421P Ghost stoma – solving the dilemma of diversion after anterior resection: A single centre experience from India

Abstract

Anastomotic leak is one of the most dreaded complication after anterior resection(AR) with leak rates ranging from 3 - 20 %. To avoid such leaks, many surgeons routinely perform diversion stoma after AR. However, stomas are associated with their own set of complications leading to decreased quality of life. Thus, to do prophylactic stoma or not is a matter of constant dilemma that most surgeons face. Ghost Stoma is a technique where in unnecessary prophylactic stoma can be avoided while ensuring that a diversion stoma can be created if need arises without the need of general anaesthesia. Surgical Technique: Ghost Stoma techniques done by pulling a loop of intestine up to parietal peritoneal layer of anterior abdominal wall with the help of silicone/ plastic tube at the time of anterior resection. If an anastomotic leak is detected in postoperative period, same loop of bowel can be pulled out and fashioned into stoma under local anaesthesia. Study Design: A retrospective analysis of all the cases who underwent this procedure between January 2015 to December 2019 was done. Total 68 patients underwent AR with ghost stoma at our institute during specified time period. Total 7 patients required creation of functional stoma post-operatively for suspected or confirmed leak and was done under local anesthesia in all patients. One patient had congestion of stoma due to rotation of mesentery and required refashioning of stoma under regional anesthesia. Rest of the patients had the plastic tube removed at around 2 weeks. However, none of the patients required re-laparotomy or peritoneal wash under general anaesthesia. None of the patients had any complication due to plastic tube like bowel rotation, obstruction, strangulation, adhesion, stricture or tube migration. Ghost Stoma is a very simple & safe procedure which can decrease the need of prophylactic diversion stoma in most cases of AR. It is technically easy, oncologically safe, decreases intraoperative time & also prevents patient from morbidity as well as psychological and financial burden of stoma. Using this technique unnecessary stoma could be avoided in >80 % patients of AR in this series.