title: Does ghost ileostomy have a role in the laparoscopic rectal surgery era? A randomized controlled trial.
abstract: BACKGROUND
  Anastomotic leakage following anterior rectal resection is the most important and most commonly faced complication of laparoscopy and open surgery. To prevent this complication, the construction of a preventing stoma is usually adopted. It is not easy to decide whether to construct a protective stoma in patients with a medium risk of anastomotic leakage. In these patients, ghost ileostomy (GI), a pre-stage ileostomy that can be externalized and opened if needed, has proved useful. We conducted a prospective, randomized, controlled study to evaluate the advantages of GI in laparoscopic rectal resection.
  
  
  METHODS
  All patients with surgical indications for laparoscopic rectal resection who were at medium risk for anastomotic leakage from January 2007 to January 2013 were included and were randomly divided in 2 groups. All of the patients were subjected to laparoscopic anterior rectal resection with the performance of GI (group A) or without the construction of any protective stoma (group B). The presence and severity of clinically evident postoperative anastomotic leakage and other postoperative complications and reinterventions were investigated.
  
  
  RESULTS
  Of the 55 patients allocated to group A, 3 experienced anastomotic leakage compared with 4 in group B. The patients with GI experienced a lower severity of anastomotic leakage and shorter hospitalization compared with the patients in group B. None of the patients with GI and anastomotic leakage required laparotomy to treat the dehiscence.
  
  
  CONCLUSIONS
  The use of GI in laparoscopic rectal resections in patients at medium risk for anastomotic leakage was useful because it allowed for the avoidance of stoma creation in all of the patients, thus reducing the number of stomas performed, improving the quality of life of the patients and preserving, in most cases, the benefits gained by laparoscopy.
authors.affiliation: Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea Hospital, School of Medicine and Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy, frasavmari@yahoo.it.
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Mari
authors.forename: Tatiana
authors.initials: T
authors.lastname: Di Cesare
authors.forename: Luciano
authors.initials: L
authors.lastname: Novi
authors.forename: Marcello
authors.initials: M
authors.lastname: Gasparrini
authors.forename: Giammauro
authors.initials: G
authors.lastname: Berardi
authors.forename: Giovanni Guglielmo
authors.initials: GG
authors.lastname: Laracca
authors.forename: Andrea
authors.initials: A
authors.lastname: Liverani
authors.forename: Antonio
authors.initials: A
authors.lastname: Brescia
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D057868:Anastomotic Leak / Q000209:etiology*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome