Our Summary

This study aimed to determine if a surgical procedure called ‘ghost ileostomy’ is a safe alternative to the standard procedure of ‘conventional loop ileostomy’ for patients who are having a specific type of surgery, known as low anterior resection with total mesorectal excision, for rectal cancer.

The researchers randomly assigned patients to receive either the ghost ileostomy or the conventional loop ileostomy during their surgery. They then monitored their recovery over the next 6 months, looking at complications, the need to convert the ghost ileostomy to a conventional loop ileostomy, whether the patients still had an ostomy (a surgically created opening in the body for waste disposal) at 6 months, bowel control, and quality of life.

The trial was stopped early due to slow recruitment and included 30 patients. The results showed that there were no significant differences in complications or quality of life between the two procedures. The ghost ileostomy procedure was converted to a conventional loop ileostomy in 40% of patients.

The researchers concluded that ghost ileostomy could be a viable and safe alternative to the conventional loop ileostomy. However, they noted the challenge of selecting the right patients for the procedure, as those at high risk for leakage at the surgical site may not be suitable. They suggested that future research is needed to improve patient selection.

FAQs

  1. What is the purpose of the ‘ghost ileostomy’ procedure in this study?
  2. How was the recovery of patients who underwent ‘ghost ileostomy’ compared to those who had ‘conventional loop ileostomy’?
  3. What did the researchers conclude about the safety and viability of the ‘ghost ileostomy’ as an alternative to ‘conventional loop ileostomy’?

Doctor’s Tip

A helpful tip a doctor might tell a patient about proctectomy is to make sure to follow post-operative care instructions closely, including proper wound care, managing pain effectively, and gradually resuming normal activities as advised by your healthcare team. It’s also important to attend follow-up appointments to monitor healing progress and address any concerns or complications that may arise. Lastly, maintaining a healthy diet and staying hydrated can help support the healing process and overall recovery after proctectomy surgery.

Suitable For

Patients who are typically recommended for proctectomy, particularly low anterior resection with total mesorectal excision for rectal cancer, may include:

  1. Patients with rectal cancer who have not responded to other treatments such as chemotherapy or radiation therapy.
  2. Patients with advanced stage rectal cancer that has spread to nearby tissues or lymph nodes.
  3. Patients with a history of inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease, that has led to complications such as fistulas or strictures in the rectum.
  4. Patients with familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (HNPCC) who have a high risk of developing colorectal cancer.
  5. Patients with severe rectal prolapse or persistent rectal bleeding that cannot be managed with other treatments.
  6. Patients with recurrent or persistent rectal abscesses or fistulas that do not respond to conservative management.

Ultimately, the decision to recommend proctectomy will depend on the individual patient’s specific condition, overall health, and treatment goals. It is important for patients to discuss their options with a qualified healthcare provider to determine the most appropriate course of treatment for their unique situation.

Timeline

  • Before proctectomy:
  1. Patient is diagnosed with rectal cancer and undergoes various tests and consultations to determine the best course of treatment.
  2. Patient undergoes preoperative preparation, which may include bowel preparation, dietary restrictions, and stopping certain medications.
  3. Patient undergoes proctectomy surgery, which involves removal of the rectum and possibly other nearby structures.
  4. During surgery, the surgeon decides whether to create a ghost ileostomy or a conventional loop ileostomy for waste disposal.
  5. Patient is monitored closely for complications during the immediate postoperative period.
  • After proctectomy:
  1. Patient is monitored in the hospital for a few days to ensure proper healing and recovery.
  2. Patient may experience temporary side effects such as pain, fatigue, and changes in bowel function.
  3. Patient may be discharged from the hospital with instructions for wound care, dietary restrictions, and activity level.
  4. Patient follows up with their healthcare team for regular check-ups and monitoring of their recovery.
  5. Patient may undergo further treatment such as chemotherapy or radiation therapy, if needed.
  6. Patient gradually resumes normal activities and adjusts to life with an ostomy, if one was created.
  7. Patient may experience long-term effects such as changes in bowel habits, sexual function, and quality of life.
  8. Patient may require ongoing support and follow-up care to manage any complications or concerns.

What to Ask Your Doctor

Some questions a patient should ask their doctor about proctectomy include:

  1. What is the reason for recommending a proctectomy?
  2. What are the potential risks and complications associated with the procedure?
  3. How long is the recovery period expected to be after a proctectomy?
  4. Will I need to have an ostomy (such as a colostomy or ileostomy) after the surgery?
  5. What are the long-term effects of having an ostomy?
  6. Will I need any additional treatments or therapies after the proctectomy?
  7. What is the success rate of the procedure in terms of removing the cancer or treating the condition?
  8. How will the proctectomy affect my bowel control and quality of life?
  9. Are there any alternative treatments or procedures that could be considered?
  10. How experienced are you in performing proctectomies and what is your success rate with this procedure?

Reference

Authors: Hüttner FJ, Probst P, Mihaljevic AL, Sauer LD, Doerr-Harim C, Ulrich A, Stratmeyer S, Klotz R, Diener MK, Knebel P. Journal: Langenbecks Arch Surg. 2024 Nov 9;409(1):341. doi: 10.1007/s00423-024-03530-6. PMID: 39520543