Feasibility and efficacy of ghost ileostomy in typhoid ileal perforations: A prospective observational study

Abstract

Loop ileostomy is commonly performed for typhoid ileal perforations as temporary faecal diversion. This is associated with several stoma-related complications and also requires further surgery for its closure. Thus, we were prompted to conduct a prospective observational study on the safety, feasibility and efficacy of ghost ileostomy in typhoid ileal perforations. After dealing with the perforation, a ghost ileostomy was performed in 10 selected patients with favourable circumstances; otherwise, a conventional loop ileostomy was performed in 19 patients. The two groups were comparable (p > 0.05) for morbidity and mortality except for stoma-related complications, seen only in the loop ileostomy group. Body weight was better preserved in the ghost ileostomy group. One patient in the ghost ileostomy group required conversion to loop ileostomy owing to signs of intra-peritoneal suture leak, without any detriment to outcome. Our study shows safety, feasibility and efficacy of ghost ileostomy in selected patients with typhoid ileal perforations, thus avoiding loop ileostomy in one-third of patients.

Outcomes of Early Versus Late Reversal in Patients with Loop Ileostomy Formation Secondary to Typhoid Perforation

“…Early closure was performed at a median time of 6 (4-6) weeks, while 12 (12)(13)(14) weeks was the median for late closure. 1 , n (%) HTN 2 , n (%) CKD 3 , n (%) CVD 4 , n (%) CLD 5 , n (%) Significant variance in ASA Grade was noted between the two groups, with no group reporting a value greater than Grade 2 (P-Value=0.005). A lower grade was observed in the patients who had undergone early closure compared to those undergoing a late closure.…”

“…The incidence of postoperative complications in the late group surpassed the incidence of complications of the early group, with 26 out of 50 patients showing complications in the late reversal group, whereas only 12 out of 50 patients showed complications in the early reversal group with a significant p-value of 0.004. The median day at which post-operative complication occurred was calculated as 4.5 (3)(4)(5)(6) in the early group and 3 (3)(4)(5) in the late group with a p-value of 0.038, which is statistically significant. Paralytic ileus accounted for the most common surgical complication in the early group before discharge.…”

“…An ileostomy is a surgical procedure in which the lumen of the ileum, a part of the small intestine, is used to form the stoma. In regions where intestinal perforation secondary to typhoid is a usual complication, loop ileostomy is opted for in complicated cases as a contemporary route of fecal diversion 3 . A loop ileostomy is performed to bypass intestinal content to the exterior in the setting of distal colorectal anastomosis 4 .…”

“…Diabetes Mellitus,2 Hypertension,3 Chronic Kidney Disease,4 Cerebrovascular Disease,5 Chronic Liver Disease…”

Defunctioning ileostomy for typhoid ileal perforations: Out of the frying pan into the fire?

“…14 1. Notable techniques such as 'Ghost Ileostomy' are now available. 15 There is a definite need to define objectively the indications for DI, perhaps by a simple user-friendly scoring system. 5,6 The old philosophy of making a DI in cases of TIP should be re-examined as DI is not a panacea; on the contrary it brings its own set of significant problems.…”