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 costeffective 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.Endometriosis is a benign gynecological disease that affects approximately 7-10% of women, with clinically relevant conditions affecting approximately 3% of female patients at a fertile age (1). Pain is the most common symptom of endometriosis and presents as dysmenorrhea, dyspareunia, dyschezia, dysuria, and chronic pelvic pain (2). The incidence of rectum involvement varies between 5% and 12%. Pain and defecation problems often require bowel resection, including the rectum (3, 4). To reduce the risk of anastomotic leakage (AL) in cases of low or ultralow rectal resection, a protective loop ileostomy (LI) is often required. This results in a substantial psychological burden in patients with endometriosis (5, 6). Furthermore, the LI procedure is disputed, since the stoma itself imparts significant risk for 1290

Background Inguinal hernia repair is a common procedure in surgery. Patients with cardiovascular disease have an increased operative risk for postoperative morbidity. The study aimed to identify the most beneficial surgical procedure for these patients. Methods Patients undergoing elective surgery for unilateral or bilateral inguinal hernia between December 2015 and February 2020 were included. The cohort was divided into the group of patients with (CVD group) and without (NO group) cardiovascular disease and analyzed according to the postoperative morbidity distribution and correlated to the surgical technique used. Results Of the 474 patients included 223 (47%) were operated on using the Lichtenstein technique and 251 (53%) using TAPP, respectively. In the CVD group the Lichtenstein procedure was more common (n = 102, 68.9%), in the NO group it was TAPP (n = 205, 62.9%; p < 0.001). 13 (8.8%) patients in the CVD group and 12 (3.7%) patients in the NO group developed a postoperative hematoma (p = 0.023). In the further subgroup analysis within the CVD group revealed cumarine treatment as a risk factor for postoperative hematoma development, whereas the laparoscopic approach did not elevate the morbidity risk. Conclusion CVD is a known risk factor for perioperative morbidity in general surgery, however, the TAPP method does not elevate the individual perioperative risk.

Purpose Obstructive defecation syndrome (ODS) defines a disturbed defecation process frequently associated with pelvic organ prolapse (POP) in women. It substantially compromises quality of life. Conservative treatment options are limited. Surgical interventions are characterized by a variety of individual approaches. This study standardized laparoscopic resection rectopexy (L-RRP) combined with laparoscopic sacrocolpopexy (L-SCP) in an interdisciplinary setting. Additionally, offering both synthetic mesh (SM) and biological mesh (BM) material for L-SCP is a novel treatment alternative, particularly for premenopausal women. Methods Women with ODS combined with POP underwent surgery using an interdisciplinary approach. The primary endpoint was postoperative morbidity and mortality measured by the Clavien-Dindo classification (CDC). Further endpoints were improvement in bowel evacuation, POP, and urinary incontinence at a median follow-up period of > 12 months. Results Of a total of 44 patients, 36 patients were treated with L-RRP combined with L-SCP (28 patients with SM, 8 patients with BM). CDC grades and the frequency of postoperative complications were low. Clinical outcomes for ODS, bowel dysfunction, and fecal control improved significantly. Anatomical outcome for POP was significantly better with 28 (78%) patients having POP-Q stage 0 after surgery. 17 patients (47%) had urinary incontinence before surgery, which was restored in 14 patients (82%). No de-novo urinary incontinence appeared. Conclusion The interdisciplinary surgical approach with L-RRP and L-SCP is safe, feasible, and effective in treating women with ODS and POP. The use of a biomesh was established as an effective alternative to the SM and offers an additional and new uterine-preserving option.

Background Obstructive defecation syndrome (ODS) defines a disturbed defecation process frequently associated with pelvic organ prolapse (POP) in women. It substantially compromises quality of life and conservative treatment options are limited. In cases surgery is required the interventions are characterized by individual approaches. Laparoscopic resection rectopexy (L-RRP) combined with laparoscopic sacrocolpopexy (L-SCP) was established in an interdisciplinary setting. Methods Women with ODS combined with POP underwent surgery using an interdisciplinary laparoscopic approach. The primary endpoint was the postoperative morbidity and mortality measured by the Clavien-Dindo classification (CDC). Further endpoints were changes in bowel evacuation, POP, and urinary incontinence at a median follow-up period of > 12 months after surgery. Additionally, a biological mesh (BM) was offered premenopausal women and those, who asked for an alternative to synthetic mesh material (SM). Results Of a total of 44 patients, 36 patients were treated with L-RRP combined with L-SCP; 28 patients with SM and 8 patients with BM. CDC grades and the frequency of postoperative complications were low. Clinical outcomes for ODS, bowel dysfunction, and fecal control improved significantly. Anatomical outcome for POP was better with 28 (78%) patients having POP-Q stage 0 after surgery. 17 patients (47%) had urinary incontinence before surgery, which was restored in 14 patients (82%). No de-novo urinary incontinence appeared. Conclusions The interdisciplinary surgical approach with L-RRP and L-SCP is safe, feasible, and effective in treating women with ODS and POP. The use of a BM was established as an alternative to the SM and offers an additional and uterine-preserving option. Trial registration trial number NCT05910021, date of registration 10/06/2023.