Xiaocheng Zhu, MD, Linsen Shi, Chao Li, MD, Song Meng, MD, Hui Wang, Yadong Han. Department of General Surgery Affiliated Hospital of Xuzhou Medical College P. R. China
Background: Anastomotic leakage was one of the most dreaded complications after colorectal surgery. Almost every surgeon has faced the intraoperative dilemma of whether to divert in colorectal surgery because of its advantages and disadvantages. To avoid the dilemma, some surgeons use a technique, a prophylactic preplaced ileum loop attached to right low abdominal subcutaneously( a pre-stage ileostomy, Ghost Ileostomy). This technique can help them to perform ileostomy when there is anatomotic leak or reverse the loop if patients recover well. However, the technique is not widely accepted because the adhesions between ileum loop and abdominal wall lead to much inconvenient during later ileostomy or ileum loop reversal. To solve this, we design a device (patent 201420335556.1) that can avoid the adhesion and surgeon can easily do ileostomy or the loop reversal.
Objectives: The study was designed to evaluate a new type of protection device for preplaced ileum loop, which could avoid the intestinal adhesion caused by traditional method of preplaced ileum loop.
Methods: A total of 21 adult New Zealand rabbits were divided into three groups: Control (C) group (n=7), traditional prophylactic preplaced ileum loop(T) group, and prophylactic preplaced ileum loop with our protection device(D) group. In group C, open and close right low abdominal wall without touching intestine; In group T, the ileum was placed in the subcutaneous of right low abdomen and supported by a latex ring; In group D, the ileum was fixed subcutaneously with the protection device (a device contains of a main part that can cover preplaced ileum and a auxiliary part that can attach the device to abdominal wall). At postoperative day 14, rabbits were sacrificed and en bloc of ileum loop and regional abdominal wall were harvested. Adhesions were examined macroscopically, microscopically, and degree of adhesions was scored (Blauer and Collins score). The concentration of hydroxyproline, a collagen protein precursor, was measured.
Results: Group D has less adhesion from gross appearance and significant lower Blauer and Collins score than group T (p=0.005). Total microscopic score (inflammation, fibroblastic activity and vascular proliferation.) of the group D was significantly lower than that of the group T (p=0.004, 0.001 and 0.01). The concentration of hydroxyproline in the group D was lower compared to the group T ( p =0.003).
Conclusions: the new protection device appear to effectively prevent adhesions between preplaced ileum loop and abdominal wall,which might be used safely and conveniently for Ghost ileostomy, also might avoid unnecessary ileostomy.
Key words: Colorectal surgery; Preplaced ileum loop; Protection device; Adhesions