Department of Visceral Surgery and Functional Lower GI Surgery, Evangelisches Klinikum Koeln Weyertal, Cologne, Germany.
Institute of Medical Statistics and Computational Biology (IMSB), University Hospital of Cologne, Cologne, Germany.
In Vivo. 2022 May-Jun;36(3):1290-1296. doi: 10.21873/invivo.12829.
BACKGROUND/AIM: Endometriosis infiltrating the rectum often requires resection with a protecting stoma. A ghost ileostomy (GI) is an alternative to prevent the psychological burden for the young women affected. The present study evaluated the safety and cost-effectiveness of the ghost ileostomy (GI) procedure in a group of patients after rectal resection for deep infiltrating endometriosis.
The prospective controlled interventional trial was conducted in 54 consecutive patients with deep infiltrating endometriosis of the rectum. GI was considered after ultra-low resection with primary anastomosis, previous colorectal anastomosis, or pelvic redo surgery. Loop ileostomy (LI) was performed after simultaneous colpotomy with suture, only. Operating time, morbidity according to the Clavien-Dindo classification (CDC), duration of hospital stay, and patient satisfaction were obtained. Individual costs were estimated for the endometriosis procedure with or without a GI or LI, including stoma supply and closure expenses.
Of the 54 patients, 27 received GI (50%), whereas 4 underwent LI (7%). The remaining 23 patients received no outlet (NO). The complication rate did not differ among the GI, LI, and NO groups. Two cases were re-operated and required a diverting stoma, one in the GI and the NO group each. The additional healthcare expenses for each patient receiving a LI averaged 6,000 €. The patients were very satisfied with the option of a GI.
GI is a cost-effective and safe alternative to LI after rectal resection for deep infiltrating endometriosis in cases where it is required. The individual costs per patient were reduced substantially, with a cumulative savings of 160,000 € in healthcare expenditure. Additionally, the method clearly lowers the psychological burden on the young women concerned.
背景/目的：累及直肠的子宫内膜异位症常需要行保护性肠造口术切除。对于受影响的年轻女性，幽灵回肠造口术（GI）是一种替代方法，可以避免心理负担。本研究评估了直肠切除术治疗深部浸润性子宫内膜异位症患者中 GI 术的安全性和成本效益。
这项前瞻性对照干预性试验在 54 例直肠深部浸润性子宫内膜异位症患者中进行。如果需要，在超低直肠切除术后，考虑进行 GI（原发性吻合术、既往结直肠吻合术或盆腔再手术）。同时行经阴道子宫切除术和缝合后，仅行回肠造口术（LI）。获得手术时间、根据 Clavien-Dindo 分类（CDC）的发病率、住院时间和患者满意度。估计有或没有 GI 或 LI 的子宫内膜异位症手术的个人费用，包括造口供应和关闭费用。
54 例患者中，27 例行 GI（50%），4 例行 LI（7%）。其余 23 例患者未行造口术（NO）。GI、LI 和 NO 组的并发症发生率无差异。有 2 例需再次手术并需要转流造口术，GI 和 NO 组各 1 例。每位接受 LI 的患者的额外医疗费用平均为 6000 欧元。患者对 GI 的选择非常满意。
对于需要行直肠切除治疗深部浸润性子宫内膜异位症的患者，GI 是 LI 的一种具有成本效益且安全的替代方法。每位患者的个人成本显著降低，医疗支出累计节省 16 万欧元。此外，该方法明显减轻了受影响年轻女性的心理负担。
