Ghost ileostomy in advanced ovarian cancer

Autores de IIS La Fe

• Víctor Lago Leal

  Autor

• Santiago Domingo Del Pozo

  Autor

• Luis Javier Matute Tobias

  Autor

• Pablo Padilla Iserte

  Autor

• Blas Flor Lorente

  Autor

• Álvaro García-Granero García-Fuster

  Autor

Grupos

• Cirugía digestiva y Cuidados perioperatorios

  

  Leader

  Matteo Frasson

• Medicina Reproductiva

  

  Investigador Principal

  José Morales Roselló

Abstract

Objective: To report the modified posterior pelvic exenteration (MPE) technique associated with ghost ileostomy (GI) in the treatment of advanced ovarian cancer. Methods: MPE is a common procedure to reach an optimal cytoreduction and is required in both initial and interval surgery. The purpose of this operation is to remove the uterus, tubes, ovaries, rectosigmoid colon and all the parametrial tissue from the uterus to the pelvic wall. Low colorectal end-to-end anastomosis is often performed [1]. As a result temporary protective stoma should be considered [2]. To avoid the morbidity associated to this procedure, GI [3] can be created to minimize the clinical impact of a real ileostomy. Results: GI technique description: after the main procedure, a portion of terminal ileum 20 cm distant from ileocecal valve is identified. A little orifice is dissected in the mesenteric border in order to pass a vessel-loop. The afferent portion of the terminal ileum is marked with a long stitch and the efferent side with a short stitch. The loop is placed like a percutaneous surgical drainage at the same point of the theoretical stoma and fixed with a stitch. During the post-operative course, two resources are used to detect subclinical leakage. CRP and Procalcitonin serum levels are monitored in 1 degrees and 3 degrees postoperative days (POD). If a rising in their values is found throughout time, GI is converted into a defunctioning ileostomy. A sequential post-operative rectoscopy is performed in 4 degrees-5 degrees POD. If an anastomotic leakage is found, GI is also converted into a defunctioning ileostomy. Whether CRP and Procalcitonin remains in a normal or decreasing range and no leakage is found in rectoscopy then oral intake is tolerated. Notwithstanding, in case of any suspicious symptoms of leakage the GI is reconverted. If the post-operative course remains uneventful, the loop is not removed until discharge from hospital (6 degrees-9 degrees POD). Conclusions: Not only GI may prevent the complications related to defunctioning ileostomy but also presents its advantages in case of anastomotic leakage.

Keywords

• Advanced ovarian cancer; Modified posterior exenteration; Ghost ileostomy