Technique of Ghost (Khatith) Ileostomy: Our Experience and Guidelines

The concept of ghost ileostomy (GI) or Khatith (meaning ‘hidden’ in the Kashmiri language) ileostomy is a bridge between covering ileostomy (CI) and no ileostomy. Methods: To evaluate the feasibility and the eventual advantages and disadvantages of GI, we carried out a prospective case-control study of GI vs. CI in restorative colorectal resections for rectal carcinoma. We divided restorative colorectal resection patients into two groups, i.e., a GI group (33 patients) and a CI group (29 patients). Postoperatively, the two groups were studied with respect to complications, mortality, morbidity, cost, hospital stay, the conversion rate of GI, and the operating time. We also provided our instructions and guidelines for performing the GI. Results: According to our findings, the GI group was characterized by a shorter mean operating time, shorter overall hospital stay, decreased total morbidity, decreased overall treatment cost, and higher rates of stoma-free life of the patient as compared to the CI group. There was no statistically significant difference in the patients of the two groups concerning the start of oral liquids, drain removal, and anastomotic leakage (AL) rate. Conclusion: The GI prevents the creation of a formal covering loop ileostomy in more than 80% of patients undergoing restorative colorectal resections for rectal carcinoma. The GI presents as an alternative to CI in patients at low or medium risk for AL. However, we should be cautious of creating the GI in patients with postneoadjuvant treatment status with a history of neutropenia or patients with malnutrition and hypoalbuminemia.