The Impact of Ghost Ileostomy on Anastomotic Leakage: Selecting Eligible Patients for Surgery and Early Detection of Leakage

Anastomotic leakage (AL) is the main complication of colorectal surgeries. Recent studies haveassessed the effects of the ghost ileostomy on preventing complications related to a defunctioning stoma (DS)in high-risk anastomoses. In this study, we aimed to review patients who underwent ghost ileostomy and assesstheir colon leakage score (CLS) and Dutch leakage score (DULK) to evaluate their preoperative AL risk andpost-operative AL diagnostic score, respectively. We examined whether the suggested cut-off points of thesescores (>11 for CLS and >4 for DULK) could be appropriate criteria for determining when to insert ghostileostomy and when to convert it to a DS.

All patients from three referral hospitals in Shiraz, Iran who underwent colorectal surgery withghost ileostomy during 2019-2020 were enrolled in this retrospective case series. We calculated preoperativeCLS and post-operative DULK scores for all patients and assessed what diagnostic and therapeutic measureswere performed for them based on their scores.

AL was diagnosed in two of 34 patients. Eight patients had a total CLS score of 11 and above, butonly one of them experienced AL. The other case of AL had a CLS score of 10. The DULK score of these twopatients increased during hospitalization.

Because of the importance of accurately identifying high-risk patients for ghost ileostomy, itis imperative to undertake additional research aimed at determining the optimal cut-off value for CLS ordevising alternative valid scoring systems. DULK score could be an appropriate post-operative monitoring toolto reduce morbidity.