The Impact of Ghost Ileostomy on Anastomotic Leakage: Selecting Eligible Patients for Surgery and Early Detection of Leakage

Document Type : Research/Original Article

Authors

1 Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran

3 Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

10.30476/acrr.2024.101734.1207

Abstract

Background: Anastomotic leakage (AL) is the main complication of colorectal surgeries. Recent studies have
assessed the effects of the ghost ileostomy on preventing complications related to a defunctioning stoma (DS)
in high-risk anastomoses. In this study, we aimed to review patients who underwent ghost ileostomy and assess
their colon leakage score (CLS) and Dutch leakage score (DULK) to evaluate their preoperative AL risk and
post-operative AL diagnostic score, respectively. We examined whether the suggested cut-off points of these
scores (>11 for CLS and >4 for DULK) could be appropriate criteria for determining when to insert ghost
ileostomy and when to convert it to a DS.
Methods: All patients from three referral hospitals in Shiraz, Iran who underwent colorectal surgery with
ghost ileostomy during 2019-2020 were enrolled in this retrospective case series. We calculated preoperative
CLS and post-operative DULK scores for all patients and assessed what diagnostic and therapeutic measures
were performed for them based on their scores.
Results: AL was diagnosed in two of 34 patients. Eight patients had a total CLS score of 11 and above, but
only one of them experienced AL. The other case of AL had a CLS score of 10. The DULK score of these two
patients increased during hospitalization.
Conclusion: Because of the importance of accurately identifying high-risk patients for ghost ileostomy, it
is imperative to undertake additional research aimed at determining the optimal cut-off value for CLS or
devising alternative valid scoring systems. DULK score could be an appropriate post-operative monitoring tool
to reduce morbidity.

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