Anastomosis Formation Research Articles

Pelvic drain after low anterior resection of the rectum: pros and cons

Low anterior resection, unlike other large bowel resections with anastomosis, is characterized by a high incidence of postoperative complications, repeated surgical interventions, accompanied by high mortality. To reduce these indicators, the creation of a protective stoma and drainage of the pelvis has become widespread. However, the efficiency of pelvic drainage after low anterior resection remains unclear and controversial. This literature review is devoted to the relevance of the problem of efficiency and analysis of studies on this issue. Most randomized trials have not proven the effectiveness of drainage in colorectal surgery, but in these studies, as a rule, little or no attention was paid to draining the small pelvis after total mesorectal excision. This work analyzes the studies of supporters and opponents of pelvic drainage after low anterior resection of the rectum and provides arguments for and against drainage of the pelvic cavity. Although there are randomized trials showing no benefit of pelvic drainage, many clinics use pelvic drain after low anterior resection. The personal experience of the surgeon and the occurrence of intraoperative complications such as bleeding, contamination, technical difficulties in colorectal anastomosis formation has an important role to play in this. A lower rate of repeated operation in the use of pelvic drainage suggests the possibility of conservative treatment.

The results of anterior rectal resection with the formation of a hardware anastomosis in cancer patients

Purpose of the study. A retrospective analysis of the immediate results of performing anterior rectal resections in cancer. Materials and methods. In the Department of Abdominal Oncology No. 1 with a group of X-ray vascular methods of diagnosis and treatment of the clinic of the National Medical Research Centre for Oncology of the Ministry of Health of Russia treatment for rectal cancer operations of anterior rectal resection were performed in 334 patients, while in 143 (42.8 %) cases they were low. As a standard, total mesenteric excision and lymphoid dissection in volume D2 were performed. Combined surgical interventions were performed in 68 (20.4 %) patients for locally spread tumors. As a rule, they were resection in nature and were performed with tumor infiltration of adjacent organs (bladder with ureters, ovaries, uterus, vagina, small intestine, abdominal wall). Colorectal anastomosis using crosslinking devices was formed in all cases, in 316 (94.6 %) cases it was a "side – to-end" junction, in 18 patients – "end-to-end". A preventive proximal intestinal stoma was formed in 73 (21.9 %) cases, where 67 cases it was an ileostomy, and 6 – a transversostomy. The preventive proximal intestinal stoma was not formed among 261 patients. Results. After performing anterior resections for rectal cancer operations, the complications developed in 75 (22.5 %) patients. The most threatening and dangerous complication was the failure of the colorectal anastomosis, which was noted in 12 (3.5 %) cases.This complication occurred in 8.2 % (6 patients out of 73) of preventatively stoma-treated patients, in 2.3 % of patients without a stoma (6 patients out of 261).Conclusion. The use of a preventive proximal intestinal stoma allows you to form a colorectal anastomosis even in the presence of complicated forms of rectal cancer. The number of complications directly referred to the formation of a preventive proximal intestinal stoma is relatively small, but when planning surgery for uncomplicated rectal cancer, the probability of their possible occurrence should be taken into account.

Justification of the diagnostic algorithm and treatment strategies in patients with severe chronic slow-transit constipation

Surgical treatment of patients with chronic slow-transit constipation leads to unsatisfactory results in almost a third of cases. It appears relevant to the search for the causes of unsatisfactory results of surgical interventions in such patients and the need to develop a rational diagnostic algorithm; its implementation will allow us to determine the indications for surgical treatment and justify the volume of colon resection. For this purpose, the results of the examination and treatment of 53 patients with constipation were analyzed. The median disease duration was 15 years, and the median duration of constipation was 6.2 1.6 days. Patients were divided into a group with a positive effect of conservative treatment and a group without the expected effect. The symptoms, results of laboratory tests of blood and feces, and instrumental studies of the colon were analyzed. A balloon expulsion test was used to exclude proctogenic constipation. The evacuation function of the colon was studied by X-ray examination, while the transit time of barium sulfate or X-ray contrast markers through the gastrointestinal tract was estimated. Twenty-four patients underwent surgery for chronic slow-transit constipation, while the sigmoid colon was removed in one patient, including 7-left-sided hemicolectomy and 16-subtotal resection of the colon. Long-term results were examined in the period from 3 to 6 months after surgery. In the total examination of the semiotics of chronic slow-transit constipation, the results did not show significant differences between the groups of patients and did not allow us to justify the stratification into severe and non-severe disease course by its specific symptoms. The use of X-ray contrast markers for the assessment of the state of the evacuation function of the colon makes it possible to quantify the severity of various motor disorders and justify the choice of the volume of its resection. The analysis of the long-term results of the treatment of patients with chronic slow-transit constipation allows us to conclude that segmental resections of the colon (left-sided hemicolectomy, resection of the sigmoid colon) have a good therapeutic effect if the preoperative examination revealed a segmental type of failure of the evacuation function of the colon, and subtotal resection of the colon is appropriate for the common type. The absence of negative results of surgical treatment of patients with chronic slow-transit constipation, in which the formation of a colonic anastomosis was performed with a short stump of the sigmoid colon, indicates the possibility of using this option to complete the surgical intervention.

Y-en-Roux reconstruction in abdominal surgery: historical retrospective of operative method’s evolution. Part II

This historical review is more focused on the analysis of highly relevant, unique method proposed by A. Wölfl er, E. Doyen and C. Roux more than 140 years ago. We also try to present main facts and the chronology of Y-reconstruction of the digestive tube concept’s development. Hereby we present historical retrospective of theoretic concept creation, experimental confi rmation and initial clinical experience of Y-shaped reconstruction of the digestive tube on Roux-en-Y-loop, stages of concept evolution and development from the end of the 19th century and continuing into current times. Scientifi c research of surgical gastroenterology, oncology, pancreatology and hepatobiliary surgery founders, expand application of Roux-en-Y-reconstruction from distal resection of the stomach and gastroenterostomy to gastrectomy, repeated operations on the upper part of the digestive tube, the formation of biliary-enteric and pancreatic anastomosis, and the use in the routine practice of bariatric surgery.

Selective laryngeal reinnervation for management of bilateral vocal cord paralysis

The surgical treatment of bilateral vocal fold paralysis should pro-vide patients with breathing comfort and adequate vocal function without the risk of foreign body aspiration. Bilateral selective la-ryngeal reinnervation appears to fulfill the above criteria while being an innovative method which opens up new horizons while not precluding the option of traditional static surgeries being car-ried out to expand the rima glottidis in cases of previous treatment failure. Proper selection of patients including detailed diagnostic tests is important for the success of the treatment. Selective rein-nervation of posterior cricoarytenoid muscles facilitates the ab-duction of vocal folds upon breathing. Reconstruction of the se-parate innervation of laryngeal muscles prevents the adduction of vocal folds upon inspiration while simultaneously preventing their atrophy and ensuring proper tension. Pulmonary function impro-vement is observed with good voice quality being maintained and no synkinesis being observed. However, selective laryngeal rein-nervation requires high precision and experience in the formation of microsurgical nerve anastomoses. Temporary tracheostomy is also required in patients. Transient aspiration may occur following the procedure and should be prevented. </br> </br> As seen from the cited studies, long-term follow-up results are favorable and bilateral selective laryngeal reinnervation should be included in the protocols for the management of patients with bilateral vocal fold paralysis.

Abstract 84 - An illustrated description of a novel technique in uretero-ileal anastomosis formation

Abstract 84 - An illustrated description of a novel technique in uretero-ileal anastomosis formation

Intestinal anastomotic healing models during experimental colitis

BackgroundAnastomotic leakage represents a major complication following resections in colorectal surgery. Among others, intestinal inflammation such as in inflammatory bowel disease is a significant risk factor for disturbed anastomotic healing. Despite technical advancements and several decades of focused research, the underlying mechanisms remain incompletely understood. Animal experiments will remain the backbone of this research in the near future. Here, instructions on a standardized and reproducible murine model of preoperative colitis and colorectal anastomosis formation are provided to amplify research on anastomotic healing during inflammatory disease.MethodsWe demonstrate the combination of experimental colitis and colorectal anastomosis formation in a mouse model. The model allows for monitoring of anastomotic healing during inflammatory disease through functional outcomes, clinical scores, and endoscopy and histopathological examination, as well as molecular analysis.DiscussionPostoperative weight loss is used as a parameter to monitor general recovery. Functional stability can be measured by recording bursting pressure and location. Anastomotic healing can be evaluated macroscopically from the luminal side by endoscopic scoring and from the extraluminal side by assessing adhesion and abscess formation or presence of dehiscence. Histologic examination allows for detailed evaluation of the healing process.ConclusionThe murine model presented in this paper combines adjustable levels of experimental colitis with a standardized method for colorectal anastomosis formation. Extensive options for sample analysis and evaluation of clinical outcomes allow for detailed research of the mechanisms behind defective anastomotic healing.

Surgical Treatment of Cerebral Aneurysms in the Acute Period of Subarachnoid Hemorrhage: Long-Term Result

Surgical Treatment of Cerebral Aneurysms in the Acute Period of Subarachnoid Hemorrhage: Long-Term Result

Effect of Surgical Technique on the Microstructure and Microcirculation of the Small Intestine Stump during Delayed Anastomosis: Multimodal OCT Data.

The aim of the study was to use multimodal optical coherence tomography (MM OCT) to evaluate microstructure and microcirculation in the proximal and distal sections of the intestine relative to the resected area in acute mesenteric ischemia.Materials and MethodsThe study was carried out using three groups of male Wistar rats weighing 270–435 g (n=18). Acute occlusive arterial ischemia of the small intestine was initiated in all animals. After 80–90 min, the ischemic non-viable part of the intestine was resected, and the operation was completed by stoma exteriorization (group 1, n=6), by applying purse-string sutures (group 2, obstructive resection, n=6), or by internal drainage of the proximal and distal ends of the small intestine (group 3, bypass, n=6). Relaparotomy and anastomosis formation were performed 2 days later.With the help of MM OCT at each stage of the surgical intervention, images were obtained from the serous membrane side: the intestinal wall microstructure (layers) was viewed using cross-polarization OCT (CP OCT) and the intramural circulation — using optical coherent angiography (OCA). The MM OCT images obtained from the terminal intestine sections immediately after resection and 2 days later (before the anastomosis formation) were compared between the experimental groups, as well as with the pre-ischemic data (norm). All resected sections of the intestine were then histologically examined. The MM OCT data were compared with the histological and intravital macroscopy data.ResultsAs a result of studying the intestinal wall microstructure by in vivo CP OCT, it was found that during ostomy (group 1) and obstructive resection (group 2), the images showed signs of tissue edema and destructive changes in the mucous membrane that were confirmed histologically, while with bypass surgery (group 3), there were minimal changes as compared with the norm.According to the OCA data, on day 2 of ostomy in the proximal and distal segments of the intestine, there was a noticeable disappearance of small and medium blood vessels; mainly large arteries and veins could be visualized. Following obstructive resection (purse-string suturing) or bypass surgery, the most noticeable changes (a decrease in the number of visualized blood vessels) were observed in the distal part of the intestine. The L index calculated from OCA images and characterizing the total length of the intramural perfused vasculature, showed a statistically significant decrease during ostomy: 12.18 [10.40; 14.20] μm — in the proximal and 10.67 [7.98; 13.05] μm — in the distal section; for comparison, the L index before ischemia was 18.90 [17.98; 19.73] μm and 18.74 [17.46; 19.90] μm, respectively (p=0.0001). In obstructive resection (group 2), statistically significant differences in the L parameter were found only for the distal bowel section: 16.39 [12.37; 18.10] μm compared with 18.74 [17.46; 19.90] μm before ischemia (p=0.041). After bypass surgery (group 3), there were no significant deviations in the L index.ConclusionBy using MM OCT, we found that in treating the remaining sections of the intestine after its emergency resection for acute mesenteric ischemia, the type of surgical technique determines the tissue structure in the period before the delayed anastomosis is applied.The least pronounced and most balanced changes occur in the proximal and distal segments of the intestine when operated using the bypass technique. However, to recommend this type of surgery, the development of reliable, safe, and effective bypass instruments is needed.

Treatment of renal hypertension during varicocele

Aim.To evaluate the results of treatment of renal hypertension in varicocele after the formation of the proximal intervenous anastomosis.Material and methods.A survey was conducted among 167 patients with varicocele aged 16 to 39 years. The evaluation of the Varicocele degree was made by the classification of the Amerla Cubin, which is used in the WHO Classification (1997). All patients had clinical signs of varicocele. Ipsilateral testicle hypotrophy was detected in 21 (12.6%) and hydrocele 6 (3.6%) patients. All patients before and after the operation went through the analysis of ejaculate.Results and discussion.The renotesticular hemodynamic type of varicocele was found in 115 (68.9%) of 167 surveyed patients. Varicocele of 1 degree was detected in 17 (14.8%) cases, 2 degrees in 31 (26.9%) and 3 degrees in 67 (58.3%) patients. With doppler ultrasonography of the veins of the spermatic cord, the inner diameter varied from 3 to 6 mm. On average, this value was 4.3±1.1 mm. All these patients received subinguinal varicocelectomy by Marmar. Therefore, the vein drainage operations to reduce renal hypertension was carried out for 65 (56.5%) patients.Conclusion.The formation of intervenous anastomoses is a pathogenetically justified method of treating regional venous renal hypertension in varicocele.

Pyloric atresia: authors’ clinical experience and literature review

Introduction. Congenital pyloric atresia is a rare malformation of the stomach outlet which amounts to about 1% of all atresias in the gastrointestinal tract. The gastric outlet atresia may be either isolated or combined with other abnormalities.Material and methods. There are few publications on the surgical treatment of pyloric atresia with extraluminal and intraluminal endoscopic interventions; however, at present information about it is not enough to assess their effectiveness and safety in young children. In literature, one can also find only few detailed reviews on clinical observations of pyloric atresia; most of which describe anatomical type I. Membranectomy and pyloroplasty are used for surgical treatment of pyloric atresia of type I. Surgery for pyloric atresias of types II and III which includes the resection in atresia zone and the formation of anastomosis between the stomach and duodenum causes complications due to the duodeno-gastric reflux in postoperative period. To prevent these complications, there is a surgical technique which was first described by A. Dessanti, et al. and later was modified and detailed by S. Yokoyama. This article is a literature overview on the topic and authors’ own experience in treating pyloric atresia of type II in 2 patients and of type I in one 1 patient.Conclusion. The choice of surgical approach depends on the anatomical type of pyloric atresia. Currently, there is no any unified approach to the surgical treatment of atresia of types II and III. Membranectomy and gastroduodenoanastomosis seem to be the most appropriate surgical techniques to correct this abnormality what has been confirmed by our preliminary findings.

Multiple intestinal anastomosis in newborns and infants

Introduction. The present trial systematizes data, taken from one surgical center as an example, on treating patients with intestinal atresia and necrotizing enterocolitis with multiple intestinal anastomoses.Material and methods. The trial is a retrospective review on the treatment of 13 newborn infants who since 2010 have been put multiple intestinal anastomoses; the treatment was approved by the Hospital Ethics Committee. The average gestational age of patients was 31.2 weeks. The average age at the time of surgery – 7,9 days. Average weight - 2007 grams. The average number of anastomoses was 3.7 (range: 2-7). The average length of remained small intestine after the second surgery was 67.4 cm (range: 12-120 cm). No other surgical procedures, including gastrostomy or enterostomy, were performed. In all cases, surgical intervention ended with hermetic suturing of the abdominal cavity. Among them, there were 6 patients with the multifocal form of necrotizing enterocolitis; 6 patients had type IV atresia of the small intestine; 1 patient had the Ladd’s syndrome. Connection of intestinal segments was made by constructing several “end-to-end” anastomoses, double-row precision seam with PDS II 7/0 suture.Results. In the postoperative period, complications associated with anastomosis construction, such as leakage and narrowing, were not recorded. Transit function of the gastrointestinal tract restored on day 4, on average, after the surgery (range: 2-6 days). There were no early lethal outcomes within the first 28 days after the surgery which were associated with the surgery. 2 patients with short bowel syndrome (remained small intestine was 12 and 25 cm) and multivisceral disorders died on day 72 and 64 after the surgery. Survived patients were transferred to full enteral feeding in 56 days, in average, after the second surgery (range - 15-120 days).Conclusion. In our study, we have demonstrated potentials of a new surgical approach: one-stage formation of multiple intestinal anastomoses in case of multiple intestinal atresias as well as in case of multifocal forms of necrotizing enterocolitis. Maintaining the bowel length with multiple bowel anastomoses is very important factor for better survival of patients with the short bowel syndrome.

Y-en-Roux reconstruction in abdominal surgery: historical retrospective of operative method’s evolution. Part I

Target of this historical review is focused on analysis of highly relevant, unique method proposed by A. Wölfler, E. Doyen and C. Roux more than 140 years ago, also we try to present main facts and chronology of development of concept Y-reconstruction of digestive tube. Hereby we present historical retrospective of theoretic concept creation, experimental verification and initial clinical experience of Y-shaped reconstruction of digestive tube on Roux-en-Y-loop, stages of concept evolution and development till the end of XIX age till our days. The founders’ scientific research onducted in surgical gastroenterology, oncology, pancreatology and hepatobiliary surgery, has expanded application of Roux-en-Y-reconstruction from distal resection of the stomach and gastroenterostomy to gastrectomy, repeated operations on the upper part of the digestive tube, the formation of biliary-digestive and pancreatic anastomoses, as well as the use in the routine practice of bariatric surgery.

Анатомічна мінливість гілок системи підколінної артерії у плодів людини 4-6 місяців

The study of topographical variations of the branches of the popliteal artery in human fetuses from a macroscopic point of view in modern anatomy is considered relevant and promising. The need to study the anatomy of the terminal branches of the popliteal artery in fetuses of different ages is due to the rapid development of fetal surgery and the improvement in the performance of surgical procedures on the structures of the knee and lower leg areas, since the establishment of the anatomical variability of the vessels of the lower extremities allows choosing the optimal tactics of surgical intervention. In the literature, there are fragmentary data on the fetal topography of the popliteal artery and its branches. The purpose of the study. The study aimed to establish the topographic and anatomical features of the branches of the anterior and posterior tibial arteries in human fetuses of 4-6 months. Material and methods. The study of the fetal anatomy of the popliteal artery was carried out on 34 preparations of human fetuses (81.0-230.0 mm parietococcygeal length) using the methods of anatomical preparation, vascular injection, and morphometry. Results and discussion. In 21 examined fetuses, the classic variant of the branching of the anterior and posterior tibial arteries was observed both on the right and on the left extremity. In other fetuses, atypical variants of the origin and topography of the branches of the popliteal artery were found. The most interesting, from our point of view, was the anatomical variants of the terminal branches of the popliteal artery in fetuses of 160.0, 180.0, and 195.0 mm parietococcygeal length. A high variant of the branch of the peroneal artery from the popliteal artery; a rare variant of doubling the peroneal artery is trifurcation of the popliteal artery into the anterior and posterior tibial and peroneal arteries, doubling of the branches of the tibioperoneal trunk, as well as the formation of anastomoses between them were revealed. Among the most frequent atypical variants of the onset of the peroneal artery in the studied human fetuses was its branch from the tibioperoneal trunk. Conclusion. To obtain a clear idea of the spatial orientation of the peroneal artery in human fetuses, fetal surgeons should distinguish three segments in the peroneal artery trunk: segment I of the peroneal artery (it is proximal part) is the passage of the peroneal artery trunk in the ankle-popliteal canal; segment ІІ (middle part) corresponds to the topography of the peroneal artery in the inferior muscular-peroneal canal; the third segment of the peroneal artery (distal part) is a segment of its trunk from the point of exit from the inferior muscular-peroneal canal to the level of its division into terminal branches

Первинний коло-анальний степлерний анастомоз при хірургічному лікуванні хвороби Гіршпрунга в дітей

Hirschsprung’s disease (HD) belongs to group of severe congenital malformations of the colon that can be only treated surgically. Various methods of radical correction HD have been evolutionarily improved. The Soave–Boley technique is considered to be the most successful, physiological and technically acceptable. Purpose – to evaluate the effectiveness of the use of stapler for primary colo-anal anastomosis as an element of Soave-Boley surgery in the surgical treatment of HD in children. Materials and methods. The analysis of surgical treatment of 125 children with various forms of HD aged from 6 months to 18 years, the formation of the primary colo-anal anastomosis was done using the Soave–Boley technique by mechanical (stapler) method. Results. In 20 patients (16.00%) among 125 with complicated course of HD, it was difficult to do radical single stage surgical treatment they required twostage treatment (stage 1) formation of the protective intestinal stoma and (stage 2) radical surgery. In the remaining 105 (84.00%) patients, single stageradical correction of HD was performed. In 1 (0.80%) of 125 patients operated by the Soave–Boley method with a primary colo-anal stapler anastomosis, in the early postoperative period was diagnosed with hematoma between pull through colon and sero-mascular pouch, which was treated conservatively. Andin one patient (0.80%) of 125 children in the remote postoperative period there was surgical complication – residual agangliosis, which was corrected by sphincteromyectomy by Lynn technique. Conclusions. Soave–Boley surgery with stapler colo-anal anastomosis is an effective method of radical correction of HD in children of different ages with one-stage or two-stage interventions. The use of a stapler for primary colo-anal anastomosis as an element of Soave–Boley surgery for the surgical treatment of HD in children with the consideration of necessary technical precautions has significant advantages over its classic methods. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: Hirschsprung’s disease, children, surgical treatment, results.

Cervical tracheal resection without intubation

Aim. To present the experience in a new approach for the surgical treatment of cicatricial cervical tracheal stenosis tracheal resection without using an endotracheal tube.
 Methods. The technique includes preliminary metal stent placement instead of bougienage in the stenosis zone; introduction of the supraglottic airway device I-Gel instead of the endotracheal tube and; jet ventilation through the supraglottic airway device. The stent is removed together with the resected trachea. The technique of cervical tracheal resection using the supraglottic airway device was implemented in 22 patients with cicatricial tracheal stenosis.
 Results. The resection length ranged from 15 to 45 mm (on average, 273 mm). The duration of surgical interventions ranged from 65 to 180 minutes (on average, 1099 minutes). Preliminary stenting excluded preoperative bougienage of the trachea and facilitated intraoperative assessment of the extent of the stenosis. The absence of an endotracheal tube facilitated the formation of anastomosis of the trachea, eliminated the risk of trauma to the anastomosis during tube removal. There were no complications in the early postoperative period. The length of postoperative hospital stay ranged from10 to 14 days (on average, 122 days). No restenosis was detected at long term follow-up.
 Conclusion. Performing tracheal resection without intubation allows the surgeon to work comfortably, observing the safety conditions for ensuring airway patency throughout the operation by installing a supraglottic airway device.

Assessing the risk of postoperative mortality in patients undergoing emergency surgery for complicated colorectal cancer

Objective: to analyze factors affecting the mortality of patients who have undergone emergency surgeries for complicated colorectal cancer.Materials and methods. In this retrospective study, we evaluated treatment outcomes of 112 patients who underwent surgeries for complicated colorectal cancer in 3 clinical hospitals of Smolensk between 2014 and 2019. We included patients with moderate or severe disease (ASA II or III) who have undergone emergency resections for intestinal obstruction or tumor perforation. We assessed clinical, laboratory, and tumor‑associated factors affecting postoperative mortality.Results. Patients’ gender had no significant impact on postoperative mortality (p = 0.69). Mean age of study participants was 65 years (range: 43–86 years). Age also did not affect postoperative mortality; most of the patients both among those died (n = 19) and survived (n = 93) were older than 60 years (p = 0.46). We observed no significant correlation between tumor location and postoperative mortality (p = 0.27). Of 19 patients with lethal outcomes, five died due to pulmonary embolism. They have elevated level of D‑dimer, which was significantly higher than that in survivors (p = 0.014). The lowest mortality was observed in patients who have undergone two‑stage surgeries with tumor removed at the second stage compared to patients operated on using other techniques (p = 0.041). Using multivariate logistic regression, we identified independent factors that affected mortality. They included: tumor perforation (odds ratio (OR) 2.8; 95 % confidence interval (CI) 1.2–7.6; p = 0.003), severe comorbidity (OR 1.6; 95 % CI 1.7–8.2; p = 0.02), D‑dimer level >510.1 ± 10.2 ng/L (OR 1.5; 95 % CI 1.3–4.5; p = 0.01), type of surgery, namely resections with primary anastomosis formation and two‑stage surgeries with tumor removal at the first stage (OR 1.2; 95 % CI 1.1–6.3; p = 0.04).Conclusions. Tumor perforation, cardiovascular disease in combination with other comorbidities, type of surgery (resections with primary anastomosis formation and two‑stage surgeries with tumor removal at the first stage), and elevated preoperative level of D‑dimer had the most significant impact on postoperative mortality.

CYANOCRYLATE ADHESIVES IN FORMATION OF COLORECTAL ANASTOMOSIS

Data of foreign literature concerning sutureless formation of the colorectal anastomosiswith the help of cyonocrylate adhesives are presented in the article. These are quick acting glues, available on the Ukrainian market, and may be used by Ukrainiansurgeons in implementation of their ideas as to the sutureless connection of organs in theexperimental and clinical investigations.12 different types of cyanocrylate adhesives as to their resistance to the rupture of theconnected by them large intestine segments, were studied. Questions of the technicalformation of the sutureless anastomoses were considered. When substantially newtechnical devices for gluing together the organs are absent, progress is hardly possible.Objective – to acquaint the domestic surgeons and oncologists with modern achievementsof foreign scientists in the field of sutureless colorectal anastomosis formation by meansof cyanocrylate adhesives.Conclusions. For some time past foreign surgeons the problems of colorectal anastomosesintensively develop the problems of colorectal. This is due to the fact that indices ofcolorectal anastomosis insufficiency remain on high levels. Unfortunately, the hopesthat the introduction of modern advanced stapler anastomotic techniques can radicallyreduce the frequency of this complication were not justified.

The topographo-anatomical conditions of reconstruction of the trunk and roots of the portal vein during gastropancreatoduodenal resection

Topographic and anatomical variants of vascular plastics in extended gastropancreatoduodenal resection are substantiated. The anatomical study was performed on 30 organ complexes and 5 not embalmed human corpses. Significant variability of the roots and tributaries of the v. portae and their location near the pancreas was revealed. The extended contact of the mesenteric-portal segment with the head of the pancreas promotes the involvement of the veins of the portal system in the tumor process. The magistral type of the structure of the superior mesenteric vein was revealed in 19 cases, the distributed type in 11, which determines the conditions for vascular reconstruction. In the experiment the possibility of creation the formation of the direct mesenteric-portal anastomosis after duodenectomy was established in case of shifting the mobilized root of the mesentery of the small intestine in the direction of the liver gate. If splenic vein resection is necessary, adequate blood outflow from the stomach, spleen, and pancreatic stump can be provided by forming a distal splenic-renal anastomosis or, with a sufficient length of the splenic vein, a splenic-portal anastomosis. Based on computed tomography angiographs and intraoperative data 29 patients underwent extended gastropancreatoduodenal resection followed by vascular reconstruction. Tumor invasion of the trunk of the portal vein on computed tomography angiograms was represented by offset and the contact of the tumor with portal vein for over 10 mm (in 7 cases), the displacement and deformation of the portal vein tumor (in 5 cases), tumor infiltration of more than 50% of the circumference of the portal vein (in 3 cases). Extended contact with the tumor was identified in 9 cases, confluence stenosis of the portal vein in 5 cases. The tumor invasion into the portal vein, and the vascular system was restored by the formation of a port-portal anastomosis in 15 cases. Moreover at the reconstruction of mesenteric-portal segment we formed mesenteric-portal anastomosis in 10 cases. Also in 2 cases mesenteric-portal anastomosis in the confluence area of the iliac colon and jejunum tributaries was formed, in 1 case we formed anastomosis between the ileum-colon vein and the portal vein (with 1:2 diameter difference without patency disorders). In one single case we connected iliac colon vein wall with jejunum vein wall and formed anastomosis between them and portal vein. Distal splenorenal anastomosis was formed in 10 patients from this group. Spleno-portal anastomosis was formed in 3 patients above the junction of the portal and superior mesenteric veins.

Surgical treatment of patent omphalomesenteric duct

Omphalomesenteric duct (OMD) persistence in infants is a rare congenital malformation of the gut, with an incidence of about 2% of the population [1,2]. It usually has a difficult diagnosis, presenting as different skin related conditions or abdominal symptoms. This article reports two cases of total persistence of the OMD and reviews the surgical management of those lesions. Case one reports an one moth-old infant brought to hospital with persistence of the umbilical cord, with no response to topical treatment that later started draining feces from the umbilical chord. Case two reports a three-day-old male newborn that manifested a granuloma like lesion on the umbilical scar with no improvement with topical treatment. A Fistulography showed the persistence of the OMD in both cases. Both infants had a similar surgical approach, with an abdominal incision was made around the lesion on the abdominal wall. Identification of the fistula trajectory, followed by resection of the bowel segment that contains the fistulae and a formation of a termino-terminal anastomosis. OMD persistence and related malformations are rare conditions, presenting different and life threatening symptoms. They must be considered a differential diagnose for pediatric surgeons and pediatricians and surgical correction is recognized as the main treatment.