraoperative testing of anastomotic integrity after stapled anterior resection for cancer. J R Coll Surg Edinb 1990; 35: 106-109 (PMID: 2355372)
32.Sahanoue Y', Nakao K, Shoji Y, Yanayi II, Kusunoki /1, Utsunomiya J. Intraoperative colonoscopy. Surg Embosc 1993; 7; 84-97 (PMID: 8156374)
33.Lanthaler M, Bicbl M, Mittermair R, Ofner D, Nchoda H. Intraoperative colonoscopy for anastomosis assessment in laparoscopically assisted left-sided colon rescction: is it worthwhilc? J laparocndosc Adv Surg Tech A 2008; 18: 27-31(PMID: 18266570 DOI: 10.1089/ap.2007.0058]
34.Li VK, Wcxner SD, Pulido N, Wang H, Jin HY, Weiss EG, Nogcuras JJ, Sands DR. Use of routine intraoperative en-doscopy in elective laparoscopic colorcctal surgery: can it further avoid anastomotic failure? Surg Endosc 2009; 23: 2459-2465 (PMID: 19301071 DOI: 10.1007/s00464-009-0416-4]
35.Shamiych A, Szabo K, Ulf Wayand W, Zchctner J. Intraoperative endoscopy for the assessment of circular-stapled anastomosis in laparoscopic colon surgery. Surg Laparosc Endosc Percutan Tech 2012; 22: 65-67 [PMID: 22318063 DOI: 10.1097/SLE.Ob013e3182401c20]
36.Ambrosctti P, Robert J, Mathey P, Rohner A. Left-sided colon and colorectal anastomoscs: Doppler ultrasound as an aid to assess bowel vascularization. A prospective cvaluation of 200 consecutive clective cases. Int J Colorectal Dis 1994; 9:211-214 [PMID: 7876727)
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| Issue | Vol 7 No 1 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ajs.v7i1.16344 | |
| Keywords | ||
| Ghost Ileostomy Converting Stoma Low Anterior Resection Anastomosis Leakage | ||
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How to Cite
1.
Fazeli MS, Ebrahimi A, Behboudi B, Sobhanian E, Moghimi Z, Sadeghian E, Keramati MR, Keshvari A, Ahmadi Tafti SM, Pak H, zafarmandi S, Ebrahimi M, sobhanian A, Rahimi Y, Kazemeini A. Investigation of Mortality and Morbidity In Patients Associated With Low Anterior Resection and Ghost Ileostomy. AJS. 2024;7(1):1-5.
