Technique of Ghost (Khatith) Ileostomy-How I Do It?

Document Type : Research/Original Article

Authors

1 Assistant Professor, Department of General Surgery; GMC Rajouri, J&K, India

2 Department of Colorectal Surgery SKIMS, Srinagar, J&K, India

3 Directorate of Health Services, Kashmir, India

Abstract

The concept of ghost/Khatith ileostomy is a bridge between covering ileostomy and no-ileostomy (‘Khatith’ meaning ‘hidden’ in Kashmiri language). We performed the pre-stage ghost ileostomy (GI) without parietal wall split. The technique of GI is that after the completion of resection-anastomosis of rectal cancer, a terminal ileal loop at about 20cm from ileocecal junction is identified. Small (10-12F) Ryle’s tube (RT) is passed through a small opening in the mesentery of the identified ileal loop. A small 4-5mm incision is given on abdominal wall at pre-operatively marked proposed stoma site in right iliac fossa region. Haemostatic Kelly’s forceps is introduced through this small incision to get out the two limbs of the RT that has been already looped around the identified ileal loop. These two limbs of the RT are cut short and fixed to each other and to the skin around it with 2-0 silk sutures, taking care to keep the tubing loop loose enough to avoid any tension to the vascular supply of the ileal loop and without causing any luminal compression of the loop to avoid bowel obstruction. In case of AL, the pre-stage GI can be converted into a formal covering stoma under local or spinal anesthesia by gentle pull of the two limbs of the looped RT to extract the isolated ileal loop through an adequate circular incision around the site of GI. In case of uncomplicated postoperative course, the fixing RT is pulled out gently from the abdominal cavity to release down the GI.

Keywords


1)         Ajani JA. In rectal carcinoma, colostomy or no colostomy: is this the question? J Clin Oncol 1993; 11: 193-4. [4]
2)         Gastinger I, Marusch F, Steinert R, Wolff S, Koeckerling F, Lippert H. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg 2005; 92: 1137-42.
3)         Tsunoda A, Tsunoda Y, Narita K, Watanabe M, Nakao K, Kusano M (2008). Quality of life after low anterior resection and temporary loop ileostomy. Dis Colon Rectum.;51:218–222.
4)         Pakkastie TE, Ovaska JT, Pekkala ES, Luukkonen PE, Järvinen HJ (1997). A randomised study of colostomies in low colorectal anastomoses. Eur J Surg.;163:929–933.
5)          Moore AK, Esquibel KA, Thal W(2008) Ostomy options for clients with ileostomies. Gastroenterol Nurs 31:418–420, quiz 21–2
6)         Chude GG, Rayate NV, Patris V, Koshariya M, Jagad R, Kawamoto J, Lygidakis NJ (2008) Defunctioning loop ileostomy with low anterior resection for distal rectal cancer: should we make an ileostomy as a routine procedure? A prospective randomized study. Hepatogastroenterology 55:1562–1567
7)         Pata G, D’Hoore A, Fieuws S, Penninckx F (2009) Mortality risk analysis following routine vs selective defunctioning stoma formation after total mesorectal excision for rectal cancer. Colorectal Dis 11:797–805
8)         Hautefeuille P, Valeur P, Perniceni TH, Martin B, Galian A, Cherqui D, Hoang C: Functional and oncologic results after colo-anal anastomosis. Ann Surg 1988, 207:61-65.
9)         Miccini M, Bonapasta SA, Gregori M, Barillari P, Tocchi A. Ghost ileostomy: real and potential advantages. The American Journal of Surgery (2010) 200, e55–e57
10)     Nino Gullà, Trastulli S, Boselli C, Cirocchi R, Cavaliere D et. al. Ghost ileostomy after anterior resection for rectal cancer: a preliminary experience Langenbecks Arch Surg (2011) 396:997–1007
11)     Sacchi M, Legge PDPicozzi PPapa FGiovanni CLGreco L. Virtual ileostomy following TME and primary sphincter-saving reconstruction for rectal cancer. Hepatogastroenterology. 2007 Sep;54(78):1676-8.
12)     Mori, Lorenzo M.D.; Vita, Matteo M.D.; Razzetta, Francesco M.D.; Meinero, Piercarlo M.D.; D’Ambrosio, Giovanni M.D. Ghost Ileostomy in Anterior Resection for Rectal Carcinoma: Is It Worthwhile? Diseases of the Colon & Rectum: January 2013 - Volume 56 - Issue 1 - p 29–34
13)     Blas Flor-Lorente, Luis Sanchez-Guillen, Gianluca Pellino, Matteo Frasson, et al. Virtual ileostomy combined with early endoscopy to avoid diversion ileostomy in low and ultralow colorectal anastomosis; a preliminary report. Langenbeck’s Archives of Surgery. pp 1-9.
14)     Michele Cerroni et al.Ghost Ileostomy with or without abdominal parietal split. World Journal of Surgical Oncology 2011, 9:92
15)     Víctor Lago, Santiago Domingo, Luis Matute, Pablo Padilla, Blas Flor, Álvaro García-Granero. Ghost ileostomy in advanced ovarian cancer. Gynecologic Oncology 147 (2017) 488
16)     Ambe PCZirngibl HMöslein G.Routine Virtual Ileostomy Following Restorative Proctocolectomy for Familial Adenomatous Polyposis. World J Surg. 2018 Jun;42(6):1867-1871. doi: 10.1007/s00268-017-4365-0.