Interintestinal Anastomoses Research Articles

Endoscopic control after retroperitoneal pancreas transplantation with a Roux-en-Y duodenojejunostomy for exocrine drainage

Background. Simultaneous pancreas and kidney transplantation is a gold standard in the treatment of diabetes mellitus complicated by stage 5 chronic kidney disease as a result of diabetic nephropathy. One of the main problems of clinical pancreas transplantation is the pancreas graft exocrine drainage. In order to preserve the advantages of the retroperitoneal graft location and avoid the main disadvantage of duodenal drainage, namely, fatal complications potentially arising in case of necessary graft removal, we have proposed a modified method of retroperitoneal pancreatic transplantation with exocrine drainage via a modified Roux-en-Y duodenojejunostomy. It reduces the number of severe surgical complications and increases the recipient survival rate. When this method was used in previous years, it was not possible to assess the condition of donor duodenum mucosa and interintestinal anastomoses.Objective. To demonstrate the possibility of endoscopic assessment of interintestinal anastomoses when performing retroperitoneal pancreas transplantation with small intestine drainage of exocrine secretions.Results. The article presents the initial experience of endoscopic assessment of the interintestinal anastomoses and the mucous membrane of the donor duodenum after retroperitoneal pancreas transplantation with exocrine drainage via a Roux-en-Y duodenojejunostomy.Conclusion. The presented case demonstrates the feasibility of diagnostic endoscopic interventions when performing retroperitoneal pancreas transplantation with small intestine drainage of pancreatic secretions.

Gastroschisis: diagnosis and surgical treatment

Gastroschisis is a congenital malformation of the anterior abdominal wall with a defect to the right of the normally formed umbilical cord and eventration of the abdominal organs. Evented internal organs not covered with amniotic membrane are under the direct influence of amniotic fluid. Despite the increase in the incidence of the defect from 3.6 to 4.9 per 10,000 live births, over the past ten years mortality has sharply decreased to 5%. Antenatal diagnosis makes it possible to reliably identify cases of gastroschisis, starting from the 12th week of gestation, which is important especially when diagnosing complicated forms. Surgical correction involves primary radical plastic surgery of the anterior abdominal wall with simultaneous immersion of the eventrated organs into the abdominal cavity. However, in approximately every fifth patient, immediate correction is impossible due to the occurrence of viscero-abdominal disproportion and concomitant diseases. In these cases, temporary abdominal cavity occurs with delayed plasty of the anterior abdominal wall, enterostomy for intestinal decompression, resection of non-viable areas and interintestinal anastomoses. Among patients with complicated forms, there was an 8-fold increase in mortality. Despite significant advances in reducing mortality, the development of various treatment methods continues to provide an alternative method of correcting this lesion.

Unformed conglomerate debilitating jejunal fistulas and their two-stage surgical treatment via posterolateral laparotomy

To create a method of two-stage repair of high unformed conglomerate delimited debilitating jejunal fistulas via posterolateral laparotomy with low risk of surgical complications. Methodology and treatment outcomes were analyzed in 37 patients with unformed conglomerate high debilitating delimited jejunal fistulas. Of these, 22 patients underwent one-stage treatment through 2 converging incisions and/or two-stage treatment through anterolateral access. They made up a control group. Fifteen patients in the main group underwent two-stage treatment via posterolateral left-sided laparotomy with unilateral disconnection of jejunum with fistula. In most patients of both groups, fistulas complicated surgery for acute adhesive intestinal obstruction. Topography of adhesions that caused acute intestinal obstruction in both groups was studied in 172 other patients. Identical jejunal fistulas and two different surgical approaches made it possible to consider our groups representative. Two-stage treatment via posterolateral left-sided laparotomy reduced mortality from 63.6±10.2% to 20.0±10.3% (t=11.8; p<0.001). This approach simplified intraoperative diagnostics that became more informative. Posterolateral access increased the quality of anastomosis and safety of viscerolysis. A new two-stage approach with posterolateral left-sided laparotomy allowed atraumatic imposing of inter-intestinal anastomosis with proximal disconnection of jejunal fistula. This exclusion turns the fistula into analogue of the definitive Meidl's jejunostomy, unloads the intestinal anastomosis and increases the quality of suture. New strategy reduced the risk of complications and mortality.

Determination of the optimal reconstruction for pancreaticoduodenal resection based on modified scintigraphy of gastrointestinal motility

Aim. To improve the outcomes of pancreaticoduodenal resection by determining the optimal reconstruction based on objective assessment of the functional state of the upper gastrointestinal tract using a modified “double” scintigraphic study.Materials and methods. 147 pancreaticoduodenal resections were performed in the period of 2016–2022. Patients underwent “double” scintigraphic study on days 30 and 90 after surgery. The mean age of the patients was 59.6 years (23–83); the male to female ratio was 1.27:1. All patients underwent gastropancreatoduodenal resection or pancreatoduodenal resection with pylorus preservation. The patients were divided into 3 groups according to the variant of the reconstructive stage of surgery. Group 1 underwent reconstruction according to Child, group 2 – Child reconstruction and interintestinal anastomosis formation according to Brown, the reconstructive stage in group 3 involved Roux-en-Y isolation of the small intestine (Roux-en-Y reconstruction).Results. “Double” scintigraphic study revealed that the best result on the 30th and 90th postoperative days was observed in patients who underwent pancreaticoduodenal resection with pylorus preservation, reconstructive stage according to Child and formation of interintestinal anastomosis after Brown.Conclusion. “Double” scintigraphy is an effective procedure to determine the motility of the stomach, biliodigestive anastomosis and motility of the small intestine. As a result, the optimal reconstruction after pancreaticoduodenal resection was determined in patients with neoplasms of the pancreatic head or the periampullary region and chronic pancreatitis.

External Small Intestinal Fistula as a Rare Complication of Total Pelvic Infralevator Evisceration

A clinical case of a patient with external incomplete non-formed small intestinal fistula involving previously formed ureteroejunoanastomosis in infiltrate and presence of purulent cavity in small pelvis communicating with external medium in perineum is presented. This complication occurred after a planned surgery in the volume of total infralevatory evisceration of the pelvis due to local advanced rectal cancer. The patient underwent this complication for a long time and performed independent dressings. The following examinations (Rg-fistulography, multispiral computed tomography of abdominal organs with intravenous bolus contrast) revealed a purulent cavity communicating with the adductor loop of the small intestine. During the planned surgical intervention, it was intraoperatively revealed that the previously formed interintestinal anastomosis and ureteroejunoanastmoses were involved in the infiltrative process, which complicated this situation. Resection of the latter with reconstruction of anastomoses was performed. The main task in this situation was adequate drainage of the purulent cavity and the previously formed anastomosis. The postoperative period in this patient underwent no peculiarities, the drainage was removed on the 10th day. Further, the patient underwent a follow-up examination and further examination. Examination of data for intestinal fistula relapse did not reveal. A control multispiral computed tomography with contrast was performed - there are no data for relapse of the purulent cavity of the cavity, previously formed intergestinal anastomosis and conduit function adequately. In this clinical case, the patient's medical history, the clinical example of the occurrence of this complication and its cause, further treatment of the patient aimed at eliminating the small intestinal fistula, as well as an overview of the literature data on this problem are described in detail.

Intestinal anastomoses in children: The draft decision of the Russian Symposium of Children surgeons (April 2023)

The Symposium of Pediatric Surgeons of Russia, Intestinal Anastomoses in Children, was conducted in Volgograd on April 26, 2023, with around 180 doctors in attendance. Thirty papers were presented and discussed, and 41 articles were published in the proceedings of the symposium. According to the results of a systemic analysis of a questionnaire poll of major pediatric surgeons in 75 regions of Russia, 4,558 surgeries on intestinal anastomosis formation were performed in 20212022, including 1,735 operations in newborn children (36%); their share in general pediatric surgery was less than 0.6%, and it was more than 18.6% in neonatal surgeons. The number of intestinal anastomoses formed during laparoscopic procedures increased (4.4%). Pediatric surgeons equally often used double-row nodal intestinal sutures (33.3%), single-row continuous sutures (34.6%), and different types of sutures (33.3%). A T-shaped anastomosis was performed in cases of necrotizing enterocolitis where there was a significant difference in the diameters of the intestine's inflow and outflow channels. The clip-and-drop technique was used to treat neonates with multifocal necroses. Interintestinal anastomoses were favored over enterostomies in numerous segmental resections. For duodenal obstruction, duodeno-duodenal, and duodeno-jejunal anastomoses were performed. In children with Crohn's disease and choledochal cysts, most specialists prefer operations with stapling devices. Creating a magnetic interintestinal anastomosis lowers the risk of postoperative complications and facilitates the postoperative period. Clinical observations after laparoscopic surgeries accounted for a significant proportion of complications (66%). Anastomosis failure was three times more common in planned small intestinal in older children than in emergency surgeries (1.2 and 0.4%, respectively).&#x0D; The modern stage of development of intestinal anastomosis formation techniques in children is characterized by good results, the expansion of indications for intestinal anastomosis in conditions of compromised colon or peritonitis, and the introduction of laparoscopic techniques and mechanical stapling devices with slightly poorer results.

Surgical disconnection of high delineated immature debilitating jejunal fistulas using posterolateral access

Objective. The aim of the study was to develop the safest technique for surgical disconnection of high, unformed jejunal fistulas, so as to avoid problems with detection the intestine leading to the fistula and to avoid complications of viscerolysis. Material and methods. The authors present their experience in surgical management of 35 patients with high delimited unformed debilitating jejunal fistulas. Of these, 22 patients were included in the comparison group; their fistulas were closed or disconnected with the known methods. Findings obtained from other 172 patients with adhesive intestinal obstruction after infectious complications of laparotomic wounds and topography of visceroparietal planar adhesions of the peritoneum were analyzed. After studying the nature and location of visceroparietal adhesions, the authors could develop a technique for proximal disconnection of high delimited unformed debilitating jejunal fistulas using posterolateral access which was applied in 13 patients from the studied group. Research results. The proposed technique of unilateral disconnection of high unformed jejunal fistulas reduces duration, damage and risk of prolonged bowel deserosing. As a result, a significant decrease in postoperative mortality from 59.1 ± 9.2% to 23.1 ± 11.2% (t=2.5; p&lt;0.05) was registered. Due to the preoperative endoscopic marking showing direction to the fistula of intestinal loop and duodenojejunal junction, intraoperative orientation was more accurate and took much less time than in the comparison group. The posterolateral surgical approach to the fistula in the jejunal loop reduced the risk of its damage, since there was no need for extensive enterolysis anymore. Therefore, postoperative period in patients of the studied group was better and with fewer complications than in the comparison group. Conclusion. The posterolateral access prevented extended viscerolysis and allowed to put a reliable and atraumatic interintestinal anastomosis so as to disconnect the fistula. The unilateral disconnection of the jejunal fistula at postoperative intestinal paresis unloaded the interintestinal anastomosis, similar to Meidl’s definitive jejunostomy. The abovementioned positive aspects of the proposed surgical intervention allowed to significantly decrease postoperative complications and mortality rate, if to compare with outcomes after known surgical interventions with a similar purpose.

Surgical tactics in peritonitis, caused by complicated course of colorectal cancer

Objective. To improve surgical tactics in peritonitis, caused by complicated course of colorectal cancer.&#x0D; Materials and methods. Through the 2017 - 2020 yrs period in Department of Surgery in Brovary Multidisciplinary Clinical Hospital 18 patients with colorectal cancer, complicated by peritonitis, were operated. Among them there were 14 (77.8%) men and 4 (22.2%) women, ageing in spectrum 42 – 83 yrs old. In 12 (66.7%) patients the cancer of Stage III was diagnosed, while in 6 (33.3%) – Stage ІV.&#x0D; Results. The right-sided hemicolectomy was performed in 22.2% of the patients, resection of transverse colon – in 3 (16.7%), a left-sided hemicolectomy – 1 (5.6%), Hartmann operation – 9 (50.0%), subtotal colectomy – 1 (5.6%). All the operations were performed without formation of primary anastomoses, and with stoma construction in proximal part of intestine. Reoperation were performed in 4 (22.2%) patients. There were 3 (16.7%) postoperative deaths – in patients with the cancer Stage IV, peritonitis in a terminal stage – due to development of the polyorgan insufficiency syndrome.&#x0D; Conclusion. Formation of primary interintestinal anastomoses while doing surgical intervention for colorectal cancer, complicated by peritonitis, is contraindicated because of high risk of the sutures insufficiency presence.

Surgery for gastric cancer in patients with coronary heart disease (clinical cases)

The importance of a multidisciplinary approach in the surgical treatment of patients with severe combined oncological and cardiovascular pathologies is shown. In modern surgery, there is a place for both simultaneous and staged surgical treatment of this category of patients, which should be determined in each specific clinical case and requires an individual multidisciplinary approach with the inclusion in the discussion of such specialists as an oncosurgeon, a chemotherapist, a radiation therapist, a cardiologist/therapist, cardiovascular surgeon, anesthesiologist and resuscitator.&#x0D; Two clinical cases of a two-stage and one-stage surgical approach in the treatment of patients with competing gastric cancer and coronary heart disease are presented. One 47-year-old patient underwent two-stage surgical treatment: stage 1 aortocoronary bypass grafting from mini-thoracotomy (MICS CABG); stage 2 robot-assisted distal subtotal resection of the stomach (Balfour modification) with D2 lymphadenectomy, formation of intracorporeal gastroenteroanastomosis and interintestinal anastomosis according to Brown. Another 74-year-old patient underwent a one-stage surgical intervention: autovenous coronary artery bypass grafting of the anterior interventricular artery, posterior descending coronary artery on a beating heart, without cardiopulmonary bypass + extended-combined gastrectomy with resection of the distal esophagus, resection of the diaphragm, and D2+ lymphadenectomy. The postoperative period proceeded without complications.

ПРИНЦИПЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ДЕТЕЙ ГРУДНОГО ВОЗРАСТА, УГРОЖАЕМЫХ ПО РАЗВИТИЮ ПОСТРЕЗЕКЦИОННОГО СИНДРОМА КОРОТКОЙ КИШКИ И ФОРМИРОВАНИЮ ХРОНИЧЕСКОЙ КИШЕЧНОЙ НЕДОСТАТОЧНОСТИ: АНАЛИЗ РЕЗУЛЬТАТОВ СЕРИИ КЛИНИЧЕСКИХ НАБЛЮДЕНИЙ

The short bowel syndrome (SBS, or simply short gut) is the most common cause for the chronic intestinal failure (CIF). The purpose of the study was to present the results of treatment of infants at risk for the development of post-resection SBS and the formation of CIF. Research materials and methods: 22 children threatened by the formation of post-resection SBS were treated in the Surgical Department of Newborns and Infants of the National Medical Research Center for Children’s Health (Moscow, Russia) from 2017 to 2021. Results: All patients have undergone the surgical treatment. The scope of the surgical intervention included adhesiolysis with the imposition of an interintestinal anastomosis. Simultaneous imposition of multiple interintestinal anastomoses (more than 4) was performed in 7 patients (32%). As a result, the CIF formation was avoided in 8 patients (36%) by maintaining the total length of the remaining small intestine. The follow-up period ranged from 12 to 46 months. Currently, 2 patients (9%) receive partial parenteral nutrition, and in 17 patients (77%) it was possible to achieve completely autonomous enteral nutrition. A lethal outcome was stated in 3 patients (14%) due to the development of a catheter-associated infection. Conclusion: in the course of this work, the principles of surgical treatment of patients threatened by the development of post-resection SBS and the formation of CIF were developed. Adequate parenteral and enteral nutrition can optimize intestinal adaptation and improve the nutritional status of the pediatric patient.

The role of obstructive resection in the treatment of acute intestinal obstruction complicated by bowel necrosis

Methods of surgical intervention in acute intestinal obstruction with necrosis of the strangulated area of the intestine are the subject of ongoing discussions. There is no doubt that every patient with this disease should undergo emergency surgery. However, diagnosing necrosis of the strangulated area is not easy. For this reason, a number of authors recommend refraining from emergency surgery for all patients with intestinal obstruction during dynamic follow-up, which can last up to 14 days. Over the past century, the etiology of intestinal obstruction has shifted from strangulated hernia to postoperative adhesive disease, which has led to a paradigm shift in methodological approaches. In order to successfully manage acute intestinal obstruction with suspected strangulation, the clinician today must be able to distinguish between patients requiring urgent surgery and those who should receive conservative therapy.In this paper, we consider the surgical approach of delayed anastomosis formation on significant clinical material, including tactical approaches, timing and necessary conditions for anastomosis formation in patients with intestinal obstruction complicated by necrosis of the strangulated area.The complex of therapeutic measures in the treatment of patients with acute intestinal obstruction complicated by necrosis of the strangulated area of the intestine, intraoperative perforation of the intestine during separation of adhesions, both in conditions of peritonitis and without it, should include obstructive resection of the intestine in combination with the formation of an anastomosis in a delayed order, as well as or planned sanitation of the abdominal cavity. All this makes it possible to reduce the incidence of interintestinal anastomosis failure from 86.7 to 0.96% of cases, and postoperative mortality from 41.8 to 14.4%.

Usage of shape memory implants in the formation of interstitial anastomoses in the experiment

The purpose of the study was to study in an experiment the advantages of creating interintestinal anastomoses using a construction with thermomechanical memory made of titanium nickelide in comparison with the classical method of imposing interintestinal anastomoses. The work was carried out on mongrel dogs by the method of performing compression and ligature interintestinal anastomoses. The tissue response in the area of interintestinal anastomosis was studied by the authors and confirmed by histological studies. In the studied tissues of the compression interintestinal anastomosis, microscopically, the indicators of the reactive inflammatory process were less pronounced and, ultimately, no dystrophic changes and tissue nutritional disorders were found in the test material. The healing of the intestinal mucosa was significantly better than in the classical ligature anastomosis. On the basis of the experimental data obtained by us, it was concluded that the use of compression interintestinal anastomoses for the purpose of creating anastomoses occurs with the best conditions for wound healing at the site of imposition of the performed anastomosis, in contrast to the classical ligature anastomosis.

Обструктивная резекция кишки в лечении травматических повреждений кишечника в условиях перитонита

Treating bowel injuries is challenging. Although the failure of anastomosis or suture of the intestine remains a dangerous complication and multiplies in conditions of peritonitis, multistage tactics before the tactics of maintaining intestinal continuity during the first operation is becoming an increasingly preferred strategy. The aim of the research. To evaluate the treatment results for delayed formation of the inter-intestinal anastomosis in patients with bowel injury complicated by peritonitis. Material and Methods. A total of 69 patients were enrolled in the study, among which 40 were included in the retrospective group and 29 were included into the prospective group. All included patients underwent surgery for bowel injuries at the NCHKH 29 and at the NCHKH 1 within the period from 2011 to 2019. The patients’ mean age amounted to 33.4±9.2 years. A total of 35 patients were admitted with blunt trauma and 34 had stab wounds. The retrospective group received treatment with bowel resection with application of anastomosis during the initial surgery while patients of the prospective group had their anastomosis formation delayed to the time after peritonitis management. The postoperative course was analysed in regard to the frequency and severity of postoperative complications and mortality. Results. Among the 69 patients, 78% had a small bowel injury and 47% had a colon injury. A total 39.1% of the lesions in the small intestine and 21.7% of the lesions in the colon were treated with wound closure or bowel resection with primary anastomosis, regardless of the site of injury (p = 0.381). Mortality was 33%, of which 47.5% in the control group and 13.8% in the comparison group. A severe course of the disease was noted in 32% and complications in the abdominal cavity occurred in 32% of patients. The risk factors for severe course of the disease were formed intestinal stomas (p = 0.036), massive blood loss (p = 0.005) and delayed seeking medical care (p = 0.023). The incidence of intestinal suture incompetence was 28.2%. All failures occurred in the early postoperative period. Conclusion. Multi-stage surgical tactics in treatment of patients with intestinal injury complicated by peritonitis should be the preferred option, regardless of the site of injury – small or large intestine. The imposition of an intestinal stoma is an important factor in the development of postoperative complications, which can be compared with the risk of an intestinal suture or anastomosis in peritonitis

ЛАПАРОСКОПИЧЕСКИЙ МЕЖКИШЕЧНЫЙ АНАСТОМОЗ SANTULLI У МЛАДЕНЦА С МУКОВИСЦИДОЗОМ

The aim of the study was to evaluate the technical feasibility of performing a Santulli-type side-toend inter-intestinal anastomosis in infants with cystic fibrosis (CF) using laparoscopy. A clinical case of a 3-month-old child with CF who was operated on in the neonatal period for meconium ileus is presented. The baby's gestational age was 32 weeks. The primary operation consisted of the formation of a terminal enterostomy. In the postoperative period, a malabsorption syndrome was noted, accompanied by a lack of growth. As a temporary measure to restore nutritional status, a Santulli-style side-to-end laparoscopic intestinal anastomosis was performed. The observed child was found to have the F508del mutation in both alleles of the CFTR gene. The patient's weight at the time of the Santulli anastomosis construction was 2900 g, the age – 3 months. During the operation, there were no difficulties associated with the mobilization of the separated segments of the ileum. The duration of the surgical intervention was 70 min. Enteral nutrition was started on the 3rd day after the operation. The recovery period for intestinal transit through the rectum was 15 days. The postoperative period was uneventful. The duration of hospitalization was 18 days. No electrolyte imbalance or excessive fluid loss or underweight associated with enterostomy was observed. Over the next 6 months, the normalization of age-related weight and height parameters was achieved, after which the continuity of the digestive tract was restored by closing the terminal enterostomy. Currently, the patient has minimal respiratory symptoms and is receiving adequate CF therapy with pancreatic enzyme replacement therapy included with each meal. The initial experience of performing laparoscopic Santulli inter-intestinal anastomosis in an infant with CF presented in the study showed the possibility and reproducibility of this technique, expanding the boundaries of laparoscopy in pediatric practice. The decision to close the enterostomy in these patients should be deferred until a full diet is introduced and should be made in conjunction with a pediatrician specializing in the treatment of CF.

Anton Wolfler - forgotten genius of surgery

Nowadays, when surgery as a science was so rapidly developed, the names of many scientists who stood at its origins are forgotten or rarely mentioned, and their contribution remains underestimated. One of them is the innovator of surgery of the XIX century. Czech scientist Anton Welfler, whose bold ideas have spread far beyond the boundaries of abdominal surgery. Unfortunately, for many he is known only as the author of the methodology for the formation of gastroenteroanastomosis and as a student of Theodore Billroth. However, in reality, A. Welfler made an incomparably greater contribution not only to gastric surgery, but also to herniology, thyroid surgery. The result of his study of embryogenesis, the histological structure of the thyroid gland, his own clinical experience gained two monographs, subsequently recognized as fundamental in this section of surgery. He developed a histological classification of thyroid cancer, for the first time described both solid and cystic forms of papillary cancer. He also suggested the possible mechanisms of carcinogenesis. Together with Theodore Billroth A. Welfler introduced the technique of total thyroidectomy into clinical practice. Widely used in modern surgical practice, gastroenteroanastomosis with the loop of the small intestine turned off and the U-shaped inter-intestinal anastomosis, named after Caesar Roux, was in fact, developed by A. Welfler in the experiment. Caesar Roux himself noted A. Welfler’s priority in the invention of this design. In 1897, Caesar Roux modified the method of A. Welfler, forming a posterior-free version of this operation.

The fast-track surgery program application after pancreaticoduodenectomy, using interintestinal anastomosis in accordance to Brown procedure

Objective. To estimate the impact of formation of gastroenteroanastomosis with Brown’s anastomosis, while performing of pancreatico-duodenectomy, on the gastric evacuation arrest rate in a frame of the fast-track surgery program implementation.&#x0D; Materials and methods. To the investigation 92 patients, ageing 28 -75 yrs old, were included, to whom pancreaticoduodenectomy for benign and malignant pancreatic and peripancreatic zone pathology was performed in Jan. 2015 - Aug. 2020 yrs. Perioperative treatment was conducted in accordance to the fast-track surgery program. The first Group consisted of 60 patients, in whom reconstruction in accordance to Child was done, and the second Group - of 32 patients, in whom gastroenterostomy with anastomosis in accordance to Brown procedure was performed.&#x0D; Results. In the Group I complications have had occurred in 16 (26.7%) patients, in the Group II - in 7 (21.9%), in Group I there were 22 complications, in the Group II - 10, but trustworthy difference between the Groups in accordance to these indices was absent (p &gt; 0.05). Analysis of parameters for restoration of peroral feeding have shown enhanced susceptibility of the program in patients of Group II. The rate of the gastric evacuation arrest in first Group of patients have exceeded the analogous index in patients of Group II in 2 times - 13.3 and 6.3%, accordingly, but statistically significant difference between the Groups in accordance to this index was absent (p = 0.299).&#x0D; Conclusion. While formation of gastroenteroanastomosis with anastomosis in accordance to Brown procedure in pancreatico-duodenectomy the implementation level for the fast-track surgery program raises and the rate of gastric evacuation arrest diminishes.

Pathogenesis of failure in the anastomosis integrity and a prophylactic program in surgical treatment of the colon diseases.

Objective. To establish the impact of intraintestinal pressure on the intestinal anastomosis integrity and to propose a prophylactic measures of its insufficiency in surgical treatment of the colon diseases.&#x0D; Materials and methods. Intraintestinal pressure was measured in 30 patients, using Waldman method during 72 h postoperatively - before and after the transanal lavage (every 4 h). Primary operation - resection of sigmoid colon with formation of a one-barrel colostomy. The restoration intervention was performed in 3 mo with formation of a large-bowel anastomosis in accordance to the method elaborated (n=17), hand-made two-layered large-bowel anastomosis (n=3), and the apparatus large-bowel anastomosis (n=10).&#x0D; Results. There was noted the intraintestinal pressure raising during first 24 - 36 h up to (5.3 ± 0.1) mm Hg with its further lowering during 12 - 20 h down to (2.1 ± 0.3) mm Hg. In 20 min after the transanal drain lavage the intraintestinal pressure have lowered by (3.0 ± 1.3) mm Hg, and in 3 - 5 h - gradually raised. While application of a hand-made two-layered large-bowel anastomosis its insufficiency was observed (n=1) and anastomositis (n=1); and in the apparatus large-bowel anastomosis formation - anastomositis (n=1). While disorder of the intestinal suture healing the intraintestinal pressure have raised in 16 - 60 h up to (11.4 ± 0.2) mm Hg with peak at (16.3 - 17.1) mm Hg, which persisted 12 -18 h. Prophylactic measures were directed towards lowering of intraintestinal pressure and elimination of unfavorable local and general factors.&#x0D; Conclusion. While persisting noncorrected, the intraintestinal pressure in the 16.3 - 17.1 mm Hg borders during 12 - 18 h leads to complicated course of postoperative period. Direct and nondirect methods of decompression of the interintestinal anastomoses constitutes a basic prophylactic principle for it.

Prevention of Reflux Disease After Operations On Gastric And Intestinal Tract

Creating anastomoses between the hollow organs of the abdominal cavity, abdominal formations of the retroperitoneal space and the jejunum always raises the question of preventing reflux from the jejunum into the drained cavity of the esophagus, stomach, gallbladder, external hepatic ducts, cysts of the liver and pancreas. After surgery, any reflux becomes pathological. Reflux is an obligate precancer. Thus, the reflux of bile and pancreatic juices in the stomach, the stump of the stomach and esophagus contributes to the occurrence of reflux esophagitis, reflux gastritis, ulcers and gastric cancer or its stump. After internal drainage of the cavity formation in the jejunum, postoperative reflux disease develops, which is caused by the actions of the surgeon who tried to help the patient sincerely. This allowed such states to be defined as “iatrogenic postoperative reflux disease”. The purpose of this work was to develop and introduce into practice the “plug” on the resulting loop of the jejunum, which does not migrate into the lumen of the intestine, with internal drainage of the hollow organs of the abdominal cavity and abdominal formations of the retroperitoneal space and evaluate the clinical results. As a result, the authors have developed a method for creating a “plug” on the jejunum loop, which is used for drainage, studies are being conducted on its safety, adequacy of functioning, general accessibility, and clinical situations are analyzed. For drainage of the abdominal formation impose a fistula between it and the jejunum loop 40–50 cm from the ligament of Treitz. We form an inter-intestinal fistula according to Brown, above which the length leading to a drained formation of the area of ​​the jejunum is about 10 cm, in the middle of which we impose a “plug”. The length of the small intestine section which diverts from the drained formation to the inter-intestinal brown anastomosis is about 30 cm. To form a “plug”, we use the free area of ​​the greater omentum, through which we perform a ligature of non-absorbable polypropylene material by vcol-vykola. The developed method of forming a "plug" does not cause abrupt ischemic changes in the area of ​​operation, followed by necrosis of the intestinal wall and migration of the "plug" into the intestinal lumen, and its effectiveness has been proven using clinical observations, microcirculation studies, water test results and X-ray examination. The method of creating a "stub" is promising for the internal drainage of abdominal cavity formations and retroperitoneal space, for the formation of areflux nutrient eunostoma.

Применение магнитно-компрессионного межкишечного анастомоза в лечении детей с энтеростомами

Применение магнитно-компрессионного межкишечного анастомоза в лечении детей с энтеростомами

PREDICTION OF THE DEVELOPMENT OF INSOLVENCY OF ANASTOMOSES ACCORDING TO THE LEVEL OF CRYOBILK

Abstract. The aim of the study was to create individualized surgical treatment tactics in patients who underwent anastomosing intestinal surgery using the express method for determining cryoglobulins. The study was based on a study of the results of treatment in 96 patients who underwent resection of segments of the small intestine with the formation of inter-intestinal anastomoses, in the SI «ZIGUS NAMSU» during the period from 2015 to 2018 years. Using a high-quality rapid method for the determination of cryoglobulinemia (CGE) during surgery can significantly affect surgical tactics: with a low level of cryobilk in blood serum, it can perform a resection of a segment of the small intestine with the formation of primary small intestinal anastomoses; when the level of cryobilk in blood serum is more than 80 mg / l, which corresponds to a positive rapid test for cryobilk, one should refrain from the formation of primary anastomoses, and use the tactics of the formation of “delayed” anastomoses, in severe general condition of patients (and a high level of CGE – more 600 mg/l) – also the formation of the final small intestinal stoma.