Alberto Vega Hernández1, Jakob Otten1, Hildegard Christ2, Christoph Ulrici1, Elvin Piriyev3, Sebastian Ludwig4, Claudia Rudroff5. 1. Department of Visceral Surgery and Functional Lower GI Surgery, Evangelisches Klinikum Koeln Weyertal, Cologne, Germany. 2. Institute of Medical Statistics and Computational Biology (IMSB), University Hospital of Cologne, Cologne, Germany. 3. Department of Gynecology and Obstetrics, Evangelisches Klinikum Koeln Weyertal, Medical Faculty, University of Witten/Herdecke, Cologne, Germany. 4. department of Obstetrics and Gynecology, University Hospital of Cologne and Medical Faculty, Cologne, Germany sebastian.ludwig@uk-koeln.de. 5. Department of Visceral Surgery and Functional Lower GI Surgery, Evangelisches Klinikum Koeln Weyertal, Cologne, Germany; claudia@rudroff.com.
Abstract
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. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Authors: Philippe R Koninckx; Anastasia Ussia; Leila Adamyan; Muna Tahlak; Jörg Keckstein; Arnaud Wattiez; Dan C Martin Journal: Best Pract Res Clin Obstet Gynaecol Date: 2020-09-01 Impact factor: 5.237
Authors: Luigi Della Corte; Claudia Di Filippo; Olimpia Gabrielli; Sabrina Reppuccia; Valentina Lucia La Rosa; Rosalia Ragusa; Michele Fichera; Elena Commodari; Giuseppe Bifulco; Pierluigi Giampaolino Journal: Int J Environ Res Public Health Date: 2020-06-29 Impact factor: 3.390