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Ghost ileostomy in advanced ovarian cancer
YGYNO-976855; No. of page: 1; 4C: Gynecologic Oncology xxx (2017) xxx
Contents lists available at ScienceDirect
Gynecologic Oncology journal homepage: www.elsevier.com/locate/ygyno
Surgical Film
Ghost ileostomy in advanced ovarian cancer Víctor Lago a,⁎, Santiago Domingo a, Luis Matute a, Pablo Padilla a, Blas Flor b, Álvaro García-Granero b a b
Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain Department of Surgery, University Hospital La Fe, Valencia, Spain
a r t i c l e
i n f o
Article history: Received 23 May 2017 Received in revised form 10 August 2017 Accepted 16 August 2017 Available online xxxx Keywords: Advanced ovarian cancer Modified posterior exenteration Ghost ileostomy
rising in their values is found throughout time, GI is converted into a defunctioning ileostomy. A sequential post-operative rectoscopy is performed in 4°–5° 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°–9° POD). Conclusions: Not only GI may prevent the complications related to defunctioning ileostomy but also presents its advantages in case of anastomotic leakage.
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° and 3° postoperative days (POD). If a
Conflict of interest The authors report no conflicts of interest. Appendix A. Supplementary data Supplementary data to this article can be found online at http://dx. doi.org/10.1016/j.ygyno.2017.08.017. REFERENCES [1] J.H. Tseng, R.S. Suidan, O. Zivanovic, G.J. Gardner, Y. Sonoda, D.A. Levine, et al., Divertin ileostomy during primary debulking surgery of ovarian cancer: associated factors and postoperative outcome, Gynecol. Oncol. 142 (2016) 217–224. [2] K.F. Güenaga, S.A.S. Lustosa, S.S. Saad, H. Saconato, D. Matos, Ileostomy or colostomy for temporary decompression of colorectal anastomosis, Cochrane, 2008. [3] M. Miccini, S.A. Bonapasta, M. Gragori, P. Barillari, A. Tocchi, Ghost ileostomy: real and potential advantages, Am. J. Surg. 200 (2010) 55–57.
⁎ Corresponding author at: Avinguda de Fernando Abril Martorell, 106, 46026 València, F Tower, 3rd Floor, Spain. E-mail address: [email protected] (V. Lago).
http://dx.doi.org/10.1016/j.ygyno.2017.08.017 0090-8258/© 2017 Elsevier Inc. All rights reserved.
Please cite this article as: V. Lago, et al., Ghost ileostomy in advanced ovarian cancer, Gynecol Oncol (2017), http://dx.doi.org/10.1016/ j.ygyno.2017.08.017
Contents lists available at ScienceDirect
Gynecologic Oncology journal homepage: www.elsevier.com/locate/ygyno
Surgical Film
Ghost ileostomy in advanced ovarian cancer Víctor Lago a,⁎, Santiago Domingo a, Luis Matute a, Pablo Padilla a, Blas Flor b, Álvaro García-Granero b a b
Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain Department of Surgery, University Hospital La Fe, Valencia, Spain
a r t i c l e
i n f o
Article history: Received 23 May 2017 Received in revised form 10 August 2017 Accepted 16 August 2017 Available online xxxx Keywords: Advanced ovarian cancer Modified posterior exenteration Ghost ileostomy
rising in their values is found throughout time, GI is converted into a defunctioning ileostomy. A sequential post-operative rectoscopy is performed in 4°–5° 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°–9° POD). Conclusions: Not only GI may prevent the complications related to defunctioning ileostomy but also presents its advantages in case of anastomotic leakage.
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° and 3° postoperative days (POD). If a
Conflict of interest The authors report no conflicts of interest. Appendix A. Supplementary data Supplementary data to this article can be found online at http://dx. doi.org/10.1016/j.ygyno.2017.08.017. REFERENCES [1] J.H. Tseng, R.S. Suidan, O. Zivanovic, G.J. Gardner, Y. Sonoda, D.A. Levine, et al., Divertin ileostomy during primary debulking surgery of ovarian cancer: associated factors and postoperative outcome, Gynecol. Oncol. 142 (2016) 217–224. [2] K.F. Güenaga, S.A.S. Lustosa, S.S. Saad, H. Saconato, D. Matos, Ileostomy or colostomy for temporary decompression of colorectal anastomosis, Cochrane, 2008. [3] M. Miccini, S.A. Bonapasta, M. Gragori, P. Barillari, A. Tocchi, Ghost ileostomy: real and potential advantages, Am. J. Surg. 200 (2010) 55–57.
⁎ Corresponding author at: Avinguda de Fernando Abril Martorell, 106, 46026 València, F Tower, 3rd Floor, Spain. E-mail address: [email protected] (V. Lago).
http://dx.doi.org/10.1016/j.ygyno.2017.08.017 0090-8258/© 2017 Elsevier Inc. All rights reserved.
Please cite this article as: V. Lago, et al., Ghost ileostomy in advanced ovarian cancer, Gynecol Oncol (2017), http://dx.doi.org/10.1016/ j.ygyno.2017.08.017