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

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038930
Author(s):  
Felix J Hüttner ◽  
Pascal Probst ◽  
André Mihaljevic ◽  
Pietro Contin ◽  
Colette Dörr-Harim ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Loop Ileostomy ◽  
Pilot Trial ◽  
Ileostomy Closure ◽  
Ghost Ileostomy ◽  
Anterior Rectal Resection ◽  
Randomised Controlled

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.

scholarly journals The association of age with decline in renal function after low anterior resection and loop ileostomy for rectal cancer: a retrospective cohort prognostic factor study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amal Rhemouga ◽  
Stefan Buettner ◽  
Wolf O. Bechstein ◽  
Guido Woeste ◽  
Teresa Schreckenbach
Keyword(s):  
Rectal Cancer ◽  
Rectal Carcinoma ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Older Patients ◽  
Retrospective Cohort ◽  
Loop Ileostomy ◽  
Linear Regression Analysis ◽  
Multivariate Linear Regression Analysis ◽  
Group B

Abstract Background Low anterior resection (LAR) is often performed with diverting loop ileostomy (DLI) for anastomotic protection in patients with rectal cancer. We aim to analyze, if older patients are more prone to a decline in kidney function following creation and closure of DLI after LAR for rectal carcinoma versus younger patients. Methods A retrospective cohort study from a database including 151 patients undergoing LAR for rectal carcinoma with DLI was used. Patients were divided in two age groups (Group A: <65 years, n = 79; Group B: ≥65 years, n = 72). For 123 patients undergoing DLI reversal prognostic factors for an impairment of serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) 3 months after DLI reversal was analyzed using a multivariate linear regression analysis. Results SCr before LAR(T0) was significant higher in Group B (P = 0.04). Accordingly, the eGFR at T0 in group B was significantly lower (P < 0.001). No patients need to undergo hemodialysis after LAR or DLI reversal. Age and SCr at T0were able to statistically significant predict an increase in SCr (P<0.001) and eGFR (P=0.001) three months after DLI reversal (The R² for the overall model was .82 (adjusted R² = .68). Conclusion DLI creation may result in a reduction of eGFR in older patients 3 months after DLI closure. Apart from this, patients do not have a higher morbidity after creation and closure of DLI resulting from LAR regardless of their age.

The impact of timing of stoma closure on low anterior resection syndrome in patient who underwent low anterior resection for rectal cancer

2021 ◽  
pp. 126-134
Author(s):  
Hemn Hussain Kaka Ali ◽  
Qalandar Hussein Abdulkarim ◽  
Karzan Seerwan ◽  
Barham M. M .Salih
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Anal Verge ◽  
Loop Ileostomy ◽  
Low Anterior Resection Syndrome ◽  
Anterior Resection Syndrome ◽  
Closure Of Ileostomy ◽  
The Mean ◽  
The Impact

This is a multi-center retrospective study of patients underwent low anterior resection for rectal cancer. Ileostomy had been done to protect low lying Colo-rectal anastomosis, closure of ileostomy had been delayed in some patients due to patient own will, surgical complications (anastomotic leak) or coarse of chemotherapy. This study aimed to find the effect of temporary ileostomy on post-operative bowel defunction which is called Low anterior resection syndrome (LARS), and include; urgency, difficulty in emptying of bowel, and incontinence for feces and flatus.  A total of 50 patients included in this study, the age ranges from the 19 to 80 years old with a mean age of 51.96 years. The total number of males was (33, %66). Majority of patients were overweight (21, 42%). The distance of tumors from the anal verge were less than 10 cm in (31,62%). The mean duration of fecal diversion was 7.17 months. Loop ileostomy were closed before six months in (27,54%). The mean duration of diversion of patients developed no LARS was 6.87 months which is shorter than those of developed LARS (7.31). Lower BMI patients are more prone to develop LARS, while Obese patients are more susceptible to develop major LARS. Nineteen cases developed LARS among those patient’s ileostomy closed before six months, and 15 cases developed LARS in those ileostomies closed after six months.    

Anastomotic leakage following low anterior resection for rectal cancer

2010 ◽  
Vol 14 (S1) ◽  
pp. 35-37 ◽  
Author(s):  
D. Kanellos ◽  
M. G. Pramateftakis ◽  
G. Vrakas ◽  
H. Demetriades ◽  
I. Kanellos ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Low Anterior Resection

scholarly journals A Decalogue to Avoid Routine Ileostomy in Selected Patients With Border Line Risk to Develop Anastomotic Leakage After Minimally Invasive Low-Anterior Resection: A Pilot Study

2019 ◽  
Vol 27 (1) ◽  
pp. 44-53
Author(s):  
Salvador Morales-Conde ◽  
Isaias Alarcón ◽  
Tao Yang ◽  
Eugenio Licardie ◽  
Andrea Balla
Keyword(s):  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Fluorescence Angiography ◽  
Splenic Flexure Mobilization ◽  
Horizontal Section ◽  
Border Line ◽  
Ghost Ileostomy ◽  
Protective Ileostomy ◽  
Methylene Blue Test

Purpose. Protective ileostomy (PI) during anterior resection (AR) for rectal cancer decreases the incidence of anastomotic leakage (AL) and its subsequent complications, but it may itself be the cause of morbidity. The aim is to report our protocol in the management of selected patients with borderline risk to develop AL after laparoscopic AR and ghost ileostomy (GI) creation. Methods. Patients who underwent AR were stratified based on the risk to develop AL. Steps to avoid PI were splenic flexure mobilization, reduced pelvic bleeding, to employ different stapler charge if neoadjuvant chemo-radiotherapy is performed, to perform a horizontal section of the rectum, to evaluate the anastomotic vascularization with a fluorescence angiography, to perform a side-to-end anastomosis, intraoperative methylene blue test, pelvic and transanal drainage tubes placement, and the GI creation. After surgery, inflammatory blood markers were monitored to detect potential leakages. Results. Twelve patients were included. In one case, the specimen proximal section was changed after fluorescence angiography. There were no conversions in this group of patients. One postoperative AL occurred and was treated with radiological drainage placement, not being necessary to convert the GI. PI was avoided in 100% of cases. Conclusions. Patients’ characteristics cannot be changed, but several steps were used to avoid routine PI creation. The present protocol could be a valuable option to avoid PI in selected patients. Further studies with a wider sample size, and defined criteria to stratify the patients based on the risk to develop AL, are required.

Endoscopic repair of anastomotic leakage after low anterior resection for rectal cancer: A systematic review

2020 ◽  
Vol 13 (2) ◽  
pp. 141-146
Author(s):  
Angeliki Chorti ◽  
George Stavrou ◽  
Veronica Stelmach ◽  
Georgia Tsaousi ◽  
Antonios Michalopoulos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Endoscopic Repair
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