title: Ghost Ileostomy with or without abdominal parietal split.
abstract: BACKGROUND
  In patients who undergo low anterior rectal resection, the fashioning of a covering stoma (CS) is still controversial. In fact, a covering stoma (ileostomy or colostomy) is worsened by major complications related to the procedure, longer recovery time, necessity of a re-intervention under general anesthesia for stoma closure and poorer quality of life. The advantage of Ghost Ileostomy (GI) is that an ileostomy can be performed only when there is clinical evidence of anastomotic leakage, without performing further interventions with related complications when anastomotic leak is absent and therefore the procedure is not necessary. Moreover, in case of anastomotic dehiscence and necessity of delayed stoma opening, mortality and morbidity in patients with GI are comparable with the ones that occur in patients which had a classic covering stoma. On the other hand, is simple to think about the possible economic saving: avoiding an admission for performing the closure of the ileostomy, with all the costs connected (OR, hospitalization, post-operative period, treatment of possible complications) represents a huge saving for the hospital management and also raise the quality of life of the patients.
  
  
  METHODS
  In this study we prospectively analyzed 20 patients who underwent anterior extra-peritoneal rectum resection for rectal carcinoma with TME and fashioning of GI realized with or without abdominal parietal split.
  
  
  RESULTS
  In the group of patients that received a GI without split laparotomy mortality was absent and in one case an anastomotic leak occurred. In the group of patients in which GI with split laparotomy was fashioned, one death occurred and there were one case of infection and one respiratory complication. Clinical follow-up was 12 months.
  
  
  CONCLUSIONS
  The use of different techniques for fashioning a GI do not present significant differences when they are performed by expert surgeons, but further evidence is needed with more randomized trials, in order to have more data supporting the clinical observation.
authors.affiliation: Department of General Surgery, University of Perugia, St, Maria Hospital, Terni, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Cerroni
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.forename: Umberto
authors.initials: U
authors.lastname: Morelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Trastulli
authors.forename: Jacopo
authors.initials: J
authors.lastname: Desiderio
authors.forename: Mario
authors.initials: M
authors.lastname: Mezzacapo
authors.forename: Chiara
authors.initials: C
authors.lastname: Listorti
authors.forename: Luigi
authors.initials: L
authors.lastname: Esperti
authors.forename: Diego
authors.initials: D
authors.lastname: Milani
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
authors.forename: Nino
authors.initials: N
authors.lastname: Gullà
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Noya
authors.forename: Carlo
authors.initials: C
authors.lastname: Boselli
mesh_terms: D034861:Abdominal Wall; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000379:methods* / Q000523:psychology; D007558:Italy / Q000453:epidemiology; D007813:Laparotomy / Q000379:methods* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome