Department of General Surgery, Azienda Sanitaria Locale No. 4 Chiavarese, Lavagna, Genova, Italy.
Dis Colon Rectum. 2013 Jan;56(1):29-34. doi: 10.1097/DCR.0b013e3182716ca1.
There is no consensus in the literature as to whether all patients who undergo anterior resection of the rectum with total mesorectal excision should have a defunctioning stoma or only those at high risk of anastomotic dehiscence.
The aim of this retrospective study was to evaluate the results of placing a removable Silastic band around the ileum during the abdominal phase to exteriorize it and create a loop ileostomy postoperatively without the need for laparotomy in case of an anastomotic complication. This approach is known as "ghost ileostomy."
A vascular loop was passed around the terminal ileum through a window adjacent to the ileal wall. The loop was then exteriorized, through the abdominal wall, without tension, and secured to the skin on a rod. Two 24F Silastic drains were placed next to the anastomosis (anteriorly and posteriorly).
From May 1997 to May 2011, 168 patients underwent anterior resection of the rectum with total mesorectal excision plus ghost ileostomy.
Symptomatic anastomotic dehiscence was observed in 20 of 168 patients (11.96%) and developed on postoperative days 4 to 12 (median, postoperative day 7). In 13 of 20 cases, an ileostomy was fashioned with the patient under local anesthesia, and there was no need for relaparotomy. In 5 of 20 cases, the complication resolved with conservative management. In 2 of 20 cases, the patient's clinical condition rapidly deteriorated, generalized peritonitis developed, and surgical reintervention with abdominal toilette and colostomy was required.
Ghost ileostomy allows selective loop ileostomy formation after low anterior resection of the rectum without the need for laparotomy in most cases. However, the technique should be reserved for instances in which the risk of leak is relatively low, such as anastomoses performed in the absence of neoadjuvant therapy. The role of routine ghost ileostomy following higher-risk anastomoses remains to be determined.
对于接受全直肠系膜切除的直肠前切除术的所有患者，是否都应行预防性造口术，还是仅对吻合口裂开高风险的患者行预防性造口术，目前文献中尚无共识。
本回顾性研究旨在评估在腹部阶段将可移动的 Silastic 带环绕回肠并将其引出体外，以及在吻合口并发症发生时无需剖腹手术即可创建 Loop 造口术（称为“幽灵造口术”）的效果。
通过与回肠壁相邻的窗口穿过血管环。然后将该环无张力地引出腹壁，并固定在杆上的皮肤上。在吻合口（前侧和后侧）附近放置两个 24F Silastic 引流管。
1997 年 5 月至 2011 年 5 月，168 例患者接受了全直肠系膜切除加幽灵造口术的直肠前切除术。
168 例患者中有 20 例（11.96%）出现症状性吻合口裂开，发生于术后第 4 至 12 天（中位术后第 7 天）。在 20 例中的 13 例中，在局部麻醉下形成了造口术，无需再次剖腹手术。在 20 例中的 5 例中，通过保守治疗解决了并发症。在 20 例中的 2 例中，患者的病情迅速恶化，出现弥漫性腹膜炎，需要进行剖腹手术、腹腔冲洗和结肠造口术。
幽灵造口术允许在大多数情况下无需剖腹手术即可选择性地形成 Loop 造口术，适用于直肠前切除术。然而，该技术应保留用于吻合口漏风险相对较低的情况，例如在没有新辅助治疗的情况下进行的吻合术。在高风险吻合术后常规行幽灵造口术的作用仍有待确定。
