DOI: 10.7860/JCDR/2018/36482.

11847
Letter to Editor

Jategaonkar’s Modification of
Surgery Section

Brooke’s End-Ileostomy
Priyadarshan Anand Jategaonkar1, Smita PRIYADARSHAN JATEGAONKAR2, SUDEEP PRADEEP YADAV3

Keywords: Ileostomy, Surgery, Stoma, Modification

Sir, seepage of enteral contents, thereby dislodgement of stoma

Since its inception in the year 1952, Brooke’s ileostomy has remained appliance that could lead to further leakage and multiple bag
a standardised and widely practiced method of faecal diversion [1]. exchanges; 3) On long run, it is potentially cost-effective; this is
However, despite all the precautions, as high as 76% ileostomies particularly crucial for resource-limited countries; 4) Unlike traditional
develop long-term morbid complications (skin excoriation being stoma, its non-dependant bowing configuration tends to prevent
significantly common) which adversely affect the quality of life of mucosal prolapsed; 5) Its simple to learn even by the junior-most
these individuals [2,3]. At times, this may even necessitate stoma member of surgical team; the learning curve for our postgraduates
relocation [4]. Thus, for improvised outcomes, some efficient and is just 3 cases; 6) It continues to maintain these benefits even
robust modification in the hitherto-used technique seems the need when patient is fully ambulatory; 7) It may be similarly employed in
of the hour. In that context, we propose some modifications in the emergency settings; 8) It is a fail-safe method for ill-fitting devices; 9)
conventional Brooke’s end-ileostomy. It could be favourably implemented in obese individuals; 10) It can
be applied to colostomies as well as loop ileostomies; 11) Overall,
While the initial steps remain the same, our technique commences at
it likely improves patient’s self-image, removes social stigma and
maturing the ileostomy per-operatively. Herein, three 3/O absorbable
enhances quality of life. We have used this method in 110 cases
sutures are passed sequentially through the lateral cut-edge of the
without any complications. It has received encouraging positive
ileum (full-thickness), the corresponding ileal wall (sero-muscular, 1
feedback from stoma-nurses and therapists locally. Therefore, we
cm proximal to the cut-margin) and then via subcuticular tissue of
recommend it for regular use.
the stoma incision. Remaining sutures remain as for the standard
Brooke’s ileostomy [Table/Fig-1]. Once tied, these sutures evert the
bowel wall around its circumference in a peculiar fashion to achieve
REFERENCES
[1] Marsh P, Clark JS. The spouted colostomy. Ann R Coll Surg. Engl.
lateral bowing of the stoma [Table/Fig-2]. Now, the external stoma 2007;89(1):78.
device may be secured as usual. [2] Jayarajah U, Samarasekara AM, Samarasekera DN. A study of long-term
complications associated with enteral ostomy and their contributory factors.
Our technique has several advantages: 1) It ensures effective BMC Res Notes. 2016;9(1):500.
drainage of projectile as well as non-projectile components of [3] Schiergens TS, Hoffmann V, Schobel TN, Englert GH, Kreis ME, Thasler WE, et
typically voluminous enteric effluent, thereby keeping the peristomal al. Long-term quality of life of patients with permanent end ileostomy: results of a
nationwide cross-sectional survey. Dis Colon Rectum. 2017;60(1):51-60.
skin free of chemical excoriation, especially in early post-operative [4] Dodd BR, Mccallion K. Iieostomy efferent limb prolapse: a temporising measure.
period when patient remains mostly bedridden; 2) It avoids under- Ann R Coll Surg Engl. 2007;89(5):534-35.

[Table/Fig-2]: Final appearance of modified ileostomy. Note that, the direction

[Table/Fig-1]: Schematic representation of constructing Jategaonkar’s modified of the effluent ejection from the traditional ileostomy (vertical white arrow) differs
end-ileostomy: (a) Suture-pathways. Note that, in modified approach, the sero- largely from that of the modified ileostomy (horizontal white arrow). The projectile
muscular bytes (□) are taken half-way between the cut-margin of the bowel and (upper oblique arrow) and the non-projectile (lower oblique arrow) intestinal effluents
the conventional byte-points (•) in order to accomplish an outwardly angulated produce a resultant horizontal vector that leads to effective drainage of the stoma-
spigot; (b) Geometry of the circumferential bytes. Note that the modified bytes (□) are output; 2) Stoma at post-operative day-7. Note that the typical “stooping” nature of
segregated in the lateral 45 degrees and the conventional bytes (•) are spread over the ileostomy keeps the surrounding skin totally free of chemical dermatitis. And, the
the remaining 315 degrees of the bowel circumference; this minimises the peristomal flange-imprint of the stoma appliance denotes complete dryness of the peristomal
skin area amenable to excoriation. skin. Further note that, the healthy stoma indicates preserved vascularity post
modified bytes.

PARTICULARS OF CONTRIBUTORS:
1. Professor, Department of General Surgery, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India.
2. Assistant Professor, Department of Pediatrics, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India.
3. Senior Resident, Department of Plastic and Reconstructive Surgery, Grant’s Government Medical College & Sir J.J. Group of Hospitals, Mumbai, Maharashtra, India.

NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR:

Dr. Priyadarshan Anand Jategaonkar,
E-4, Senior Staff Quarter, MGIMS, Medical Square, Sewagram-442102, Wardha, Maharashtra, India. Date of Submission: Mar 20, 2018
E-mail: [email protected] Date of Peer Review: Apr 30, 2018
Date of Acceptance: May 03, 2018
Financial OR OTHER COMPETING INTERESTS: None. Date of Publishing: Aug 01, 2018

Journal of Clinical and Diagnostic Research. 2018 Aug, Vol-12(8): PL01 1