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Ghost Ileostomy in Anterior Resection for Bowel Endometriosis: Technical Description.
Ferreira, Hélder; Smith, Andres Vigueras; Vilaça, Jaime.
  • Ferreira H; Department of Minimally Invasive Gynecologic Surgery, Centro Hospitalar Universitário do Porto, University of Porto (Drs. Ferreira and Vigueras Smith). Electronic address: helferreira@hotmail.com.
  • Smith AV; Department of Minimally Invasive Gynecologic Surgery, Centro Hospitalar Universitário do Porto, University of Porto (Drs. Ferreira and Vigueras Smith).
  • Vilaça J; General Surgery Department, Hospital da Luz Arrábida (Dr. Vilaça), Porto, Portugal.
J Minim Invasive Gynecol ; 27(5): 1014-1016, 2020.
Article in English | MEDLINE | ID: covidwho-1454309
Semantic information from SemMedBD (by NLM)
1. Intestines LOCATION_OF Endometriosi
Subject
Intestines
Predicate
LOCATION_OF
Object
Endometriosi
2. Excision TREATS Endometriosi
Subject
Excision
Predicate
TREATS
Object
Endometriosi
3. BOWEL RESECTION TREATS Nodule
Subject
BOWEL RESECTION
Predicate
TREATS
Object
Nodule
4. Organ LOCATION_OF Injury
Subject
Organ
Predicate
LOCATION_OF
Object
Injury
5. Excision AFFECTS Endometriosi
Subject
Excision
Predicate
AFFECTS
Object
Endometriosi
6. Intestines PART_OF Woman
Subject
Intestines
Predicate
PART_OF
Object
Woman
7. Vaginal mucous membrane PART_OF Woman
Subject
Vaginal mucous membrane
Predicate
PART_OF
Object
Woman
8. Ileostomy PREVENTS Complication
Subject
Ileostomy
Predicate
PREVENTS
Object
Complication
9. Ileostomy PREVENTS Extravasation
Subject
Ileostomy
Predicate
PREVENTS
Object
Extravasation
10. General surgeon DIAGNOSES Endometriosi
Subject
General surgeon
Predicate
DIAGNOSES
Object
Endometriosi
11. Dissection USES Scissors
Subject
Dissection
Predicate
USES
Object
Scissors
12. Dysmenorrhea PROCESS_OF Woman
Subject
Dysmenorrhea
Predicate
PROCESS_OF
Object
Woman
13. Dyschezia PROCESS_OF Woman
Subject
Dyschezia
Predicate
PROCESS_OF
Object
Woman
14. Rectal hemorrhage PROCESS_OF Woman
Subject
Rectal hemorrhage
Predicate
PROCESS_OF
Object
Woman
15. Deep pain on intercourse PROCESS_OF Woman
Subject
Deep pain on intercourse
Predicate
PROCESS_OF
Object
Woman
16. Intestines LOCATION_OF End-to-end anastomosis
Subject
Intestines
Predicate
LOCATION_OF
Object
End-to-end anastomosis
17. Mesentery LOCATION_OF Ileal Loop
Subject
Mesentery
Predicate
LOCATION_OF
Object
Ileal Loop
18. BOWEL RESECTION PRECEDES Colorectostomy
Subject
BOWEL RESECTION
Predicate
PRECEDES
Object
Colorectostomy
19. Intestines LOCATION_OF Endometriosis, site unspecified
Subject
Intestines
Predicate
LOCATION_OF
Object
Endometriosis, site unspecified
20. Excision TREATS Endometriosis, site unspecified
Subject
Excision
Predicate
TREATS
Object
Endometriosis, site unspecified
21. BOWEL RESECTION TREATS Nodule
Subject
BOWEL RESECTION
Predicate
TREATS
Object
Nodule
22. Organ LOCATION_OF Injury
Subject
Organ
Predicate
LOCATION_OF
Object
Injury
23. Excision AFFECTS Endometriosis, site unspecified
Subject
Excision
Predicate
AFFECTS
Object
Endometriosis, site unspecified
24. Intestines PART_OF Woman
Subject
Intestines
Predicate
PART_OF
Object
Woman
25. Vaginal mucous membrane PART_OF Woman
Subject
Vaginal mucous membrane
Predicate
PART_OF
Object
Woman
26. Ileostomy PREVENTS Complication
Subject
Ileostomy
Predicate
PREVENTS
Object
Complication
27. Ileostomy PREVENTS Extravasation
Subject
Ileostomy
Predicate
PREVENTS
Object
Extravasation
28. General surgeon DIAGNOSES Endometriosis, site unspecified
Subject
General surgeon
Predicate
DIAGNOSES
Object
Endometriosis, site unspecified
29. Dissection USES Scissors
Subject
Dissection
Predicate
USES
Object
Scissors
30. Dysmenorrhea PROCESS_OF Woman
Subject
Dysmenorrhea
Predicate
PROCESS_OF
Object
Woman
31. Dyschezia PROCESS_OF Woman
Subject
Dyschezia
Predicate
PROCESS_OF
Object
Woman
32. Rectal hemorrhage PROCESS_OF Woman
Subject
Rectal hemorrhage
Predicate
PROCESS_OF
Object
Woman
33. Deep pain on intercourse PROCESS_OF Woman
Subject
Deep pain on intercourse
Predicate
PROCESS_OF
Object
Woman
34. Intestines LOCATION_OF End-to-end anastomosis
Subject
Intestines
Predicate
LOCATION_OF
Object
End-to-end anastomosis
35. Mesentery LOCATION_OF Ileal Loop
Subject
Mesentery
Predicate
LOCATION_OF
Object
Ileal Loop
36. BOWEL RESECTION PRECEDES Colorectostomy
Subject
BOWEL RESECTION
Predicate
PRECEDES
Object
Colorectostomy
ABSTRACT

OBJECTIVE:

To demonstrate our application of the ghost ileostomy in the setting of laparoscopic segmental bowel resection for symptomatic bowel endometriosis nodule.

DESIGN:

Technical step-by-step surgical video description (educative video)

SETTING:

University Tertiary Hospital. Institutional Review Board ruled that approval was not required for this study. Endometriosis affects the bowel in 3% to 37% of all cases, and in 90% of these cases, the rectum or sigmoid colon is also involved. Infiltration up to the rectal mucosa and invasion of >50% of the circumference have been suggested as an indication for bowel resection [1]. Apart from general risks (bleeding, infection, direct organ injuries) and bowel and bladder dysfunctions, anastomotic leakage is one of the most severe complications. In women with bowel and vaginal mucosa endometriosis involvement, there is a risk of rectovaginal fistula after concomitant rectum and vagina resections. Hence, for lower colorectal anastomosis, the use of temporary protective ileostomy is usually recommended to prevent these complications but carries on stoma-related risks, such as hernia, retraction, dehydration, prolapse, and necrosis. Ghost ileostomy is a specific technique, first described in 2010, that gives an easy and safe option to prevent anastomotic leakage with maximum preservation of the patient's quality of life [2]. In case of anastomotic leakage, the ghost (or virtual) ileostomy is converted, under local anesthesia, into a loop (real) ileostomy by extracting the isolated loop through an adequate abdominal wall opening. In principle, avoiding readmission for performing the closure of the ileostomy, with all the costs related, means a considerable saving for the hospital management. Also, applying a protective rectal tube in intestinal anastomosis may have a beneficial effect [3]. These options are performed by general surgeons in oncological scenarios, but their use in endometriosis has never been described.

INTERVENTIONS:

In a 32-year-old woman with intense dysmenorrhea, deep dyspareunia, dyschesia, and cyclic rectal bleeding, a complete laparoscopic approach was performed using blunt and sharp dissection with cold scissors, bipolar dissector and a 5-mm LigaSure Advance (Covidien, Valley lab, Norwalk, Connecticut). An extensive adhesiolysis restoring the pelvic anatomy and endometriosis excision was done. Afterward, the segmental bowel resection was performed using linear and circular endo-anal stapler technique with immediate end-to-end bowel anastomosis and transit reconstitution. Once anastomosis was done, the terminal ileal loop was identified, and a window was made in the adjacent mesentery. Then, an elastic tape (vessel loop) was passed around the ileal loop, brought out of the abdomen through the right iliac fossa 5-mm port site incision and, fixed to the abdominal wall using nonabsorbable stitches. Finally, a trans-anal tube was placed for 5 days. The patient was discharged on the fifth day postoperatively without any complications. The tape was removed 10 days after surgery, and the loop dropped back. Two months after the intervention, the patient remains asymptomatic.

CONCLUSION:

Ghost ileostomy is a simple, safe, and feasible technique available in the setting of lower colorectal anastomosis following bowel endometriosis resection.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Ileostomy / Laparoscopy / Endometriosis / Intestinal Diseases Type of study: Etiology study Topics: Long Covid Limits: Adult / Female / Humans Language: English Journal: J Minim Invasive Gynecol Journal subject: Gynecology Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Ileostomy / Laparoscopy / Endometriosis / Intestinal Diseases Type of study: Etiology study Topics: Long Covid Limits: Adult / Female / Humans Language: English Journal: J Minim Invasive Gynecol Journal subject: Gynecology Year: 2020 Document Type: Article