Anastomosis of the intestine consequences. What is an intestinal anastomosis, its types, indications and procedure

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Fistulas are the cause of colon cancer.

There are two types of operations on the intestines that require subsequent anastomosis - these are enterectomy and resection.

Preparation and procedure

Espumizan eliminates gases.

You can eat boiled rice, boiled beef or chicken, simple crackers. Do not break the diet, as this can lead to problems during the operation. Sometimes it is recommended to drink Espumizan before surgery to eliminate gases.

In the first days after the operation, the patient is observed in the hospital. Small bleeding is possible, but it is not always dangerous. Seams are regularly inspected and processed.

It is impossible to completely protect yourself from complications after surgery, but you can significantly reduce the likelihood of their occurrence if you follow all the doctor's recommendations, regularly undergo preventive examinations after surgery, and follow the rules of nutrition.

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In anatomy, fistulas of large and small vessels are called natural anastomoses in order to increase the blood supply to the organ or support it in case of thrombosis of one of the directions of blood flow. Anastomosis of the intestine - an artificial connection created by the surgeon, the two ends of the intestinal tube or intestine and a hollow organ (stomach).

The purpose of creating such a structure:

ensuring the passage of the food bolus to the lower sections for the continuity of the digestive process;
formation of a bypass path in case of a mechanical obstacle and the impossibility of its removal.

Operations can save many patients, make them feel fairly well, or help prolong life in the case of an inoperable tumor.

What types of anastomoses are used in surgery?

According to the connected parts, anastomosis is distinguished:

esophageal - between the end of the esophagus and the duodenum, bypassing the stomach;
gastrointestinal (gastroenteroanastomosis) - between the stomach and intestines;
interintestinal.

The third option is a mandatory component of most bowel operations. Among this type, anastomoses are distinguished:

small intestine,
enteric,
colonic.

In addition, in abdominal surgery (a section related to operations on the abdominal organs), it is customary, depending on the technique for performing the connection of the inlet and outlet sections, to distinguish between certain types of anastomoses:

end to end;
side to side;
end to side;
side to end.

What should be the anastomosis?

The created anastomosis must correspond to the expected functional goals, otherwise there is no point in operating on the patient. The main requirements are:

providing a sufficient width of the lumen so that the narrowing does not interfere with the passage of the contents;
no or minimal interference with the mechanism of peristalsis (contraction of the intestinal muscles);
complete tightness of the seams providing the connection.

It is important for the surgeon not only to determine what type of anastomosis will be applied, but also with what suture to fasten the ends. This takes into account:

the intestine and its anatomical features;
the presence of inflammatory signs at the site of surgery;
intestinal anastomoses require a preliminary assessment of the viability of the wall, the doctor carefully examines it by color, the ability to contract.

The most commonly used classic seams:

Gambi or nodular - needle punctures are made through the submucosal and muscle layers, without capturing the mucous;
Lambert - the serous membrane (outer in relation to the intestinal wall) and the muscle layer are sutured.

Description and characteristics of the essence of anastomoses

The formation of an anastomosis of the intestine, as a rule, is preceded by the removal of part of the intestine (resection). Next, it becomes necessary to connect the leading and outgoing ends.

end-to-end type

It is used to sew together two identical segments of the large intestine or small intestine. It is carried out with a two- or three-row seam. It is considered the most beneficial in terms of compliance with anatomical features and functions. But technically difficult to implement.

The connection condition is the absence of a large difference in the diameter of the compared sections. The end that is smaller in clearance is notched for full compliance. The method is used after resection of the sigmoid colon, in the treatment intestinal obstruction.

Anastomosis "end to side"

The method is used to connect sections of the small intestine or on the one hand - thin, on the other - thick. The small intestine is usually sutured to the side of the large intestine wall. Provides 2 stages:

At the first stage, a dense stump is formed from the end of the efferent colon. The other (open) end is applied to the intended site of the anastomosis from the side and sutured along the back wall with a Lambert suture.
Then an incision is made along the efferent intestine along a length equal to the diameter of the leading section, and the anterior wall is sutured with a continuous suture.

side to side type

It differs from the previous options by the preliminary “blind” closure with a two-row suture and the formation of stumps from the connected intestinal loops. The end, above the located stump, is connected with the lateral surface to the underlying area with a Lambert suture, which is 2 times longer than the diameter of the lumen. It is believed that technically the implementation of such an anastomosis is the easiest.

It can be used both between homogeneous sections of the intestine, and to connect dissimilar areas. Main indications:

the need for resection of a large area;
danger of overstretching in the anastomosis zone;
small diameter of connected sections;
the formation of an anastomosis between the small intestine and the stomach.

The advantages of the method include:

no need to suture the mesentery of different areas;
tight connection;
guaranteed prevention of intestinal fistula formation.

side to end type
If this type of anastomosis is chosen, this means that the surgeon intends to sew the end of the organ or intestine after resection into the hole created on the lateral surface of the afferent intestinal loop. More often used after resection of the right half of the large intestine to connect the small and large intestine.

The connection may have a longitudinal or transverse (more preferred) direction with respect to the main axis. In the case of a transverse anastomosis, fewer muscle fibers are crossed. It does not disturb the wave of peristalsis.

Prevention of complications

Complications of anastomoses can be:

divergence of seams;
inflammation in the area of the anastomosis (anastomosis);
bleeding from damaged vessels;
the formation of fistulous passages;
the formation of narrowing with intestinal obstruction.

To avoid adhesions and intestinal contents entering the abdominal cavity:

the site of the operation is lined with napkins;
an incision for suturing the ends is carried out after clamping the intestinal loop with special intestinal clamps and squeezing out the contents;
the incision of the mesenteric edge ("window" is sutured);
the patency of the created anastomosis is determined by palpation until the operation is completed;
in the postoperative period, broad-spectrum antibiotics are prescribed;
the rehabilitation course necessarily includes a diet, physiotherapy exercises and breathing exercises.

Modern ways to protect anastomoses

In the immediate postoperative period, the development of anastomositis is possible. Its cause is considered:

inflammatory reaction to the suture material;
activation of conditionally pathogenic intestinal flora.

For the treatment of subsequent cicatricial narrowing of the esophageal anastomosis, the installation of polyester stents (expanding tubes that support the walls in an expanded state) using an endoscope is used.

In order to strengthen the sutures in abdominal surgery, autografts are used (suturing of own tissues):

from the peritoneum;
gland;
fat suspensions;
mesenteric flap;
serous-muscular flap of the stomach wall.

However, many surgeons limit the use of the omentum and pedunculated peritoneum with a blood-supplying vessel to only the last stage of colon resection, since they consider these methods to be the cause of postoperative purulent and adhesive processes.

Various drug-filled protectors for suppressing local inflammation are widely accepted. These include adhesives with biocompatible antimicrobial content. It includes for the protective function:

collagen;
cellulose ethers;
polyvinylpyrrolidone (biopolymer);
Sanguirythrin.

As well as antibiotics and antiseptic:

The surgical adhesive becomes stiff when cured, so narrowing of the anastomosis is possible. Gels and solutions of hyaluronic acid are considered more promising. This substance is a natural polysaccharide secreted by organic tissues and some bacteria. It is part of the intestinal cell wall, therefore it is ideal for accelerating the regeneration of anastomotic tissues, does not cause inflammation.

Hyaluronic acid is included in biocompatible bioresorbable films. A modification of its combination with 5-aminosalicylic acid (the substance belongs to the class of non-steroidal anti-inflammatory drugs) is proposed.

Postoperative atonic constipation

Especially often coprostasis (stagnation of feces) appears in elderly patients. Even short-term bed rest and diet disrupt their bowel function. Constipation may be spastic or atonic. Loss of tone is removed as the diet expands and physical activity increases.

To stimulate the intestines, a cleansing enema in a small volume with hypertonic saline solution is prescribed for 3-4 days. If the patient needs a long exclusion of food intake, then vaseline oil or Mucofalk is used inside.

With spastic constipation, it is necessary:

relieve pain with medicines with analgesic action in the form of rectal suppositories;
lower the tone of the sphincters of the rectum with the help of drugs of the antispasmodic group (No-shpy, Papaverine);
to soften the stool, microclysters are made from warm vaseline oil in a solution of furacilin.

senna leaves,
buckthorn bark,
rhubarb root,
Bisacodyl,
Castor oil,
Gutalax.

Osmotic action have:

Glauber and Karlovy Vary salt;
magnesium sulfate;
lactose and lactulose;
Mannitol;
Glycerol.

Laxatives that increase the amount of fiber in the colon - Mucofalk.

Early treatment of anastomositis

To relieve inflammation and swelling in the area of the seams appoint:

antibiotics (Levomycetin, aminoglycosides);
with localization in the rectum - microclysters from warm furacilin or by installing a thin probe;
soft laxatives based on vaseline oil;
patients are advised to take up to 2 liters of liquid, including kefir, fruit drink, jelly, compote to stimulate the passage of intestinal contents.

If bowel obstruction develops

The occurrence of obstruction can cause swelling of the anastomosis zone, cicatricial narrowing. When acute symptoms a repeated laparotomy is performed (an incision in the abdomen and an opening of the abdominal cavity) with the elimination of the pathology.

In case of chronic obstruction in the late postoperative period, an intensive antibiotic therapy, removal of intoxication. The patient is examined to decide whether surgery is necessary.

Technical reasons

Sometimes complications are associated with inept or insufficiently qualified operation. This leads to excessive tension of the suture material, excessive imposition of multi-row sutures. Fibrin falls out at the junction and mechanical obstruction is formed.

Intestinal anastomoses require adherence to the technique of the operation, careful consideration of the state of the tissues, and the skill of the surgeon. They are imposed as a result of surgical intervention only in the absence of conservative methods of treating the underlying disease.

The term "resection" (cutting off) means surgical removal either the entire affected organ or part of it (much more often). Intestinal resection is an operation during which the damaged part of the intestine is removed. A distinctive feature of this operation is the imposition of an anastomosis. The concept of anastomosis in this case refers to the surgical connection of the continuity of the intestine after the removal of its part. In fact, this can be explained as stitching one part of the intestine to another.

Resection is a rather traumatic operation, so you need to know the indications for it well, possible complications and methods of patient management in the postoperative period.

Classification of resections

Operations to remove (resection) part of the intestine have many varieties and classifications, the main ones are the following classifications.

By the type of intestine on which the surgical access is performed:

Removal of part of the colon;
Removal of part of the small intestine.

In turn, operations on the small and large intestine can be divided into another classification (according to the departments of the small and large intestine):

Among the departments of the small intestine, there may be resections of the ileum, jejunum or duodenum 12;
Among the sections of the large intestine, resections of the caecum, colon, and rectum can be distinguished.

According to the type of anastomosis, which is superimposed after resection, there are:

Resection and formation of anastomosis

End-to-end type. With this type of operation, the two ends of the resected colon are connected or the connection of two adjacent sections (for example, the colon and sigmoid, the ileum and the ascending colon, or the transverse colon and the ascending colon). This compound is more physiological and repeats the normal course of the digestive tract, however, with it there is a high risk of developing scarring of the anastomosis and the formation of obstruction;
Side to side type. Here, the lateral surfaces of the departments are connected and a strong anastomosis is formed, without the risk of developing obstruction;
Side to side type. Here, an intestinal anastomosis is formed between the two ends of the intestine: the outlet, located on the resected section, and the adductor, located on the adjacent section of the intestine (for example, between the ileum and the caecum, transverse colon and descending).

Indications for surgery

The main indications for resection of any of the sections of the intestine are:

Strangulation obstruction ("torsion");
Invagination (the introduction of one section of the intestine into another);
Nodulation between intestinal loops;
Cancer of the colon or small intestine (rectum or ileum);
Necrosis of the intestines.

Preparing for the operation

The course of preparation for resection consists of the following points:

Diagnostic examination of the patient, during which the localization of the affected area of the intestine is determined and the condition of the surrounding organs is assessed;
Laboratory studies, during which the state of the patient's body, his blood coagulation system, kidneys, etc., as well as the absence of concomitant pathologies, are assessed;
Consultations of specialists who confirm / cancel the operation;
Examination of the anesthesiologist, who determines the patient's condition for anesthesia, the type and dose of the anesthetic substance that will be used during the intervention.

Conducting surgery

The course of the operation itself usually consists of two stages: direct resection of the necessary section of the intestine and further imposition of the anastomosis.

Resection of the intestine can be completely different and depends on the main process that caused the damage to the intestine and the intestine itself (transversely the colon, ileum, etc.), and therefore its own version of the anastomosis is chosen.

There are also several approaches to the intervention itself: a classic (laparotomy) incision of the abdominal wall with the formation of an operating wound and laparoscopic (through small holes). Recently, the laparoscopic method is the leading approach used during the intervention. This choice is explained by the fact that laparoscopic resection has a much less traumatic effect on the abdominal wall, which means it contributes to more quick recovery patient.

Complications of resection

The consequences of bowel removal can be different. Sometimes the following complications may develop in the postoperative period:

infectious process;
Obstructive obstruction - with cicatricial lesions of the operated intestinal wall at the junction;
Bleeding in the postoperative or intraoperative period;
Hernial protrusion of the intestine at the site of access on the abdominal wall.

Dietary nutrition during resection

Nutrition provided not after surgery will be different during resection various departments intestines

The diet after resection is sparing and involves the intake of light, quickly absorbed foods, with minimal irritating effect on the intestinal mucosa.

Dietary nutrition can be divided into a diet used for resection of the small intestine and for the removal of part of the large intestine. Such features are explained by the fact that different parts of the intestines have their own digestive processes, which determines the types of food products, as well as the tactics of eating with these types of diets.

So, if part of the small intestine was removed, then the ability of the intestine to digest chyme (a food bolus moving along the gastrointestinal tract) will be significantly reduced, as well as to absorb the necessary nutrients from this food bolus. In addition, during resection of the thin section, the absorption of proteins, minerals, fats and vitamins will be impaired. In this regard, in the postoperative period, and then in the future, the patient is recommended to take:

Lean meats (to compensate for protein deficiency after resection, it is important that the protein consumed is of animal origin);
As fats in this diet, it is recommended to use vegetable and butter.

Foods containing a large amount of fiber (for example, cabbage, radish);
Carbonated drinks, coffee;
beetroot juice;
Products that stimulate intestinal motility (prunes).

The diet for removal of the large intestine is practically the same as that after resection of the small intestine. The very assimilation of nutrients during resection of the thick section is not disturbed, however, the absorption of water, minerals, and the production of certain vitamins are disturbed.

In this regard, it is necessary to form a diet that would compensate for these losses.

Advice: many patients are afraid of resection precisely because they do not know what to eat after bowel surgery. and what is not, assuming that resection will lead to a significant reduction in nutrition. Therefore, the doctor needs to pay attention to this issue and describe in detail to such a patient the entire future diet, regimen and type of nutrition, as this will help to convince the patient and reduce his possible fear of surgery.

Light massage of the abdominal wall will help to start the intestines after surgery

Another problem for patients is the postoperative decrease in the motility of the operated intestine. In this regard, a logical question arises about how to start the intestines after surgery. To do this, in the first few days after the intervention, a sparing dietary and strict bed rest is prescribed.

Prognosis after surgery

Prognostic indicators and quality of life depend on various factors. The main ones are:

Type of underlying disease that led to resection;
Type of surgery and the course of the operation itself;
The patient's condition in the postoperative period;
Absence/presence of complications;
Proper observance of the mode and type of nutrition.

Different types of the disease, during the treatment of which resection of various parts of the intestine was used, have different severity and risk of complications in the postoperative period. Thus, the most alarming in this regard is the prognosis after resection for oncological lesions, since this disease can recur, as well as give various metastatic processes.

Operations to remove part of the intestine, as already described above, have their own differences and, therefore, also affect the further prognosis of the patient's condition. So, surgical interventions, including, together with the removal of part of the intestine and work on the vessels, are distinguished by a longer course of execution, which has a more exhausting effect on the patient's body.

Compliance with the prescribed diet, as well as the correct diet, significantly improves further prognostic indicators of life. This is due to the fact that with the correct observance of dietary recommendations, the traumatic effect of food on the operated intestine is reduced, and the correction of substances missing from the body is carried out.

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult a doctor!

This article will tell you what lifestyle cancer patients should lead so that bowel cancer does not recur after surgery and does not resume with renewed vigor. It will also provide advice on proper nutrition: what should the patient do during the rehabilitation period, and what complications can occur if the recommendations prescribed by the doctor are not followed?

Complications and possible consequences

Bowel cancer surgery is risky and dangerous, like other surgical interventions of this complexity. The first signs that are considered harbingers of postoperative complications, physicians call the outflow of blood into the peritoneal cavity; as well as problems with wound healing or infectious diseases.

After surgical removal of an intestinal tumor, other complications arise:

Anastomosis is the fastening of two anatomical segments to each other. If the anastomotic sutures are insufficient, the two ends of the intestine sewn together may soften or tear. As a result, intestinal contents will enter the peritoneal cavity and cause peritonitis (inflammation of the peritoneum).

Most patients after surgery complain about the deterioration of the process of eating. They often complain of flatulence and disorder of the act of defecation. As a result, patients have to change their usual diet, making it more monotonous.

Most often, adhesions do not bother the patient, but due to impaired intestinal muscle motility and poor patency, they can cause pain and be dangerous to health.

What should recovery after bowel cancer surgery include?

In the intensive care unit, the person returns from anesthesia to a normal state. After the end of the operation, the patient is prescribed analgesics to relieve discomfort and pain in the abdominal cavity. The doctor may prescribe injection anesthesia (epidural or spinal). To do this, with the help of droppers, drugs that relieve pain are injected into their body. A special drainage is placed in the area of the surgical wound, which is needed to drain the accumulated excess fluid, and after a couple of days it is removed.

Without the help of medical staff, patients are allowed to eat a few days after the operation. The diet must include liquid cereals and well-mashed soups. Only after a week the patient is allowed to move around the hospital. In order for the intestines to heal, patients are advised to wear a special bandage, which is needed to reduce the load on the abdominal muscles. In addition, the bandage allows you to provide the same pressure over the entire area in the abdominal cavity, and it contributes to the rapid and effective healing of sutures after surgery.

For rehabilitation to be successful, patients are prescribed a special diet after the intervention, which they must adhere to. There is no clearly established diet for cancer patients, and it depends only on the preferences of the patient. But, in any case, your diet should be compiled with your doctor or nutritionist.

If during the operation the stoma (artificial opening) was removed to the patient, then in the first days it will look swollen. But within the first two weeks, the stoma shortens and decreases in size.

If the patient's condition has not worsened, he is in the hospital for no more than 7 days. The sutures or clips that the surgeon put on the wound opening are removed after 10 days.

Nutrition after bowel cancer surgery

About the diet after surgical treatment of intestinal oncology, it can be said that patients can adhere to their usual diet. But with symptoms of indigestion (belching, indigestion, constipation), it is recommended to correct the dysregulation of the stool, which is very important for patients with an artificial anus.

If after surgery you are tortured by frequent liquid stool, doctors advise eating foods low in fiber. Gradually, the old diet of the patient is restored, and food products that previously caused problems in the work of the body are introduced into the menu. To restore the diet, you should go to a consultation with a nutritionist.

Food should be consumed in small portions five times a day.
Drink plenty of fluids between meals.
While eating, you should not rush, you need to chew food well.
Eat medium temperature food (not too cold and not too hot).
Get systematic and regular in your meals.
Patients whose weight deviates from the norm, doctors advise to eat food in full. Patients with a weight below normal are recommended to eat a little more, and those suffering from excess weight- a little less.
Food is best steamed, boiled or stewed.
Avoid foods that cause bloating (flatulence); and also from spicy or fried foods, if you can hardly bear them.
Avoid eating foods that you have an intolerance to.

The main question that worries people after being discharged from the hospital is whether they will be able to work after the operation? After surgical treatment of intestinal oncology, the performance of patients depends on many factors: the stage of tumor development, the type of oncology, and the profession of patients. After cardinal operations, for a couple of years, patients are not considered able to work. But, if a relapse has not occurred, they can return to their old job (we are not talking about physically demanding professions).

It is especially important to restore the consequences of a surgical operation that lead to improper functioning of the intestine (inflammation processes in the area of the artificial anus, a decrease in the diameter of the intestine, inflammation of the colon, fecal incontinence, etc.).

If the treatment is successful, the patient should undergo regular examinations for 2 years: general analysis feces and blood; regularly undergo a survey of the surface of the large intestine (colonoscopy); organ x-ray chest. If no recurrence has occurred, diagnostics should be carried out at least once every 5 years.

Completely cured patients are not restricted in any way, but are advised not to engage in severe physical work within six months after discharge from the hospital.

Relapse prevention

The chance of recurrence after removal of benign tumors is extremely small, sometimes they occur due to non-radical surgery. After two years of therapy, it is very difficult to indicate the origin of tumor growth progress (metastasis or recurrence). A neoplasm that has appeared again is qualified as a relapse. Relapses of malignant tumors are often treated with conservative methods, using anticancer drugs and radiation therapy.

The main prevention of tumor recurrence is early diagnosis and topical surgical intervention in local oncology, as well as full compliance with ablastic norms.

There are no specific recommendations for the secondary prevention of recurrence of this oncology. But doctors still advise to follow the same rules as for primary prevention:

Constantly be in motion, that is, lead an active lifestyle.
Keep alcohol consumption to a minimum.
Quit smoking (if bad habit available).
It is worth losing weight (if you are overweight).

During the recovery period, in order to avoid the recurrence of cancer, it is necessary to carry out special gymnastic exercises that will strengthen the intestinal muscles.

It's important to know:

Anastomosis is also divided into several types:

"Side to side". During stitching, parts of the intestine parallel to each other are taken. The postoperative result of such treatment has a fairly good prognosis. In addition to the fact that the anastomosis comes out strong, the risk of obstruction is minimized.
"Side to the end". The formation of the anastomosis is carried out between the two ends of the intestine: the outlet, located on the resected section, and the adductor, located on the adjacent section of the intestine (for example, between the ileum and the caecum, transverse colon and descending).
"End to end". The 2nd end of the resected intestine or 2 adjacent sections is connected. Such an anastomosis is considered the most similar to the natural position of the intestine, that is, the position before the operation. If there is severe scarring, then there is a chance of obstruction.

2 Indications and preparations

The procedure for excision of the intestine is prescribed in the presence of one of the following pathologies:

Cancer of one of the intestines.
The introduction of one section of the intestine into another (invagination).
The appearance of nodes between parts of the intestine.
Departmental necrosis.
Obstruction or inversion.

Depending on the diagnosis, the operation can be planned or emergency.

The complex of preparatory measures includes a thorough examination of the organ and an accurate determination of the localization of the pathogenic site. Additionally, they take blood and urine for analysis, and also check the body's compatibility with one of the anesthetic drugs, since the resection is carried out under general anesthesia. In the presence of an allergic reaction, another anesthetic is selected medicinal product. If this is not done, then problems can begin even before the start of the surgical intervention itself or in the process of its implementation. Incorrectly selected anesthesia can cause lethal outcome.

≡ Digestion > Gastrointestinal diseases > Intestinal anastomosis: features, preparation, purpose

Operations on the intestines are considered to be one of the most complex and requiring special professionalism of the surgeon. It is important not only to restore the broken integrity of the organ, but also to make it so that the intestine continues to function normally, does not lose its contractile function.

Intestinal anastomosis is a complex operation, which is performed only in case of emergency and in 4-20% of cases leads to various complications.

What is an intestinal anastomosis, and in what cases is it prescribed?

Fistulas are the cause of colon cancer.

Anastomosis is the connection of two hollow organs and their stitching together. In this case, we are talking about stitching two parts of the intestine.

There are two types of operations on the intestines that require subsequent anastomosis - these are enterectomy and resection.

In the first case, the intestine is cut to remove a foreign body from it.

During resection, an anastomosis is indispensable, in this case the intestine is not only cut, but part of it is also removed, after only two parts of the intestine are sutured in one way or another (types of anastomosis).

Anastomosis of the intestine is a major surgical procedure. It is performed under general anesthesia, and after it the patient needs a long rehabilitation, and complications are not excluded. Bowel resection with anastomosis may be prescribed in the following cases:

Colon cancer. Colon cancer is the leading cancer in developed countries. The cause of its occurrence can be fistulas, polyps, ulcerative colitis, heredity. Resection of the affected area with subsequent anastomosis is prescribed for initial stages diseases, but can also be carried out in the presence of metastases, since leaving a tumor in the intestine is dangerous due to possible bleeding and intestinal obstruction due to tumor growth.
Intestinal obstruction. Obstruction can occur due to a foreign body, tumor, or severe constipation. In the latter case, you can wash the intestines, but the rest will most likely have to be operated on. If the intestinal tissues have already begun to die due to the transferred vessels, part of the intestine is removed and an anastomosis is performed.
Bowel infarction. With this disease, the outflow of blood to the intestines is disturbed or completely stops. This is a dangerous condition that leads to tissue necrosis. It is more common in older people with heart disease.
Crohn's disease. This is a whole complex of different conditions and symptoms that lead to disruption of the intestines. This disease is not treated surgically, but patients have to go for surgery, because in the course of the disease, life-threatening complications can occur.

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Preparation and procedure

Espumizan eliminates gases.

Such a serious procedure as intestinal anastomosis requires careful preparation. Previously, preparation was carried out with the help of enemas and diet.

Now the need to follow a slag-free diet remains (for at least 3 days before the operation), but at the same time, the day before the operation, the patient is prescribed Fortrans, which quickly and efficiently cleanses the entire intestine.

Before the operation, fried foods, sweets, hot sauces, some cereals, beans, seeds and nuts should be completely excluded.

The day before the procedure, the patient only eats breakfast and starts taking Fortrans in the afternoon. It is available in powder form. You need to drink at least 3-4 liters of the diluted drug (1 sachet per liter, 1 liter per hour). After taking the drug, a painless watery stool begins in a couple of hours.

Fortrans is considered the most effective drug to prepare for various manipulations on the intestines. It allows you to completely clean it in short time. The procedure itself is performed under general anesthesia. Anastomosis has 3 varieties:

"End to end". The most efficient and commonly used method. It is possible only if the connected parts of the intestine do not have a big difference in diameter. If it is slightly smaller from the parts, the surgeon slightly cuts it and increases the lumen, and then stitches the parts edge to edge.
"Side to side". This type of anastomosis is performed when a significant part of the intestine has been removed. After the resection, the doctor sews up both parts of the intestine, makes incisions and stitches them side to side. This technique of the operation is considered the simplest.
"End to Side". This type of anastomosis is suitable for more complex operations. One of the parts of the intestine is sewn tightly, making a stump and pre-squeezing out all the contents. The second part of the intestine is sewn to the side of the stump. Then, a neat incision is made on the lateral part of the deaf intestine so that it coincides in diameter with the second part of the intestine and the edges are sutured.

Read: Classification, treatment and symptoms of esophageal hernia. Types of therapy

Postoperative period and complications

Eating cereals will reduce the load on the intestines.

After surgery on the intestines, the patient must undergo a mandatory rehabilitation course. Unfortunately, complications after bowel resection are very common even with the high professionalism of the surgeon.

In the first days after the operation, the patient is observed in the hospital. There may be minor bleeding. but they are not always dangerous. Seams are regularly inspected and processed.

The first time after the operation, you can only drink water without gas, after a few days, liquid food is acceptable. This is due to the fact that after such a serious operation, you need to reduce the load on the intestines and avoid stools for at least the first 3-4 days.

Proper nutrition is especially important in the postoperative period. It should provide loose stools and replenish the body's strength after abdominal surgery. Only those products are allowed that do not cause increased gas formation, constipation and do not irritate the intestines.

Liquid cereals, dairy products, after a while fiber (fruits and vegetables), boiled meat, mashed soups are allowed.

Complications after surgery may appear as the fault of the patient himself (non-compliance with the regimen, malnutrition, increased physical activity), and due to circumstances. Complications after anastomosis:

Infection. Doctors in the operating room follow all safety rules. All surfaces are disinfected, but even in this case it is not always possible to avoid infection of the wound. With infection, redness and suppuration of the suture, fever, weakness are observed.
Obstruction. The intestines after surgery may stick together due to scarring. In some cases, the intestine is bent, which also leads to obstruction. This complication may not appear immediately, but some time after the operation. It requires repeated surgery.
Bleeding. The abdominal operation is most often accompanied by blood loss. The most dangerous after the operation is internal bleeding, since the patient may not notice it immediately.

Read: Cholelithiasis. Disease symptoms and other important issues

It is impossible to completely protect yourself from complications after surgery, but you can significantly reduce the likelihood of their occurrence if you follow all the doctor's recommendations and regularly undergo preventive examinations after surgery. follow the rules of nutrition.

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When it comes to bowel cancer, then, as a rule, they mean malignant tumor colon (carcinoma (cancer) of the colon) and rectum (rectal carcinoma). Further in the article, we present to your attention an overview of the methods surgical treatment of bowel cancer. and also talk about possible consequences for patients who have had one of the following operations .

Overview of Colon Cancer Surgery

Cancer of the small intestine and cancer of the anus (cancer of the anus) are rare. If we are talking about colon cancer, then, as a rule, they mean a malignant tumor of the colon (carcinoma (cancer) of the colon) and rectum (rectal carcinoma). These types of cancer are also called colorectal cancer. Although colorectal cancer can develop in all parts of the colon and rectum, it most often occurs in the lower region within 30-40 centimeters. Harbingers of colon cancer are often mushroom-shaped growths, the so-called intestinal polyps, which are often benign tumor-like formations. The main treatment for bowel cancer is surgery, that is, the removal of the affected area of the large intestine along with its lymphatic and blood vessels. In the case of advanced cancer, when there is no prospect of recovery, surgery is in most cases abandoned, except in cases where it is necessary to prevent complications such as intestinal obstruction. Surgery for bowel cancer, with the exception of intestinal obstruction, is not an emergency surgical intervention, there is enough time left for diagnosis and treatment planning. In this way, complications can be avoided and the chances of recovery improved. The following text contains information about the methods of surgical intervention for bowel cancer and the consequences after the operation that the patient may face.

Surgical Treatment of Colon Cancer: Indications and Aims

Bowel cancer operations are performed in many clinics (university clinics, district hospitals) and bowel cancer centers. Bowel Cancer Centers are clinics that have been certified for their specific care for clients with bowel cancer.

The main goal of bowel cancer surgery is to completely remove the tumor and thereby cure the cancer. The goal of surgery, in addition to removing the intestinal tumor, is also to remove metastases (secondary tumors, for example, in the lungs and liver), to examine the abdominal cavity and its organs, and to remove lymph nodes for diagnostic purposes to check for possible spread through the intestines. This, in turn, is important for determining the stage of cancer (Staging), so that further treatment can be planned and predicted. In addition, bowel cancer surgery may be required if there is a risk of intestinal obstruction (complicated intestinal transit) due to fusion.

Curative and palliative operations for bowel cancer

If during surgical intervention all tumor tissue is removed, including possible metastases in the lymph nodes or other organs, then in this case we are talking about therapeutic surgery for bowel cancer. With this surgical intervention, along with the affected area of \u200b\u200bthe intestine, nearby healthy tissue is removed to reduce the risk of the tumor reappearing (recurrence). Since individual cancer cells may already be able to multiply and penetrate into nearby The lymph nodes, they are also removed.

The situation looks different when it comes to palliative surgery for bowel cancer at its progressive stage (for example, with metastases that cannot be removed). Here, specialists attempt to prevent complications and pain associated with the tumor, while there is no chance of recovery. If the tumor grows, for example, inside the intestines, then it can interfere with the passage of intestinal contents, which, in turn, can lead to the development of life-threatening intestinal obstruction. In this case, the surgeon will try to reduce the tumor to such a size as to eliminate the narrow passage. Palliative operations also include avoiding narrowing by means of a bypass anastomosis and the installation of an artificial anus (stoma).

Surgical treatment of bowel cancer: preoperative stage

Before surgery for bowel cancer, a very thorough examination should be carried out regarding the condition of the tumor or, more precisely, the location of the tumor in the intestine and its possible growth.

The most common examinations include:

digital rectal examination (palpation of the lower part of the rectum) in order to assess the spread of the tumor and predict the preservation of sphincter function after bowel cancer surgery;
ultrasound examination (ultrasound) of the abdominal organs in order to assess the possible growth of a tumor outside the affected organ;
a chest x-ray (chest x-ray) to rule out or detect lung metastases
determination of the level of CEA (carcinoembryonic antigen, CEA) before bowel cancer surgery serves as an initial indicator for subsequent monitoring of the course of the disease, as well as for evaluating the prognosis after surgery;
rectoscopy (proctoscopy) to determine the extent of the tumor in rectal cancer;
endosonography (endoscopic ultrasound) to determine the depth of tumor infiltration in rectal cancer;
A colonoscopy is used to accurately examine the entire colon to look for other possible colon polyps or tumors.

Immediately before the operation of bowel cancer and during its implementation, the following measures are taken:

the intestines are thoroughly cleansed (with a special solution that has a laxative effect and is usually taken orally);
an antibiotic is taken against infections (bacteria of the intestinal flora can cause dangerous infections in the abdominal cavity);
the area of skin where the incision is to be made is shaved (for better disinfection);
preventive measures are taken against thrombosis.

Surgical treatment of bowel cancer: Methods

In bowel surgery, there are two main methods of treating bowel cancer. At radical bowel cancer surgery not only the tumor is removed from the body, but also healthy tissues adjacent to it. Unlike the radical local surgery for bowel cancer only the tumor itself is removed at a safe distance (a narrow border of healthy tissue), but not adjacent healthy tissue.

Depending on the stage and severity of the tumor, colon cancer surgery can be performed using the laparotomy method (opening the abdominal cavity) or minimally invasive.

Open and minimally invasive surgical treatment of bowel cancer

Tumors of small size that have not yet penetrated into the deeper layers of the intestine can be removed during colonoscopy. If there is doubt about the complete removal of the tumor tissue, then this is followed by a conventional bowel cancer operation. "Conventional" bowel cancer surgery can be performed as a minimally invasive keyhole technique ( laparoscopy) or with an opening of the abdominal cavity ( laparotomy).

In the later stages of bowel cancer, due to the extensiveness of the operation, laparotomy is performed almost without exception. In other cases, the laparoscopic method of removing the tumor, which has taken root to date, is used in patients suffering from bowel cancer. Although this method is widely used, it is desirable to carry out such an operation by an experienced surgeon. The laparoscopic method of tumor removal gives almost the same result as the traditional operation with the opening of the abdominal cavity. The main advantage of this method is that the operation is more gentle and the patient recovers faster.

Radical surgery for bowel cancer

Since individual cancer cells in intestinal cancer can separate from the primary tumor and spread throughout the body, forming metastases there (including in the lymph nodes), then during a radical operation, for the sake of reliability, the tumor is removed with a margin (i.e., including healthy tissue around the tumor) along with adjacent lymph nodes, lymphatic and blood vessels. Radical surgery is often critical to successful removal of the tumor without the risk of the disease recurring (recurrence). Often the decision on the size of the removed segment of the intestine is made during the operation.

Non-contact operation (No-Touch)

In order to avoid dispersion of tumor cells during the operation, the blood and lymphatic vessels associated with the tumor are first tied up, and then the segment of the intestine affected by the tumor is cut off from the healthy segment of the intestine. Carefully so as not to touch the tumor and not damage it (the so-called No-Touch-technology, the affected segment of the intestine, including the lymph nodes, lymphatic and blood vessels, is cut off and removed from the abdominal cavity. The goal of a non-contact operation is to prevent destruction tumors and thus the spread cancer cells in organism.

Radical En-bloc operation

If the tumor is so large that neighboring organs are already affected, experienced surgeons perform the so-called radical En-bloc operation. In this case, not only the tumor is removed, but also the organs affected by it according to the “en bloc” method (“removal by the “block”). The purpose of such an operation is also to prevent damage to the tumor.

Local removal of the tumor

With local removal of a cancerous tumor of the intestine, only the tumor itself is subject to surgery, taking into account the safe distance. Such an operation can be performed at an early stage for small tumors, the following methods are mainly used:

colonoscopy and polypectomy (for colon cancer);
laparotomy or laparoscopy (for colon cancer);
polypectomy or transanal endoscopic microsurgery (for rectal cancer).

In the event that at a subsequent histological examination it is confirmed that the tumor has been completely removed and the risk of recurrence is minimized, eliminating the need for a subsequent radical operation for bowel cancer.

Surgical Treatment of Colon Cancer: Artificial Anus

An artificial anus (stoma or anus praeter) is a connection of a healthy intestine with an opening in the wall of the abdominal cavity, through which the contents of the intestine are brought out. This method can be used both temporarily and for a long time.

At colon cancer for a long period of time, a stoma can only be used in rare cases. However, in difficult cases, a temporary stoma may be needed to relieve the bowel or intestinal suture after bowel cancer surgery. If earlier during the operation small intestine cancer(for example, with tumors near the anus), along with the affected area of the rectum, the entire sphincter was also removed, at present, in most cases, rectal cancer surgery is performed in such a way as to preserve the sphincter apparatus. For experienced rectal surgeons, a safe distance of 1 cm from the anus is sufficient to prevent a permanent stoma.

Temporary artificial anus

A temporary artificial anus (temporary colostomy) is placed during bowel cancer surgery to take stress off the operated bowel and sutures. Through the colostomy, the contents of the intestine are brought out, thus creating conditions for faster healing of the intestine and sutures. This stoma is also called unloading stoma. A temporary artificial anus is superimposed, as a rule, in the form double-barreled stoma. This means that the intestine (small or large intestine) is brought out through the wall of the abdominal cavity, cut from above and everted so that two holes in the intestine are visible. After a small operation to close the temporary stoma and the hole in the abdominal wall, natural digestion is restored in about 2-3 months.

Permanent (permanent) artificial anus

If the tumor is located so close to the sphincter that preservation of the anus is not possible, both the rectum and the sphincter itself are completely removed. In this bowel cancer operation, a permanent (permanent) stoma is applied. In a permanent stoma, the healthy lower part of the colon is brought out through an opening in the abdominal wall and stitched to the skin there. Most patients have no problems with a permanent stoma after a period of familiarization and instruction. Even regular bowel movements do not cause them any special problems.

Special plasters or so-called caps are available for ostomy patients for water sports (for example, swimming) and saunas. In addition, for patients with an unnatural anus, there are no restrictions in their professional activity or choosing a sport.

Surgical Treatment of Colon Cancer: Risks and Consequences

Like any other surgery, bowel cancer surgery can also have its own risks and dangers. The first signs of serious complications after bowel cancer surgery include, for example, bleeding into the abdominal cavity, problems with wound healing or infection.

Other risks and complications after bowel surgery are:

Anastomotic failure: An anastomosis is a connection between two anatomical structures. If the anastomosis is insufficient, the two ends of the intestine sewn together or the suture between the intestine and the skin with an artificial anus may weaken or break. As a result, intestinal contents can enter the abdominal cavity and cause peritonitis (inflammation of the peritoneum).
Digestive disorder: Since the process of eating in the large intestine is largely completed, the operations, in terms of the process of digestion of food, are less problematic than in the small intestine. However, water reabsorption occurs in the colon, which, depending on the segment of the colon removed, can lead to disruption of the stool hardening process. This leads to more or less severe diarrhea. Many patients (especially those with an ostomy) also complain of digestive disorders such as bloating, constipation, and odors after bowel cancer surgery. As a result, patients change their usual diet, which can lead to a monotonous diet.
Fecal incontinence, dysfunction Bladder, sexual dysfunction (impotence in men): When performing a surgical operation on the rectum, the nerves in the operated area can be irritated and damaged, which can subsequently cause complaints from patients.
Union (adhesions): In most cases, adhesions are harmless and painless, but sometimes, due to limited intestinal motility and intestinal obstruction, they can be painful and dangerous.

Surgical treatment of bowel cancer: Postoperative care

Metastases (secondary tumors) or recurrence (recurrence of a tumor in the same place) can be detected in a timely manner only in the case of regular monitoring after surgery.

After a successful bowel cancer operation, the following post-operative examinations are offered in particular:

regular colonoscopy;
determination of the CEA tumor marker (carcinoembryonic antigen, CEA);
ultrasound examination of the organs of the abdominal cavity (stomach);
x-ray examination of the lungs;
computed tomography (CT) of the lungs and abdomen.

Surgical treatment of bowel cancer: Nutrition after surgery

With regard to dietary norms after surgical treatment of bowel cancer, there is practically no need for patients to give up their usual food and drink intake. However, due to digestive disorders (bloating, diarrhea, constipation, odors), it is recommended to adjust the regulation of the stool. This is especially true for patients with an artificial anus. To avoid monotonous eating, the following tips should be taken into account:

Diet advice after bowel cancer surgery

Eat 5-6 small meals a day. Avoid eating large portions.
Between meals, it is recommended to consume a sufficiently large amount of liquid.
Eat slowly and chew well.
Avoid eating very hot and very cold foods.
Stick to a regular meal and stop dieting.
Eat enough food, i.e. patients who are underweight are advised to eat a little more, and those who are overweight - a little less than usual.
Braising and steaming are gentle cooking methods.
Avoid very fatty, sugary, and bloating foods, as well as fried, fried, and spicy foods if you are intolerant to them.
Avoid those foods that you have had a bad tolerance for several times.

Photo: www. Chirurgie-im-Build. de We thank Prof. Dr. Thomas W. Kraus, who kindly provided us with these materials.

In contact with

Intestinal anastomoses can be applied end-to-end, side-to-side, end-to-side and side-to-end (Fig. 233).

End-to-end anastomosis - direct connection of the ends of hollow organs with the imposition of a two- or three-row suture. It is more physiological and therefore widely used in various operations. In order not to cause narrowing of the intestinal lumen at the site of the anastomosis, the intestine should be crossed obliquely, removing it more along the free edge. It is not recommended to connect the ends of the intestines of different diameters (thin and thick) with this type of anastomosis.

Side-to-side anastomosis: tightly closed two stumps are placed isoperistaltically and connected by anastomosis on the lateral surfaces of the intestinal loops or stomach and intestine. There is no danger of narrowing in this type of anastomosis, since the width of the anastomosis here is not limited by the diameter of the intestines to be sutured and can be freely adjusted.

End-to-side anastomosis is used when connecting segments of the gastrointestinal tract of different diameters: during resection of the stomach, when its stump is sewn into the side wall of the small intestine; when connecting the small intestine to the large intestine, when the end of the small intestine is sutured to the side wall of the large intestine.

Side-to-end anastomosis: the lateral surface of the more proximal organ is connected to the end of the more distal organ. It is used less often than others (gastroenteroanastomosis according to Roux, ileotransverse anastomosis).

When naming an anastomosis, the more proximal organ is always indicated first, and then the organ located distally: for example, end-to-side ileotransversal anastomosis - the end of the ileum is connected to the lateral surface of the transverse; ileo-

transverse anastomosis side to end - the formation of an anastomosis between the lateral surface of the ileum and the end of the transverse colon.

Suturing wounds of the small intestine

Access - median laparotomy. With a small stab wound, a purse-string serous-muscular suture is placed around it, while tightening its edges, the wound is immersed with tweezers into the intestinal lumen.

Incised wounds a few centimeters long are sutured with a double-row suture: 1) internal through all layers of the intestinal wall - with catgut with the introduction of the edges according to Schmiden; 2) external serous-muscular - interrupted silk sutures.

To avoid narrowing of the intestine, longitudinal wounds are sutured in the transverse direction (Fig. 234). The abdominal cavity is thoroughly dried. The wound of the abdominal wall is sutured tightly.

Resection of the small intestine

Indications: tumors of the intestine or its mesentery, necrosis of the intestine in acute intestinal obstruction, strangulated hernia, thrombosis of the arteries of the small intestine, multiple wounds. The position of the patient on the back. Anesthesia - endotracheal anesthesia. Access - median laparotomy.

Enteroenteroanastomosis end to end. The separation of the mesentery from the intestine can be done in two ways: either parallel to the intestine at its edge at the level of the direct arteries, or wedge-shaped with preliminary ligation of the vessels closer to the root of the mesentery (extensive resections, tumors of the intestine) (Fig. 235).

Bowel resection. On the proximal and distal ends of the removed section of the intestine in an oblique direction at an angle of 45°, rigid hemostatic clamps are applied so that on the side opposite to the mesenteric edge, the section of the intestine to be removed would be somewhat larger. This achieves better blood supply to the antimesenteric edge of the intestine in the area of the anastomosis, as well as an increase in the width of the intestinal lumen at the site of the anastomosis.

Departing 1.0-1.5 cm from the line of the proposed resection and outward from the applied hard clamps, soft intestinal sphincter is applied. The part of the intestine to be removed is excised in an oblique direction parallel to the rigid clamps. After removal of the excised area, the ends of the intestine are brought together.

The formation of enteroenteroanastomosis begins with the stitching of its posterior wall with interrupted serous-muscular sutures. Particularly carefully sutured at the mesenteric edge of the intestine. Then the soft clamps are removed and the posterior edges (lips) of the anastomosis are sutured with a continuous twisting catgut suture, and the anterior edges (lips) are sutured with a Schmiden screw suture. Over the catgut suture, nodal silk serous-muscular sutures are applied to the anterior wall of the anastomosis (Fig. 236). The opening in the mesentery is sutured with separate silk sutures.

Enteroenteroanastomosis side in side. Mobilization and resection of the intestine are performed in the same way as in the previous method, only clamps are applied transversely to the intestine.

The formation of the stump of the adductor and efferent sections of the intestine after resection is performed according to the Doyen method, which consists of the following steps: 1) ligation of the intestine with a catgut ligature under a clamp on the clamped area; 2) applying a purse-string suture at a distance of 1.5 cm from the place of dressing; 3) immersion of the stump with tightening of the purse-string suture, over which a number of interrupted serous-muscular sutures are applied.

Sewing up the hole in the stomach with a perforated ulcer

The position of the patient on the back. Anesthesia - endotracheal anesthesia.

Access - upper median laparotomy. A perforated hole is found, which is more often located in the pyloric region on the anterior wall of the stomach. The hole is sutured with interrupted serous-muscular sutures in the direction transverse to the axis of the stomach, followed by the imposition of the second row of serous-muscular sutures in the same direction (Fig. 227).

Drying of the abdominal cavity. Gastric contents and effusion are carefully removed from the abdominal cavity with an electric suction and dry wipes. The wound of the abdominal wall is sutured tightly in layers.

To connect hollow organs during surgical interventions, a special technique is used - the imposition of an anastomosis.

Types of operations on the intestines

Most often, operations such as enterotomy and resection are performed on the intestine. The first type is chosen if the organ is found foreign body. Its essence lies in the surgical opening of the intestine with a scalpel or electric knife. The suture is selected depending on the part of the intestine, the presence or absence of an inflammatory process in the area of intervention. The wound is sutured with the so-called interrupted Gumby suture, making a puncture through the muscular, submucosal layer without capturing the mucosa, as well as with the Lambert suture, connecting the serous (covers the small intestine from the outside) and the muscular membranes.

Resection means the surgical removal of an organ or part of it. Before its implementation, the doctor evaluates the viability of the intestinal wall (color, the ability to contract, the presence of an inflammatory process). After the doctor marks the boundaries of the resected area, he chooses the type of anastomosis.

Anastomosis methods

There are several ways of imposing an anastomosis. Let's consider them in detail.

end to end

This type is considered the most effective and is most often used if the difference in the diameter of the compared ends of the intestine is not very large. On what has a smaller diameter, the surgeon makes a linear incision to increase the lumen of the organ. At the end of the resection of the sigmoid colon (this is the final region of the colon before going into the straight line), this technique is used.

After surgery on the intestines, the patient must undergo a course of rehabilitation: breathing exercises, therapeutic exercises, physiotherapy, diet therapy. Together, these components will greatly increase the chances of effective recovery of the body.

side to side

It is used when a large area needs to be resected or when there is a risk of high tension at the anastomotic site. Both ends are closed with a two-row suture, and then the stumps are sutured with a continuous Lambert suture. Moreover, its length is 2 times the diameter of the lumen. The surgeon makes an incision and opens both stumps along the longitudinal axis, squeezes out the contents of the intestine, and then sews the edges of the wound with a continuous suture.

End to side

This type of anastomosis consists in the fact that the stump of the efferent intestine is closed using the “side-to-side” technique, the contents of the organ are squeezed out and clamped with intestinal sphincter. Then the open end is applied to the intestine from the side, sewn with a continuous Lambert suture.

The next stage - the surgeon makes a longitudinal incision and opens the outlet part of the intestine. Its length should correspond to the width of the open end of the organ. The anterior part of the anastomosis is also sutured with a continuous suture. This type of anastomosis is optimal for many interventions, even such complex ones as extirpation of the esophagus (means its complete removal, including the nearest lymph nodes, fatty tissue).

Intestinal anastomoses with any kind of connection are used on the small and large intestines. But in the first case, a one-story suture is necessarily chosen (that is, they capture all layers of tissues), in the second, only two-story interrupted sutures (the first row consists of simple sutures through the thickness of the walls to be sutured, and the second without puncturing the mucous membrane).

The main goal of the anastomosis is to restore the continuity of the intestine after resection, to form a passage in case of intestinal obstruction. This technique allows you to save life and at least partially compensate for the role of removed organs. Even with a hemicolectomy (removal of half of the large intestine with the formation of a bone fracture - an unnatural anus brought to the anterior abdominal wall), it allows you to save most of the functionality of the intestine.

Surgery on the rectum for oncology almost always involves its removal, especially if the tumor is "low", that is, it is located close to the anus (less than 6 cm). The formation of an anastomosis is the only way to restore its patency, most often if an anterior resection of the organ is performed.

In 4-20% of cases (depending on the condition of the tissues, the professionalism of the doctor), complications arise: impaired patency, insufficient sutures, peritonitis. To minimize the risk, the surgeon must carry out a thorough debridement of the suture and adjacent areas from the side of the lumen.

Tip: to reduce the likelihood of complications, the patient must follow all the doctor's recommendations and do not forget to monitor the connection on their own. For example, in order to minimize the threat of development of narrowing, obstruction after removal of the stomach, it is worth regularly undergoing x-ray examination.

The imposition of an intestinal anastomosis is a unique surgical technique that allows you to connect hollow organs and at least partially restore the functionality of the intestine. different ways overlays are used depending on the type of operation. To maximize the effectiveness of the anastomosis, the doctor needs to follow the technology and carefully treat the suture with antiseptics.

Intestinal anastomosis: features, preparation, purpose

Fistulas are the cause of colon cancer.

There are two types of operations on the intestines that require subsequent anastomosis - these are enterectomy and resection.

Colon cancer. Colon cancer is the leading cancer in developed countries. The cause of its occurrence can be fistulas, polyps, ulcerative colitis, heredity. Resection of the affected area with subsequent anastomosis is prescribed at the initial stages of the disease, but can also be carried out in the presence of metastases, since it is dangerous to leave the tumor in the intestine due to possible bleeding and intestinal obstruction due to tumor growth.
Intestinal obstruction. Obstruction can occur due to a foreign body, tumor, or severe constipation. In the latter case, you can wash the intestines, but the rest will most likely have to be operated on. If the intestinal tissues have already begun to die due to the transferred vessels, part of the intestine is removed and an anastomosis is performed.
Bowel infarction. With this disease, the outflow of blood to the intestines is disturbed or completely stops. This is a dangerous condition that leads to tissue necrosis. It is more common in older people with heart disease.
Crohn's disease. This is a whole complex of different conditions and symptoms that lead to disruption of the intestines. This disease is not treated surgically, but patients have to go for surgery, because in the course of the disease, life-threatening complications can occur.

Preparation and procedure

Espumizan eliminates gases.

"End to end". The most efficient and commonly used method. It is possible only if the connected parts of the intestine do not have a big difference in diameter. If it is slightly smaller from the parts, the surgeon slightly cuts it and increases the lumen, and then stitches the parts edge to edge.
"Side to side". This type of anastomosis is performed when a significant part of the intestine has been removed. After the resection, the doctor sews up both parts of the intestine, makes incisions and stitches them side to side. This technique of the operation is considered the simplest.
"End to Side". This type of anastomosis is suitable for more complex operations. One of the parts of the intestine is sewn tightly, making a stump and pre-squeezing out all the contents. The second part of the intestine is sewn to the side of the stump. Then, a neat incision is made on the lateral part of the deaf intestine so that it coincides in diameter with the second part of the intestine and the edges are sutured.

Infection. Doctors in the operating room follow all safety rules. All surfaces are disinfected, but even in this case it is not always possible to avoid infection of the wound. With infection, redness and suppuration of the suture, fever, weakness are observed.
Obstruction. The intestines after surgery may stick together due to scarring. In some cases, the intestine is bent, which also leads to obstruction. This complication may not appear immediately, but some time after the operation. It requires repeated surgery.
Bleeding. The abdominal operation is most often accompanied by blood loss. The most dangerous after the operation is internal bleeding, since the patient may not notice it immediately.

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ileonal anastomosis. Intestinal anastomosis as a treatment for ulcerative colitis.

This disease belongs to the specializations: General surgery

1. What is an ileonal anastomosis?

Ileonal anastomosis is performed in the treatment of nonspecific ulcerative colitis - chronic inflammatory disease colon and rectum with damage to the mucous membrane and submucosal layer of the intestine and the formation of ulcers.

2. How is the operation performed?

Sometimes the intestinal anastomosis is performed in two stages. First, the doctor removes the colon, makes an opening in the abdomen, and attaches the ileum to the opening. Through this opening, processed food is excreted from the body into special bags. The process is called an ileostomy. At the second stage of intestinal anastomosis, a bag (reservoir) is formed from the ileum and attached to the anus. Recovery after each operation takes from 1 to 2 weeks. The two stages can be combined into one operation if the doctor considers it acceptable.

Ilional anastomosis in the treatment of ulcerative colitis, as a rule, gives good results. 8 out of 10 people have no problems after the procedure. Most patients report an improvement in their quality of life after surgery.

3. When is the operation not performed?

Ileonal anastomosis surgery is not performed on patients whose rectal muscles do not work properly, or people who have been diagnosed with rectal cancer.

4. Risks of bowel anastomosis

Like any surgery, ileonal anastomosis comes with some risks. In 100 people, the following complications may occur after surgery:

10 out of 100 patients may experience sexual problems. Women who have this surgery are less likely to become pregnant (risk of infertility).

In most cases, intestinal anastomosis is performed on patients who are prone to developing cancer, and their disease is not amenable to drug treatment.

Intestinal anastomoses

The purpose of creating such a structure:

ensuring the passage of the food bolus to the lower sections for the continuity of the digestive process;
formation of a bypass path in case of a mechanical obstacle and the impossibility of its removal.

Operations can save many patients, make them feel fairly well, or help prolong life in the case of an inoperable tumor.

What types of anastomoses are used in surgery?

According to the connected parts, anastomosis is distinguished:

esophageal - between the end of the esophagus and the duodenum, bypassing the stomach;
gastrointestinal (gastroenteroanastomosis) - between the stomach and intestines;
interintestinal.

The third option is a mandatory component of most bowel operations. Among this type, anastomoses are distinguished:

small intestine,
enteric,
colonic.

What should be the anastomosis?

The created anastomosis must correspond to the expected functional goals, otherwise there is no point in operating on the patient. The main requirements are:

providing a sufficient width of the lumen so that the narrowing does not interfere with the passage of the contents;
no or minimal interference with the mechanism of peristalsis (contraction of the intestinal muscles);
complete tightness of the seams providing the connection.

If one specialist cannot decide what to do with the patient, they convene a consultation

It is important for the surgeon not only to determine what type of anastomosis will be applied, but also with what suture to fasten the ends. This takes into account:

the intestine and its anatomical features;
the presence of inflammatory signs at the site of surgery;
intestinal anastomoses require a preliminary assessment of the viability of the wall, the doctor carefully examines it by color, the ability to contract.

The most commonly used classic seams:

Gambi or nodular - needle punctures are made through the submucosal and muscle layers, without capturing the mucous;
Lambert - the serous membrane (outer in relation to the intestinal wall) and the muscle layer are sutured.

Description and characteristics of the essence of anastomoses

The formation of an anastomosis of the intestine, as a rule, is preceded by the removal of part of the intestine (resection). Next, it becomes necessary to connect the leading and outgoing ends.

end-to-end type

The connection condition is the absence of a large difference in the diameter of the compared sections. The end that is smaller in clearance is notched for full compliance. The method is used after resection of the sigmoid colon, in the treatment of intestinal obstruction.

First, the posterior wall of the anastomosis is formed, then the anterior

Anastomosis "end to side"

At the first stage, a dense stump is formed from the end of the efferent colon. The other (open) end is applied to the intended site of the anastomosis from the side and sutured along the back wall with a Lambert suture.
Then an incision is made along the efferent intestine along a length equal to the diameter of the leading section, and the anterior wall is sutured with a continuous suture.

side to side type

It can be used both between homogeneous sections of the intestine, and to connect dissimilar areas. Main indications:

the need for resection of a large area;
danger of overstretching in the anastomosis zone;
small diameter of connected sections;
the formation of an anastomosis between the small intestine and the stomach.

The advantages of the method include:

no need to suture the mesentery of different areas;
tight connection;
guaranteed prevention of intestinal fistula formation.

With side-to-side anastomosis, the preliminary creation of stumps is one of the disadvantages of the technique.

side to end type

If this type of anastomosis is chosen, this means that the surgeon intends to sew the end of the organ or intestine after resection into the hole created on the lateral surface of the afferent intestinal loop. More often used after resection of the right half of the large intestine to connect the small and large intestine.

Prevention of complications

Complications of anastomoses can be:

divergence of seams;
inflammation in the area of the anastomosis (anastomosis);
bleeding from damaged vessels;
the formation of fistulous passages;
the formation of narrowing with intestinal obstruction.

To avoid adhesions and intestinal contents entering the abdominal cavity:

the site of the operation is lined with napkins;
an incision for suturing the ends is carried out after clamping the intestinal loop with special intestinal clamps and squeezing out the contents;
the incision of the mesenteric edge ("window" is sutured);
the patency of the created anastomosis is determined by palpation until the operation is completed;
in the postoperative period, broad-spectrum antibiotics are prescribed;
the rehabilitation course necessarily includes a diet, physiotherapy exercises and breathing exercises.

Modern ways to protect anastomoses

In the immediate postoperative period, the development of anastomositis is possible. Its cause is considered:

inflammatory reaction to the suture material;
activation of conditionally pathogenic intestinal flora.

In order to strengthen the sutures in abdominal surgery, autografts are used (suturing of own tissues):

from the peritoneum;
gland;
fat suspensions;
mesenteric flap;
serous-muscular flap of the stomach wall.

The process of anastomosis is painstaking work

Various drug-filled protectors for suppressing local inflammation are widely accepted. These include adhesives with biocompatible antimicrobial content. It includes for the protective function:

As well as antibiotics and antiseptic:

Intestinal pulp is applied along the longitudinal axis, allows you to safely select the area necessary for resection

Postoperative atonic constipation

With spastic constipation, it is necessary:

relieve pain with medicines with analgesic action in the form of rectal suppositories;
lower the tone of the sphincters of the rectum with the help of drugs of the antispasmodic group (No-shpy, Papaverine);
to soften the stool, microclysters are made from warm vaseline oil in a solution of furacilin.

Osmotic action have:

Laxatives that increase the amount of fiber in the colon - Mucofalk.

Early treatment of anastomositis

To relieve inflammation and swelling in the area of the seams appoint:

antibiotics (Levomycetin, aminoglycosides);
with localization in the rectum - microclysters from warm furacilin or by installing a thin probe;
soft laxatives based on vaseline oil;
patients are advised to take up to 2 liters of liquid, including kefir, fruit drink, jelly, compote to stimulate the passage of intestinal contents.

If bowel obstruction develops

The occurrence of obstruction can cause swelling of the anastomosis zone, cicatricial narrowing. In the case of acute symptoms, a second laparotomy is performed (an incision in the abdomen and an opening of the abdominal cavity) with the elimination of the pathology.

In case of chronic obstruction in the late postoperative period, intensive antibiotic therapy and removal of intoxication are prescribed. The patient is examined to decide whether surgery is necessary.

Any complications require treatment

Technical reasons

Comments

There was a right-sided chemicolectomy, anastomosis without a colostomy, a year has passed since the operation. After eating, a dense knot began to bulge above the navel, and one can see how the feces pass through the transverse colon. The chair is regular in the morning and in the evening. I'm on a diet.

Anastomosis of the large intestine

Intestinal anastomosis is a complex operation, which is performed only in case of emergency and in 4-20% of cases leads to various complications.

What is an intestinal anastomosis, and in what cases is it prescribed?

Fistulas are the cause of colon cancer.

Anastomosis is the connection of two hollow organs and their stitching together. In this case, we are talking about stitching two parts of the intestine.

There are two types of operations on the intestines that require subsequent anastomosis - these are enterectomy and resection.

In the first case, the intestine is cut to remove a foreign body from it.

Colon cancer. Colon cancer is the leading cancer in developed countries. The cause of its occurrence can be fistulas, polyps, ulcerative colitis, heredity. Resection of the affected area with subsequent anastomosis is prescribed at the initial stages of the disease, but can also be carried out in the presence of metastases, since it is dangerous to leave the tumor in the intestine due to possible bleeding and intestinal obstruction due to tumor growth. Intestinal obstruction. Obstruction can occur due to a foreign body, tumor, or severe constipation. In the latter case, you can wash the intestines, but the rest will most likely have to be operated on. If the intestinal tissues have already begun to die due to the transferred vessels, part of the intestine is removed and an anastomosis is performed. Bowel infarction. With this disease, the outflow of blood to the intestines is disturbed or completely stops. This is a dangerous condition that leads to tissue necrosis. It is more common in older people with heart disease. Crohn's disease. This is a whole complex of different conditions and symptoms that lead to disruption of the intestines. This disease is not treated surgically, but patients have to go for surgery, because in the course of the disease, life-threatening complications can occur.

Learn more about colon cancer in this video:

Preparation and procedure

Espumizan eliminates gases.

Such a serious procedure as intestinal anastomosis requires careful preparation. Previously, preparation was carried out with the help of enemas and diet.

Before the operation, fried foods, sweets, hot sauces, some cereals, beans, seeds and nuts should be completely excluded.

Fortrans is considered the most effective drug for preparing for various manipulations on the intestines. It allows you to completely clean it in a short time. The procedure itself is performed under general anesthesia. Anastomosis has 3 varieties:

"End to end". The most efficient and commonly used method. It is possible only if the connected parts of the intestine do not have a big difference in diameter. If it is slightly smaller from the parts, the surgeon slightly cuts it and increases the lumen, and then stitches the parts edge to edge. "Side to side". This type of anastomosis is performed when a significant part of the intestine has been removed. After the resection, the doctor sews up both parts of the intestine, makes incisions and stitches them side to side. This technique of the operation is considered the simplest. "End to Side". This type of anastomosis is suitable for more complex operations. One of the parts of the intestine is sewn tightly, making a stump and pre-squeezing out all the contents. The second part of the intestine is sewn to the side of the stump. Then, a neat incision is made on the lateral part of the deaf intestine so that it coincides in diameter with the second part of the intestine and the edges are sutured.

Postoperative period and complications

Eating cereals will reduce the load on the intestines.

In the first days after the operation, the patient is observed in the hospital. Small bleeding is possible, but it is not always dangerous. Seams are regularly inspected and processed.

Liquid cereals, dairy products, after a while fiber (fruits and vegetables), boiled meat, mashed soups are allowed.

Complications after surgery can appear both through the fault of the patient himself (non-compliance with the regimen, malnutrition, increased physical activity), and through the fault of circumstances. Complications after anastomosis:

Infection. Doctors in the operating room follow all safety rules. All surfaces are disinfected, but even in this case it is not always possible to avoid infection of the wound. With infection, redness and suppuration of the suture, fever, weakness are observed. Obstruction. The intestines after surgery may stick together due to scarring. In some cases, the intestine is bent, which also leads to obstruction. This complication may not appear immediately, but some time after the operation. It requires repeated surgery. Bleeding. The abdominal operation is most often accompanied by blood loss. The most dangerous after the operation is internal bleeding, since the patient may not notice it immediately.

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What is an intestinal anastomosis?

Anastomosis refers to the connection of two hollow organs in a natural or surgical way. Natural anastomoses are mainly fistulas located between blood vessels. Anastomoses contribute to the blood filling of organs. Via surgical methods impose different anastomoses to connect certain organs. For example, a gastroenteroanastomosis is used between the small intestine and the stomach, and intestinal loops are interconnected using interintestinal anastomoses. Intestinal anastomosis is used to restore intestinal continuity after resection, or to create a bypass in case of intestinal obstruction.

Most operations on the intestine end with the imposition of an interintestinal anastomosis. According to the nature of the organs subject to anastomosis, there are small-intestinal, small-colonic and large-intestinal anastomosis.

Intestinal anastomosis is applied using the “end-to-end”, “end-to-side”, “side-to-side”, “side-to-end” methods.

The end-to-end connection serves to directly connect the ends of two homogeneous hollow organs (sections of either the large or small intestine). The seam is superimposed in two or three rows. This type of anastomosis is anatomically and functionally advantageous, but its implementation is technically quite difficult.

An end-to-side anastomosis connects the small intestine to the small intestine and the large intestine to the small intestine. The last connection is made by suturing the end of the small intestine to the lateral surface of the wall of the large intestine.

When connecting "side to side", two tightly closed stumps of intestinal loops connect them with lateral surfaces. Anastomosis of the intestine in the side-to-side manner is performed by connecting the lateral surface of the proximal (closer) organ to the end of the distal (further) organ. The technique of applying this anastomosis is considered the simplest, even a novice surgeon can handle it. The disadvantages of this method is the need to form "plugs" at the ends of the loops. The side-to-side connection can be superimposed both between homogeneous and between heterogeneous intestinal sections.

With the side-to-end anastomosis, the efferent end of the resected (subject to resection) organ is sewn into the hole located on the lateral surface of the adductor organ.

Anastomositis

Anastomosis is an inflammatory process that forms in the area of artificially imposed anastomosis (connection of vessels) in the organs of the gastrointestinal tract. In most cases, anastomosis leads to a violation of the function of the patency of the food of the operated stomach.

Causes

The main causes of anastomosis are:

Injury to the tissues of the gastrointestinal tract; Poor adaptation of the mucous membranes during the operation; Gastrointestinal anastomosis infections; Disposition to hyperplastic processes; Body reactions to suture material.

Anastomosis after resection of the stomach is one of the most frequent complications and requires additional treatment.

Symptoms

Symptoms of the manifestation of the disease are divided into three groups:

mild degree - clinical manifestations no. At endoscopic examination, edema and hemorrhage are observed, the patency of the anastomosis is not impaired; Average degree- there is heaviness in the stomach after eating, slight vomiting, hiccups. Endoscopic examination reveals mucosal edema, many small hemorrhages, a slight layering of fibrin films and a decrease in the lumen of the anastomosis; Severe degree - clinical disorders are manifested by profuse vomiting with an admixture of bile, patients lose weight dramatically, dehydration occurs. Endoscopic analysis shows severe edema of the anastomotic mucosa, profuse hemorrhages, large fibrin overlays, and complete narrowing of the connected vessels.

Diagnostics

Diagnosis of gastrointestinal anastomoses is performed using instrumental and laboratory research methods and does not present great difficulties.

Instrumental methods are endoscopic and X-ray studies. Endoscopic analysis consists of inserting a probe into the enteral feeding loop and is done early in the anastomosis after gastrointestinal resection.

Conducted endoscopic examinations in the postoperative period are more informative and provide an opportunity to more accurately determine the patient's condition and carry out the necessary treatment.

X-ray definition of the disease is more complete in the study of the function of the anastomosis of the gastrointestinal tract, and the data obtained can be decisive in the diagnosis of the disease. The results of x-ray examination of the esophageal anastomosis depend on the location and type of disease.

except diagnostic treatment play an important role laboratory research, which allow you to establish how effective the conservative treatment is.

Course of the disease

In the postoperative period, against the background of organic transformations, a complication develops, as a result of which an inflammatory edema of the mucosa appears in the area of the anastomosis. Symptoms of manifestations are due to the appearance of fluid and gases in the stump of the stomach, resulting in nausea and vomiting.

Acute inflammation is accompanied by narrowing and obstruction of the patency of the gastro-intestinal tract. In the acute course of the disease, the patient loses weight dramatically and shows signs of dehydration. In this case, a second resection of the stomach is necessary.

Treatment

In the treatment of anastomositis, anti-inflammatory therapy and radiotherapy are widely used. Anti-inflammatory measures include the appointment of drugs that reduce swelling of the anastomosis mucosa: antibiotics, desensitizing agents, as well as physiotherapy procedures: UHF and compresses in the abdomen. The patient undergoes a systematic gastric lavage, a complete parenteral nutrition and treatment with restorative drugs.

Anti-inflammatory radiotherapy is an effective method of timely treatment of the disease and often leads to the restoration of the anastomosis patency function. If the conservative method of treatment of anastomositis is not effective, a second resection of the stomach is prescribed.

Forecast

The prognosis for the treatment of anastomositis for a long-term period can be obtained after the diagnosis and the results of the ongoing complex therapy. In mild to moderate stages, the disease has a positive prognosis. It happens that after the operation the patient feels good, but this is just an illusion.

In the postoperative period, you should adhere to medical prescriptions (restriction of motor activity and a strict diet) for 5-6 months. Otherwise, there is a possibility of a disappointing prognosis.

In 25% of cases, dumping syndrome was recorded - instant dumping of undigested food into the intestines. This process accompanied by nausea, dizziness, sweating and fainting. To prevent such a deviation, you should eat small meals 6-7 times a day.

In some cases, after treatment of anastomositis, a malignant tumor and alkaline reflux gastritis (ingress of alkaline contents from the intestine into the stomach) may develop.

How we save on supplements and vitamins. vitamins, probiotics, gluten-free flour, etc., and we order on iHerb (link $5 discount). Delivery to Moscow only 1-2 weeks. Much is cheaper several times than to take in a Russian store, and some goods, in principle, cannot be found in Russia.

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The term "resection" (cutting off) refers to the surgical removal of either the entire affected organ or part of it (much more often). Intestinal resection is an operation during which the damaged part of the intestine is removed. A distinctive feature of this operation is the imposition of an anastomosis. The concept of anastomosis in this case refers to the surgical connection of the continuity of the intestine after the removal of its part. In fact, this can be explained as stitching one part of the intestine to another.

Resection is a rather traumatic operation, so it is necessary to know well the indications for its implementation, possible complications and the method of managing the patient in the postoperative period.

Classification of resections

Operations to remove (resection) part of the intestine have many varieties and classifications, the main ones are the following classifications.

By the type of intestine on which the surgical access is performed:

Removal of part of the colon;
Removal of part of the small intestine.

In turn, operations on the small and large intestine can be divided into another classification (according to the departments of the small and large intestine):

Among the departments of the small intestine, there may be resections of the ileum, jejunum or duodenum 12;
Among the sections of the large intestine, resections of the caecum, colon, and rectum can be distinguished.

According to the type of anastomosis, which is superimposed after resection, there are:

Resection and formation of anastomosis

End-to-end type. With this type of operation, the two ends of the resected colon are connected or the connection of two adjacent sections (for example, the colon and sigmoid, the ileum and the ascending colon, or the transverse colon and the ascending colon). This compound is more physiological and repeats the normal course of the digestive tract, however, with it there is a high risk of developing scarring of the anastomosis and the formation of obstruction;
Side to side type. Here, the lateral surfaces of the departments are connected and a strong anastomosis is formed, without the risk of developing obstruction;
Side to side type. Here, an intestinal anastomosis is formed between the two ends of the intestine: the outlet, located on the resected section, and the adductor, located on the adjacent section of the intestine (for example, between the ileum and the caecum, transverse colon and descending).

Indications for surgery

The main indications for resection of any of the sections of the intestine are:

Strangulation obstruction ("torsion");
Invagination (the introduction of one section of the intestine into another);
Nodulation between intestinal loops;
Cancer of the colon or small intestine (rectum or ileum);
Necrosis of the intestines.

Preparing for the operation

The course of preparation for resection consists of the following points:

Diagnostic examination of the patient, during which the localization of the affected area of the intestine is determined and the condition of the surrounding organs is assessed;
Laboratory studies, during which the state of the patient's body, his blood coagulation system, kidneys, etc., as well as the absence of concomitant pathologies, are assessed;
Consultations of specialists who confirm / cancel the operation;
Examination of the anesthesiologist, who determines the patient's condition for anesthesia, the type and dose of the anesthetic substance that will be used during the intervention.

Conducting surgery

The course of the operation itself usually consists of two stages: direct resection of the necessary section of the intestine and further imposition of the anastomosis.

Complications of resection

The consequences of bowel removal can be different. Sometimes the following complications may develop in the postoperative period:

infectious process;
Obstructive obstruction - with cicatricial lesions of the operated intestinal wall at the junction;
Bleeding in the postoperative or intraoperative period;
Hernial protrusion of the intestine at the site of access on the abdominal wall.

Dietary nutrition during resection

The nutrition provided not after the operation will differ during resection of various sections of the intestine

The diet after resection is sparing and involves the intake of light, quickly absorbed foods, with minimal irritating effect on the intestinal mucosa.

Lean meats (to compensate for protein deficiency after resection, it is important that the protein consumed is of animal origin);
As fats in this diet, it is recommended to use vegetable and butter.

Foods containing a large amount of fiber (for example, cabbage, radish);
Carbonated drinks, coffee;
beetroot juice;
Products that stimulate intestinal motility (prunes).

In this regard, it is necessary to form a diet that would compensate for these losses.

Light massage of the abdominal wall will help to start the intestines after surgery

Prognosis after surgery

Prognostic indicators and quality of life depend on various factors. The main ones are:

Type of underlying disease that led to resection;
Type of surgery and the course of the operation itself;
The patient's condition in the postoperative period;
Absence/presence of complications;
Proper observance of the mode and type of nutrition.

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult a doctor!

This article will tell you what lifestyle cancer patients should lead so that bowel cancer does not recur after surgery and does not resume with renewed vigor. And also advice will be given on proper nutrition: what should the patient do during the rehabilitation period, and what complications can occur if you do not follow the recommendations prescribed by the doctor?

Complications and possible consequences

After surgical removal of an intestinal tumor, other complications arise:

Most often, adhesions do not bother the patient, but due to impaired intestinal muscle motility and poor patency, they can cause pain and be dangerous to health.

What should recovery after bowel cancer surgery include?

If the patient's condition has not worsened, he is in the hospital for no more than 7 days. The sutures or clips that the surgeon put on the wound opening are removed after 10 days.

Nutrition after bowel cancer surgery

If after surgery you are tortured by frequent loose stools, doctors advise eating foods low in fiber. Gradually, the old diet of the patient is restored, and food products that previously caused problems in the work of the body are introduced into the menu. To restore the diet, you should go to a consultation with a nutritionist.

Food should be consumed in small portions five times a day.
Drink plenty of fluids between meals.
While eating, you should not rush, you need to chew food well.
Eat medium temperature food (not too cold and not too hot).
Get systematic and regular in your meals.
Patients whose weight deviates from the norm, doctors advise to eat food in full. Patients who are underweight are recommended to eat a little more, and those suffering from excess weight ─ a little less.
Food is best steamed, boiled or stewed.
Avoid foods that cause bloating (flatulence); and also from spicy or fried foods, if you can hardly bear them.
Avoid eating foods that you have an intolerance to.

If the treatment is successful, the patient should undergo regular examinations for 2 years: take a general analysis of feces and blood; regularly undergo a survey of the surface of the large intestine (colonoscopy); chest x-ray. If no recurrence has occurred, diagnostics should be carried out at least once every 5 years.

Completely cured patients are not restricted in any way, but are advised not to engage in heavy physical work for six months after discharge from the hospital.

Relapse prevention

The main prevention of tumor recurrence is early diagnosis and topical surgical intervention in local oncology, as well as full compliance with ablastic norms.

There are no specific recommendations for the secondary prevention of recurrence of this oncology. But doctors still advise to follow the same rules as for primary prevention:

Constantly be in motion, that is, lead an active lifestyle.
Keep alcohol consumption to a minimum.
Quit smoking (if you have this bad habit).
It is worth losing weight (if you are overweight).

During the recovery period, in order to avoid the recurrence of cancer, it is necessary to carry out special gymnastic exercises that will strengthen the intestinal muscles.

It's important to know:

Anastomosis is also divided into several types:

"Side to side". During stitching, parts of the intestine parallel to each other are taken. The postoperative result of such treatment has a fairly good prognosis. In addition to the fact that the anastomosis comes out strong, the risk of obstruction is minimized.
"Side to the end". The formation of the anastomosis is carried out between the two ends of the intestine: the outlet, located on the resected section, and the adductor, located on the adjacent section of the intestine (for example, between the ileum and the caecum, transverse colon and descending).
"End to end". The 2nd end of the resected intestine or 2 adjacent sections is connected. Such an anastomosis is considered the most similar to the natural position of the intestine, that is, the position before the operation. If there is severe scarring, then there is a chance of obstruction.

2 Indications and preparations

The procedure for excision of the intestine is prescribed in the presence of one of the following pathologies:

Cancer of one of the intestines.
The introduction of one section of the intestine into another (invagination).
The appearance of nodes between parts of the intestine.
Departmental necrosis.
Obstruction or inversion.

Depending on the diagnosis, the operation can be planned or emergency.

The complex of preparatory measures includes a thorough examination of the organ and an accurate determination of the localization of the pathogenic site. Additionally, they take blood and urine for analysis, and also check the compatibility of the body with one of the anesthetic drugs, since the resection is performed under general anesthesia. In the presence of an allergic reaction, another anesthetic drug is selected. If this is not done, then problems can begin even before the start of the surgical intervention itself or in the process of its implementation. Improperly selected anesthesia can lead to death.

≡ Digestion > Gastrointestinal diseases > Intestinal anastomosis: features, preparation, purpose

Intestinal anastomosis is a complex operation, which is performed only in case of emergency and in 4-20% of cases leads to various complications.

What is an intestinal anastomosis, and in what cases is it prescribed?

Fistulas are the cause of colon cancer.

Anastomosis is the connection of two hollow organs and their stitching together. In this case, we are talking about stitching two parts of the intestine.

There are two types of operations on the intestines that require subsequent anastomosis - these are enterectomy and resection.

In the first case, the intestine is cut to remove a foreign body from it.

Colon cancer. Colon cancer is the leading cancer in developed countries. The cause of its occurrence can be fistulas, polyps, ulcerative colitis, heredity. Resection of the affected area with subsequent anastomosis is prescribed at the initial stages of the disease, but can also be carried out in the presence of metastases, since it is dangerous to leave the tumor in the intestine due to possible bleeding and intestinal obstruction due to tumor growth.
Intestinal obstruction. Obstruction can occur due to a foreign body, tumor, or severe constipation. In the latter case, you can wash the intestines, but the rest will most likely have to be operated on. If the intestinal tissues have already begun to die due to the transferred vessels, part of the intestine is removed and an anastomosis is performed.
Bowel infarction. With this disease, the outflow of blood to the intestines is disturbed or completely stops. This is a dangerous condition that leads to tissue necrosis. It is more common in older people with heart disease.
Crohn's disease. This is a whole complex of different conditions and symptoms that lead to disruption of the intestines. This disease is not treated surgically, but patients have to go for surgery, because in the course of the disease, life-threatening complications can occur.

Read: Mucus Poop Is a Cause for Concern

Learn more about colon cancer in this video:

Preparation and procedure

Espumizan eliminates gases.

Such a serious procedure as intestinal anastomosis requires careful preparation. Previously, preparation was carried out with the help of enemas and diet.

Before the operation, fried foods, sweets, hot sauces, some cereals, beans, seeds and nuts should be completely excluded.

"End to end". The most efficient and commonly used method. It is possible only if the connected parts of the intestine do not have a big difference in diameter. If it is slightly smaller from the parts, the surgeon slightly cuts it and increases the lumen, and then stitches the parts edge to edge.
"Side to side". This type of anastomosis is performed when a significant part of the intestine has been removed. After the resection, the doctor sews up both parts of the intestine, makes incisions and stitches them side to side. This technique of the operation is considered the simplest.
"End to Side". This type of anastomosis is suitable for more complex operations. One of the parts of the intestine is sewn tightly, making a stump and pre-squeezing out all the contents. The second part of the intestine is sewn to the side of the stump. Then, a neat incision is made on the lateral part of the deaf intestine so that it coincides in diameter with the second part of the intestine and the edges are sutured.

Read: Classification, treatment and symptoms of esophageal hernia. Types of therapy

Postoperative period and complications

Eating cereals will reduce the load on the intestines.

In the first days after the operation, the patient is observed in the hospital. There may be minor bleeding. but they are not always dangerous. Seams are regularly inspected and processed.

Liquid cereals, dairy products, after a while fiber (fruits and vegetables), boiled meat, mashed soups are allowed.

Infection. Doctors in the operating room follow all safety rules. All surfaces are disinfected, but even in this case it is not always possible to avoid infection of the wound. With infection, redness and suppuration of the suture, fever, weakness are observed.
Obstruction. The intestines after surgery may stick together due to scarring. In some cases, the intestine is bent, which also leads to obstruction. This complication may not appear immediately, but some time after the operation. It requires repeated surgery.
Bleeding. The abdominal operation is most often accompanied by blood loss. The most dangerous after the operation is internal bleeding, since the patient may not notice it immediately.

Read: Cholelithiasis. Disease symptoms and other important issues

It is impossible to completely protect yourself from complications after surgery, but you can significantly reduce the likelihood of their occurrence if you follow all the doctor's recommendations and regularly undergo preventive examinations after surgery. follow the rules of nutrition.

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If we are talking about colon cancer, then, as a rule, they mean a malignant tumor of the colon (carcinoma (cancer) of the colon) and rectum (rectal carcinoma). Further in the article, we present to your attention an overview of the methods surgical treatment of bowel cancer. and also talk about the possible consequences for patients who have undergone one of the listed operations .

Overview of Colon Cancer Surgery

Surgical Treatment of Colon Cancer: Indications and Aims

Curative and palliative operations for bowel cancer

Surgical treatment of bowel cancer: preoperative stage

The most common examinations include:

digital rectal examination (palpation of the lower part of the rectum) in order to assess the spread of the tumor and predict the preservation of sphincter function after bowel cancer surgery;
ultrasound examination (ultrasound) of the abdominal organs in order to assess the possible growth of a tumor outside the affected organ;
a chest x-ray (chest x-ray) to rule out or detect lung metastases
determination of the level of CEA (carcinoembryonic antigen, CEA) before bowel cancer surgery serves as an initial indicator for subsequent monitoring of the course of the disease, as well as for evaluating the prognosis after surgery;
rectoscopy (proctoscopy) to determine the extent of the tumor in rectal cancer;
endosonography (endoscopic ultrasound) to determine the depth of tumor infiltration in rectal cancer;
A colonoscopy is used to accurately examine the entire colon to look for other possible colon polyps or tumors.

Immediately before the operation of bowel cancer and during its implementation, the following measures are taken:

the intestines are thoroughly cleansed (with a special solution that has a laxative effect and is usually taken orally);
an antibiotic is taken against infections (bacteria of the intestinal flora can cause dangerous infections in the abdominal cavity);
the area of skin where the incision is to be made is shaved (for better disinfection);
preventive measures are taken against thrombosis.

Surgical treatment of bowel cancer: Methods

Depending on the stage and severity of the tumor, colon cancer surgery can be performed using the laparotomy method (opening the abdominal cavity) or minimally invasive.

Open and minimally invasive surgical treatment of bowel cancer

Radical surgery for bowel cancer

Non-contact operation (No-Touch)

Radical En-bloc operation

Local removal of the tumor

colonoscopy and polypectomy (for colon cancer);
laparotomy or laparoscopy (for colon cancer);
polypectomy or transanal endoscopic microsurgery (for rectal cancer).

In the event that subsequent histological examination confirms that the tumor has been completely removed and the risk of recurrence is minimized, the need for a subsequent radical operation for bowel cancer is eliminated.

Surgical Treatment of Colon Cancer: Artificial Anus

At colon cancer a long-term stoma can be used only in rare cases. However, in difficult cases, a temporary stoma may be needed to relieve the bowel or intestinal suture after bowel cancer surgery. If earlier during the operation small intestine cancer(for example, with tumors near the anus), along with the affected area of the rectum, the entire sphincter was also removed, at present, in most cases, rectal cancer surgery is performed in such a way as to preserve the sphincter apparatus. For experienced rectal surgeons, a safe distance of 1 cm from the anus is sufficient to prevent a permanent stoma.

Temporary artificial anus

Permanent (permanent) artificial anus

Surgical Treatment of Colon Cancer: Risks and Consequences

Other risks and complications after bowel surgery are:

Anastomotic failure: An anastomosis is a connection between two anatomical structures. If the anastomosis is insufficient, the two ends of the intestine sewn together or the suture between the intestine and the skin with an artificial anus may weaken or break. As a result, intestinal contents can enter the abdominal cavity and cause peritonitis (inflammation of the peritoneum).
Digestive disorder: Since the process of eating in the large intestine is largely completed, the operations, in terms of the process of digestion of food, are less problematic than in the small intestine. However, water reabsorption occurs in the colon, which, depending on the segment of the colon removed, can lead to disruption of the stool hardening process. This leads to more or less severe diarrhea. Many patients (especially those with an ostomy) also complain of digestive disorders such as bloating, constipation, and odors after bowel cancer surgery. As a result, patients change their usual diet, which can lead to a monotonous diet.
Fecal incontinence, bladder dysfunction, sexual dysfunction (male impotence): When performing a surgical operation on the rectum, the nerves in the operated area can be irritated and damaged, which can subsequently cause complaints from patients.
Union (adhesions): In most cases, adhesions are harmless and painless, but sometimes, due to limited intestinal motility and intestinal obstruction, they can be painful and dangerous.

Surgical treatment of bowel cancer: Postoperative care

Metastases (secondary tumors) or recurrence (recurrence of a tumor in the same place) can be detected in a timely manner only in the case of regular monitoring after surgery.

After a successful bowel cancer operation, the following post-operative examinations are offered in particular:

regular colonoscopy;
determination of the CEA tumor marker (carcinoembryonic antigen, CEA);
ultrasound examination of the organs of the abdominal cavity (stomach);
x-ray examination of the lungs;
computed tomography (CT) of the lungs and abdomen.

Surgical treatment of bowel cancer: Nutrition after surgery

Diet advice after bowel cancer surgery

Eat 5-6 small meals a day. Avoid eating large portions.
Between meals, it is recommended to consume a sufficiently large amount of liquid.
Eat slowly and chew well.
Avoid eating very hot and very cold foods.
Stick to a regular meal and stop dieting.
Eat enough food, i.e. patients who are underweight are advised to eat a little more, and those who are overweight - a little less than usual.
Braising and steaming are gentle cooking methods.
Avoid very fatty, sugary, and bloating foods, as well as fried, fried, and spicy foods if you are intolerant to them.
Avoid those foods that you have had a bad tolerance for several times.

Photo: www. Chirurgie-im-Build. de We thank Prof. Dr. Thomas W. Kraus, who kindly provided us with these materials.

Anastomosis is a phenomenon of fusion or stitching of two hollow organs, with the formation of a fistula between them. Naturally, this process occurs between the capillaries and does not cause noticeable changes in the functioning of the body. An artificial anastomosis is a surgical stitching of the intestines.

Types of intestinal anastomoses

There are different ways to carry out this operation. The choice of method depends on the nature of the particular problem. The list of anastomosis methods is as follows:

End-to-end anastomosis. The most common, but at the same time the most complex technique. Used after removal of part of the sigmoid colon.
Anastomosis of the intestine "side to side". The simplest type. Both parts of the intestine are turned into stumps and stitched on the sides. This is where the bypass anastomosis of the intestine comes into play.
End to Side method. It consists in turning one end into a stump and sewing the second on the side.

Mechanical anastomosis

There are also alternative methods for applying the three types of anastomoses described above using special staplers instead of surgical threads. A similar method of anastomosis is called hardware or mechanical.

There is still no consensus on which of the methods, manual or hardware, is more effective and gives fewer complications.

Numerous studies conducted to identify the most effective way anastomosis, often showed opposite results. So, the results of some studies spoke in favor of manual anastomosis, others - in favor of mechanical, according to the third, there was no difference at all. Thus, the choice of the method of performing the operation lies entirely with the surgeon and is based on the personal convenience for the doctor and his skills, as well as on the cost of the operation.

Preparing for the operation

Careful preparation must be made before an intestinal anastomosis is performed. It includes several points, the implementation of each of which is mandatory. These are the points:

It is necessary to follow a slag-free diet. Boiled rice, biscuits, beef and chicken are allowed for consumption.
Before the operation, you need to have a bowel movement. Previously, enemas were used for this, now laxatives, such as Fortrans, are taken during the day.
Before the operation, fatty, fried, spicy, sweet and starchy foods, as well as beans, nuts and seeds, are completely excluded.

Insolvency

Insolvency is a pathological condition in which the postoperative suture "leaks", and the contents of the intestine go beyond its limits through this leak. The reasons for the failure of the intestinal anastomosis are the divergence of postoperative sutures. There are the following types of insolvency:

Free leak. The tightness of the anastomosis is completely broken, the leak is not limited in any way. In this case, the patient's condition worsens, symptoms of diffuse peritonitis appear. A second dissection of the anterior abdominal wall is necessary to assess the extent of the problem.
Delimited leak. Leakage of intestinal contents is partially restrained by the omentum and adjacent organs. If the problem is not eliminated, the formation of a peri-intestinal abscess is possible.
Mini leak. Leakage of intestinal contents in small volumes. Occurs late after surgery, after the intestinal anastomosis has already been formed. The formation of an abscess usually does not occur.

Identification of insolvency

Seizures are the main signs of anastomosis failure. severe pain in the abdomen, accompanied by vomiting. Also noteworthy is increased leukocytosis and fever.

Diagnosis of anastomotic failure is performed using an enema with a contrast agent, followed by an x-ray. A CT scan is also used. According to the results of the study, the following scenarios are possible:

The contrast agent freely enters the abdominal cavity. A CT scan shows fluid in the abdomen. In this case, an operation is urgently required.
The contrast agent accumulates delimited. There is a slight inflammation, in general, the abdominal cavity is not affected.
There is no leakage of contrast agent.

Based on the picture obtained, the doctor draws up a plan for further work with the patient.

Elimination of insolvency

Depending on the severity of the leak, different methods are used to eliminate it. Conservative management of the patient (without reoperation) is provided in the case of:

Limited insolvency. Apply the removal of an abscess with the help of drainage instruments. Also produce the formation of a delimited fistula.
Insolvency with a disconnected intestine. In this situation, after 6-12 weeks, the patient is re-examined.
Failure with the appearance of sepsis. In this case, supportive measures are carried out as an addition to the operation. These measures include: the use of antibiotics, the normalization of the heart and respiratory processes.

The surgical approach may also vary, depending on the timing of the diagnosis of failure.

In case of early symptomatic failure (the problem was detected 7-10 days after the operation), a second laparotomy is performed in order to find the defect. Then one of the following can be used the following ways position fixes:

Disconnection of the intestine and pumping out the abscess.
Separation of the anastomosis with the formation of a stoma.
Secondary anastomosis attempt (with/without shutdown).

In the event that intestinal wall rigidity (caused as a result of inflammation) is found, neither resection nor stoma formation can be performed. In this case, the defect is sutured/abscess pumped out or drainage system in the problem area, in order to form a delimited fistulous tract.

With late diagnosis of insolvency (more than 10 days from the moment of operation), they automatically speak of unfavorable conditions during relaparotomy. In this case, the following actions are taken:

Formation of the proximal stoma (if possible).
impact on the inflammatory process.
Installation of drainage systems.
Formation of a delimited fistulous tract.

With diffuse sepsis/peritonitis, a sanitation laparotomy with wide drainage is performed.

Complications

In addition to leaks, anastomosis can be accompanied by the following complications:

Infection. It can be the fault of both the surgeon (inattention during the operation) and the patient (non-observance of hygiene rules).
Intestinal obstruction. It occurs as a result of bending or sticking of the intestines. Requires a second operation.
Bleeding. May occur during surgery.
Narrowing of the intestinal anastomosis. Impairs permeability.

Contraindications

There are no specific guidelines for when an intestinal anastomosis should not be performed. The decision on the admissibility / inadmissibility of the operation is made by the surgeon based on both the general condition of the patient and the condition of his intestines. However, a number general recommendations you can still give. So, anastomosis of the colon is not recommended in the presence of an intestinal infection. As for the small intestine, preference is given to conservative treatment if one of the following factors is present:

Postoperative peritonitis.
Failure of the previous anastomosis.
Violation of the mesenteric blood flow.
Severe swelling or distension of the bowel.
Exhaustion of the patient.
Chronic steroid deficiency.
The general unstable condition of the patient with the need for constant monitoring of violations.

Rehabilitation

The main goals of rehabilitation are to restore the patient's body and prevent a possible recurrence of the disease that caused the operation.

After the operation is completed, the patient is prescribed drugs that relieve pain and discomfort in the abdomen. They are not specialized medicines for the intestines, but are the most common painkillers. In addition, drainage is used to drain excess accumulated fluid.

The patient is allowed to move around the hospital 7 days after the operation. To accelerate the healing of the intestines and postoperative sutures, it is recommended to wear a special bandage.

If the patient is in a stable good condition, he can leave the hospital within a week after the operation. 10 days after the operation, the doctor removes the stitches.

Nutrition for anastomosis

In addition to taking various medications, nutrition plays an important role for the intestines. Without the help of medical staff, patients are allowed to eat a few days after the operation.

Nutrition for intestinal anastomosis at first should consist of boiled or baked food, which should be served in crushed form. Allowed vegetable soups. The diet should include foods that do not interfere with normal bowel movements and smoothly stimulate it.

A month later, it is allowed to gradually introduce other foods into the patient's diet. These include: cereals (oatmeal, buckwheat, barley, semolina, etc.), fruits, berries. As a source of protein, you can enter dairy products (kefir, cottage cheese, yogurt, etc.) and light boiled meat (chicken, rabbit).

Food is recommended to be taken at rest, in small portions, 5-6 times a day. In addition, it is recommended to consume more fluids (up to 2-3 liters per day). The first months after surgery, the patient may experience nausea, vomiting, abdominal pain, constipation, diarrhea, flatulence, weakness, heat. This should not be afraid, such processes are normal for the recovery period and pass over time. Nevertheless, with a certain frequency (every 6 months or more), it is necessary to undergo an irrigoscopy and a colonoscopy. These examinations are carried out as prescribed by a doctor, in order to monitor the work of the intestines. In accordance with the data obtained, the doctor will adjust the rehabilitation therapy.

Conclusion

In conclusion, it should be noted that intestinal anastomosis is a rather difficult operation that imposes strong restrictions on the subsequent lifestyle of a person. However, most often this operation is the only way to eliminate the pathology. Therefore, the best way out of the situation is to monitor your health and maintain a healthy lifestyle, which will reduce the risk of developing diseases that require an anastomosis.

The purpose of creating such a structure:

ensuring the passage of the food bolus to the lower sections for the continuity of the digestive process;
formation of a bypass path in case of a mechanical obstacle and the impossibility of its removal.

Operations can save many patients, make them feel fairly well, or help prolong life in the case of an inoperable tumor.

What types of anastomoses are used in surgery?

According to the connected parts, anastomosis is distinguished:

esophageal - between the end of the esophagus and the duodenum, bypassing the stomach;
gastrointestinal (gastroenteroanastomosis) - between the stomach and intestines;
interintestinal.

The third option is a mandatory component of most bowel operations. Among this type, anastomoses are distinguished:

small intestine,
enteric,
colonic.

end to end;
side to side;
end to side;
side to end.

What should be the anastomosis?

The created anastomosis must correspond to the expected functional goals, otherwise there is no point in operating on the patient. The main requirements are:

providing a sufficient width of the lumen so that the narrowing does not interfere with the passage of the contents;
no or minimal interference with the mechanism of peristalsis (contraction of the intestinal muscles);
complete tightness of the seams providing the connection.

It is important for the surgeon not only to determine what type of anastomosis will be applied, but also with what suture to fasten the ends. This takes into account:

the intestine and its anatomical features;
the presence of inflammatory signs at the site of surgery;
intestinal anastomoses require a preliminary assessment of the viability of the wall, the doctor carefully examines it by color, the ability to contract.

The most commonly used classic seams:

Gambi or nodular - needle punctures are made through the submucosal and muscle layers, without capturing the mucous;
Lambert - the serous membrane (outer in relation to the intestinal wall) and the muscle layer are sutured.

Description and characteristics of the essence of anastomoses

The formation of an anastomosis of the intestine, as a rule, is preceded by the removal of part of the intestine (resection). Next, it becomes necessary to connect the leading and outgoing ends.

end-to-end type

Anastomosis "end to side"

At the first stage, a dense stump is formed from the end of the efferent colon. The other (open) end is applied to the intended site of the anastomosis from the side and sutured along the back wall with a Lambert suture.
Then an incision is made along the efferent intestine along a length equal to the diameter of the leading section, and the anterior wall is sutured with a continuous suture.

side to side type

It can be used both between homogeneous sections of the intestine, and to connect dissimilar areas. Main indications:

the need for resection of a large area;
danger of overstretching in the anastomosis zone;
small diameter of connected sections;
the formation of an anastomosis between the small intestine and the stomach.

The advantages of the method include:

no need to suture the mesentery of different areas;
tight connection;
guaranteed prevention of intestinal fistula formation.

Prevention of complications

Complications of anastomoses can be:

divergence of seams;
inflammation in the area of the anastomosis (anastomosis);
bleeding from damaged vessels;
the formation of fistulous passages;
the formation of narrowing with intestinal obstruction.

To avoid adhesions and intestinal contents entering the abdominal cavity:

the site of the operation is lined with napkins;
an incision for suturing the ends is carried out after clamping the intestinal loop with special intestinal clamps and squeezing out the contents;
the incision of the mesenteric edge ("window" is sutured);
the patency of the created anastomosis is determined by palpation until the operation is completed;
in the postoperative period, broad-spectrum antibiotics are prescribed;
the rehabilitation course necessarily includes a diet, physiotherapy exercises and breathing exercises.

Modern ways to protect anastomoses

In the immediate postoperative period, the development of anastomositis is possible. Its cause is considered:

inflammatory reaction to the suture material;
activation of conditionally pathogenic intestinal flora.

In order to strengthen the sutures in abdominal surgery, autografts are used (suturing of own tissues):

from the peritoneum;
gland;
fat suspensions;
mesenteric flap;
serous-muscular flap of the stomach wall.

Various drug-filled protectors for suppressing local inflammation are widely accepted. These include adhesives with biocompatible antimicrobial content. It includes for the protective function:

collagen;
cellulose ethers;
polyvinylpyrrolidone (biopolymer);
Sanguirythrin.

As well as antibiotics and antiseptic:

Postoperative atonic constipation

With spastic constipation, it is necessary:

relieve pain with medicines with analgesic action in the form of rectal suppositories;
lower the tone of the sphincters of the rectum with the help of drugs of the antispasmodic group (No-shpy, Papaverine);
to soften the stool, microclysters are made from warm vaseline oil in a solution of furacilin.

senna leaves,
buckthorn bark,
rhubarb root,
Bisacodyl,
Castor oil,
Gutalax.

Osmotic action have:

Glauber and Karlovy Vary salt;
magnesium sulfate;
lactose and lactulose;
Mannitol;
Glycerol.

Laxatives that increase the amount of fiber in the colon - Mucofalk.

Early treatment of anastomositis

To relieve inflammation and swelling in the area of the seams appoint:

antibiotics (Levomycetin, aminoglycosides);
with localization in the rectum - microclysters from warm furacilin or by installing a thin probe;
soft laxatives based on vaseline oil;
patients are advised to take up to 2 liters of liquid, including kefir, fruit drink, jelly, compote to stimulate the passage of intestinal contents.

If bowel obstruction develops

Technical reasons

Intestinal surgery is considered one of the most difficult. The surgeon must not only eliminate the pathology, but also preserve the maximum functionality of the organ. To connect hollow organs during surgical interventions, a special technique is used - the imposition of an anastomosis.

Types of operations on the intestines

Most often, operations such as enterotomy and resection are performed on the intestine. The first type is chosen if a foreign body is found in the organ. Its essence lies in the surgical opening of the intestine with a scalpel or electric knife. The suture is selected depending on the part of the intestine, the presence or absence of an inflammatory process in the area of intervention. The wound is sutured with the so-called interrupted Gumby suture, making a puncture through the muscular, submucosal layer without capturing the mucosa, as well as with the Lambert suture, connecting the serous (covers the small intestine from the outside) and the muscular membranes.

Anastomosis methods

There are several ways of imposing an anastomosis. Let's consider them in detail.

end to end

End to side

Advice: to reduce the likelihood of complications, the patient must follow all the recommendations of the doctor and do not forget to independently monitor the connection. For example, in order to minimize the threat of development of narrowing, obstruction after removal of the stomach, it is worth regularly undergoing x-ray examination.

The imposition of an intestinal anastomosis is a unique surgical technique that allows you to connect hollow organs and at least partially restore the functionality of the intestine. Different overlay methods are used depending on the type of operation. To maximize the effectiveness of the anastomosis, the doctor needs to follow the technology and carefully treat the suture with antiseptics.

In contact with

REQUIREMENTS FOR INTESTINAL SUTURE

1. Tightness of the anastomosis (serous membrane)
2. Mechanical strength of the suture (submucosa)
3. Prevention of narrowing of the lumen of the organ at the site of suturing
4. Ensuring reliable hemostasis (submucosa)

TYPES OF INTESTINAL SEAM

Hand seam
Mechanical seam

MANUAL SEAM
according to the technique of threading:

Edge seams

Gray-serous sutures

Edge seams- the thread passes through the edges of the intestinal membranes, ensuring their strong comparison with each other and stopping bleeding from the vessels of the submucosal membrane (hemostasis)

through seam
- serous-muscular-submucosal - suture of Pirogov N.I.

Seam of Kirpatovsky I.D. (submucosal)

Gray-serous sutures (Lambert)- the thread passes through the serous membrane (with the capture of the muscular, and sometimes submucosal membranes) - the injection and puncture of the needle at each of the stitched edges of the intestinal wound is performed on the serous membrane, stepping back from the edge.
They ensure the tightness of the organ due to the widest possible contact of the serous surfaces of its stitched sections.

according to the number of rows of stitches

Single row
-Multi-row
-Double row

Albert seam- the most common:

- second row - gray-serous

Options: Czerny's suture, Welfer's suture

three-row

The first row is a through edge seam;
- second and third row - gray-serous seam

Options:
the first row is the marginal suture of the mucous membrane;
second row - marginal serous-muscular-submucosal suture;
third row - gray-serous seam

MECHANICAL SEAM
Single staplers- forceps-clamps, allowing you to connect the matched edges of the intestine by successive flashing with separate tantalum clips;
Apparatus for simultaneous application of one row (marginal) or two rows (marginal and gray-serous) sutures;
NZhKA - apparatus for applying gastrointestinal anastomosis;
UKZh - apparatus for suturing the stomach stump;
SK-60, SZhK-60 - apparatus for applying inter-intestinal and gastrointestinal anastomoses;
Stapling instruments in laparoscopic surgery when performing video endosurgical operations (applicators, clippers, staplers, etc.)

Advantages of a mechanical seam
- asepsis;
- minimal trauma;
- good adaptation and close contact of the stitched organs;
- does not narrow the lumen of the sutured organs; - simplification of the operation

MICROSURGICAL TECHNIQUE OF INTESTINAL SUTURE
Based on the study and recognition of the sheath structure of the organs of the gastrointestinal tract
-Optical magnification makes cases easily distinguishable;

- The use of microsurgical instruments, atraumatic needles allows:
make an exact comparison of the connected ends of each of the cases separately
perform suturing with minimal trauma to tissues and their vascular network

-Microsurgical technique provides:
optimal adaptation of homogeneous tissues
good hemostasis
tightness of the seam line
formation of a “gentle” scar and wound healing by primary intention

Types of intestinal anastomoses

Overlay technique
end to end
End to side
side to side

Depending on connected organs
Gastrointestinal
Esophageal - intestinal
Interintestinal

7. SURGICAL INTERVENTIONS ON THE STOMACH
Gastrotomy- dissection of the wall of the stomach
gastrostomy- fistula

Temporary fistula - the first stage of the operation on the esophagus (the method of Witzel, Stamm-Kader)
permanent fistula - if it is impossible to reconstruct the esophagus or if its tumors are inoperable (Topraver's method)

Gastroenterostomy- gastrointestinal anastomoses

Anterior anterior colonic
posterior retrocolic

Resection of the stomach- partial removal of the stomach
Gastrectomy- complete removal of the stomach
Vagotomy- dissection of the vagus nerve (vagal denervation) with draining operations:

Stem (total);
- selective - isolated denervation of the stomach;
- selective proximal (SPV) - intersection of branches n. vagus, going only to the acid-producing zone of the stomach (body and fundus):
~ in the thickness of the lesser omentum; ~ in the thickness of the stomach wall

8. STAGES OF STOMACH RESECTION according to Hofmeister-Finsterer
1. Laparotomy (upper midline)
2. Mobilization of the removed part of the stomach
3. Crossing duodenum and suturing her lumen
4. Resection of the stomach and partial suturing of its lumen in the region of the lesser curvature
5. Formation of an end-to-side gastrointestinal anastomosis (end of the stomach to the side of the intestine)
6. Creating a "spur" at the upper edge of the anastomosis by suturing the leading end of the small intestine to the sutured part of the stomach lumen
7. Fixation of the anastomosis in the window of the mesentery of the transverse colon
8. Suturing the incision of the anterior abdominal wall

9.TYPES OF GASTROINTESTINAL RESECTION according to the method of restoring the continuity of the gastrointestinal tract
1. Billroth I - end-to-end anastomosis between the stomach and duodenum;
2. Billroth II - the lumen of the stomach and duodenum closes tightly. Side-to-side anastomosis between the stomach and jejunum (anterior gastroenteroanastomosis)
3. Polia - Reichel - the lumen of the duodenum closes tightly. End-to-side anastomosis between the entire stomach stump and the jejunum
4. Chamberlain - Finsterer - the lumen of the duodenum closes tightly. The lumen of the stomach is partially sutured. End-to-side anastomosis between partially sutured gastric stump and jejunum
5. Kupriyanov - Zakharov - anastomosis of the stump of the stomach and duodenum using an insert from the segment of the small intestine on the mesentery

10. REQUIREMENTS FOR VAGOTOMY
-Accurate knowledge of branching options n. vagus
-Careful execution of techniques
- Denervation of the antrum of the stomach to exclude gastrin production
- Should not impair the motor function of the stomach, especially the pyloric region
- Must necessarily be supplemented with drainage operations to ensure the free passage of food from the stomach to the duodenum (stem, selective, PWS - not always)