Skip to main content
SpringerLink
Log in

Ghost Stoma Solving the Dilemma of Diversion After Anterior Resection: Surgical Technique Description and Experience from a Single Centre

  • Original Article
  • Published:
Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

Anastomotic leak is the most dreaded complication after anterior resection (AR). To do prophylactic diversion stoma or not is a matter of constant dilemma that most surgeons face. In such a situation, ghost stoma (GS) technique offers a middle path, wherein unnecessary prophylactic stomas can be avoided and at the same time ensuring that a diversion stoma can be created if need arises without the need of any major surgery or anaesthesia. Retrospective data of patients who underwent anterior resection with ghost stoma at our institute from January 2015 to December 2019 was analysed for clinical characteristics, operative outcomes and postoperative complications. Ghost stoma is fashioned by pulling up a loop of intestine up to parietal peritoneum layer of anterior abdominal wall with the help of silicone or plastic tube after anterior resection. During the study period, this technique was used in 68 patients of which 7 patients required creation of stoma under local anaesthesia for suspected or confirmed post-operative leak. One of these patients developed congestion of stoma for which the stoma was refashioned under regional anaesthesia. There were no major complications like bowel obstruction, strangulation or tube migration. However, two patients had prolonged ileus and were managed conservatively. Thus, unnecessary stoma was avoided in 89% patients of anterior resection. This is a simple, easy to learn, less time-consuming and oncologically safe procedure which can prevent patients from morbidity as well as psychological and financial burden associated with unnecessary stoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bertelsen CA, Andreasen AH, Jørgensen T, Harling H, Danish Colorectal Cancer Group (2010) Anastomotic leakage after curative anterior resection for rectal cancer: short and long-term outcome. Colorectal Dis: Off J Assoc Coloproctology Great Britain Ireland 12(7 Online):e76–e81. https://doi.org/10.1111/j.1463-1318.2009.01935.x

    Article  CAS  Google Scholar 

  2. Eberl T, Jagoditsch M, Klingler A, Tschmelitsch J (2008) Risk factors for anastomotic leakage after resection for rectal cancer. Am J Surg 196(4):592–598. https://doi.org/10.1016/j.amjsurg.2007.10.023

    Article  PubMed  Google Scholar 

  3. Chapman WC Jr, Subramanian M, Jayarajan S, Makhdoom B, Mutch MG, Hunt S, Silviera ML, Glasgow SC, Olsen MA, Wise PE (2019) First, Do No Harm: Rethinking Routine Diversion in Sphincter-Preserving Rectal Cancer Resection. J Am Coll Surg 228(4):547–556.e8. https://doi.org/10.1016/j.jamcollsurg.2018.12.012

    Article  PubMed  PubMed Central  Google Scholar 

  4. Enker WE, Merchant N, Cohen AM, Lanouette NM, Swallow C, Guillem J, Paty P, Minsky B, Weyrauch K, Quan SH (1999) Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg 230(4):544–554. https://doi.org/10.1097/00000658-199910000-00010

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85(3):355–358. https://doi.org/10.1046/j.1365-2168.1998.00615.x

    Article  CAS  PubMed  Google Scholar 

  6. Miccini M, Amore Bonapasta S, Gregori M, Barillari P, Tocchi A (2010) Ghost ileostomy: real and potential advantages. Am J Surg 200(4):e55–e57. https://doi.org/10.1016/j.amjsurg.2009.12.017

    Article  PubMed  Google Scholar 

  7. Sacchi M, Legge PD, Picozzi P, Papa F, Giovanni CL, Greco L (2007) Virtual ileostomy following TME and primary sphincter-saving reconstruction for rectal cancer. Hepato-gastroenterology 54(78):1676–1678

    PubMed  Google Scholar 

  8. Bax TW, McNevin MS (2007) The value of diverting loop ileostomy on the high-risk colon and rectal anastomosis. Am J Surg 193(5):585–588. https://doi.org/10.1016/j.amjsurg.2007.01.005

    Article  PubMed  Google Scholar 

  9. Graffner H, Fredlund P, Olsson SA, Oscarson J, Petersson BG (1983) Protective colostomy in low anterior resection of the rectum using the EEA stapling instrument. A randomized study. Dis Colon Rectum 26(2):87–90. https://doi.org/10.1007/BF02562579

    Article  CAS  PubMed  Google Scholar 

  10. Pakkastie TE, Ovaska JT, Pekkala ES, Luukkonen PE, Järvinen HJ (1997) A randomised study of colostomies in low colorectal anastomoses. The European journal of surgery =. Acta chir 163(12):929–933

    CAS  Google Scholar 

  11. Wong NY, Eu KW (2005) A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study. Dis Colon Rectum 48(11):2076–2079. https://doi.org/10.1007/s10350-005-0146-1

    Article  CAS  PubMed  Google Scholar 

  12. Phan K, Oh L, Ctercteko G, Pathma-Nathan N, El Khoury T, Azam H, Wright D, Toh JWT (2019) Does a stoma reduce the risk of anastomotic leak and need for re-operation following low anterior resection for rectal cancer: systematic review and meta-analysis of randomized controlled trials. J gastrointest Oncol 10(2):179–187. https://doi.org/10.21037/jgo.2018.11.07

    Article  PubMed  PubMed Central  Google Scholar 

  13. Wu SW, Ma CC, Yang Y (2014) Role of protective stoma in low anterior resection for rectal cancer: a meta-analysis. World J Gastroenterol 20(47):18031–18037. https://doi.org/10.3748/wjg.v20.i47.18031

    Article  PubMed  PubMed Central  Google Scholar 

  14. Garg PK, Goel A, Sharma S, Chishi N, Gaur MK (2019) Protective Diversion Stoma in Low Anterior Resection for Rectal Cancer: A Meta-Analysis of Randomized Controlled Trials. Visceral Med 35(3):156–160. https://doi.org/10.1159/000497168

    Article  Google Scholar 

  15. 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(2):218–222. https://doi.org/10.1007/s10350-007-9101-7

    Article  PubMed  Google Scholar 

  16. Baloyiannis I, Perivoliotis K, Diamantis A, Tzovaras G (2020) Virtual ileostomy in elective colorectal surgery: a systematic review of the literature. Tech Coloproctol 24(1):23–31. https://doi.org/10.1007/s10151-019-02127-2

    Article  CAS  PubMed  Google Scholar 

  17. Zenger S, Gurbuz B, Can U, Balik E, Yalti T, Bugra D (2021) Comparative study between ghost ileostomy and defunctioning ileostomy in terms of morbidity and cost-effectiveness in low anterior resection for rectal cancer. Langenbecks Arch Surg 406(2):339–347. https://doi.org/10.1007/s00423-021-02089-w

    Article  PubMed  Google Scholar 

  18. Mori L, Vita M, Razzetta F, Meinero P, D'Ambrosio G (2013) Ghost ileostomy in anterior resection for rectal carcinoma: is it worthwhile? Dis. Colon Rectum 56(1):29–34. https://doi.org/10.1097/DCR.0b013e3182716ca1

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India

    Sanjeev Patni, Nivedita Sharma, Nishith Modi & Anish Bhatia

  2. Present address: Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

    Nivedita Sharma

Authors
  1. Sanjeev Patni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nivedita Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nishith Modi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anish Bhatia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nivedita Sharma.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Patni, S., Sharma, N., Modi, N. et al. Ghost Stoma Solving the Dilemma of Diversion After Anterior Resection: Surgical Technique Description and Experience from a Single Centre. Indian J Surg Oncol 15, 53–58 (2024). https://doi.org/10.1007/s13193-023-01840-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13193-023-01840-7

Keywords

Search

Navigation