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

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.