Профилактика осложнений тонко-толстокишечных анастомозов в условиях перитонита

Abstract

Th e aim of the research. To improve treatment outcomes for patients requiring formation of entero-colonic anastomoses using a new method for prevention of their leakage. Material and methods. A total of 60 patients operated on for peritonitis who potentially required entero-colonic anastomosis were divided into 2 groups. Th e retrospective comparison group included 33 subjects and 27 subjects were enrolled into the prospective main group. Anastomoses for patients in the main group were formed according to the proprietary method that improves blood fl ow along the suture line. Th e method consisted in the following: the leading segment of the small intestine was crossed at an angle of 50-60° to its mesenteric edge. Th e colon stump was also formed by crossing at an angle of 50-60° to its mesenteric edge; a “window” was cut in the antimesenteric part of the colon wall: an oval-shaped area with an area corresponding to the cross-sectional area of the small intestine, the end of the small intestine was connected to the oval hole in the colon “end to side” using a single-row continuous intestinal suture. Primary endpoint: development of leakage in the formed entero-colonic anastomosis. Secondary endpoint: mortality of patients in the postoperative period until discharge from the hospital. Results. Th e proportion of leakage amounted to 3.7% in the main group, and 33.3 % in the comparison group (p=0.007). Th e mortality was 7.4 % and 36.3 %, respectively (p=0.012). Conclusion. The proposed technique for entero-colonic anastomosis formation has advantages due to a signifi cant reduction in the frequency of fistula leakage and mortality