Anastomosis is the 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. Artificial anastomosis is a surgical suturing 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 specific problem. The list of methods for performing anastomosis 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.
- Side-to-side intestinal anastomosis. The simplest type. Both parts of the intestine are turned into stumps and stitched on the sides. This is where intestinal bypass comes into play.
- End to side method. It consists of 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. This method of anastomosis is called hardware or mechanical.
There is still no consensus on which method, manual or hardware, is more effective and produces fewer complications.
Numerous studies conducted to determine the most effective method of performing anastomosis often showed contradictory results. Thus, the results of some studies spoke in favor of manual anastomosis, others in favor of mechanical anastomosis, according to others, there was no difference at all. Thus, the choice of method of performing the operation rests entirely with the surgeon and is based on the personal convenience of the doctor and his skills, as well as on the cost of the operation.
Preparation for the operation
Before performing an intestinal anastomosis, careful preparation must be made. It includes several points, 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 surgery, you need to have a bowel movement. Previously, enemas were used for this; now laxatives, such as Fortrans, are taken throughout the day.
- Before the operation, fatty, fried, spicy, sweet and starchy foods, as well as beans, nuts and seeds, are completely excluded.
Insolvency
Incompetence is a pathological condition in which the postoperative suture “leaks” and the contents of the intestine escape beyond its boundaries through this leak. The reasons for the failure of the intestinal anastomosis are the divergence of postoperative sutures. The following types of insolvency are distinguished:
- Free leak. The tightness of the anastomosis is completely broken, the leak is not limited by anything. In this case, the patient’s condition worsens, and symptoms of diffuse peritonitis appear. Re-incision of the anterior abdominal wall is necessary to assess the extent of the problem.
- Limited leak. Leakage of intestinal contents is partially contained by the omentum and adjacent organs. If the problem is not eliminated, a peri-intestinal abscess may form.
- Mini leak. Leakage of intestinal contents in small amounts. Occurs late after surgery, after the intestinal anastomosis has already been formed. In this case, the formation of an abscess usually does not occur.
Identification of insolvency
The main signs of anastomotic failure are attacks of severe abdominal pain accompanied by vomiting. Also noteworthy are increased leukocytosis and fever.
Diagnosis of anastomotic leakage is made using an enema with a contrast agent followed by an x-ray. A computed tomogram is also used. Based on 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 abdominal cavity. In this case, an operation is urgently required.
- The contrast agent accumulates in a limited area. There is slight inflammation; in general, the abdominal cavity is not affected.
- No contrast agent leakage is observed.
Based on the obtained picture, the doctor draws up a plan for further work with the patient.
Resolving Insolvency
Depending on the severity of the leak, different methods are used to fix it. Conservative management of the patient (without reoperation) is provided in the following cases:
- Limited insolvency. The abscess is removed using drainage instruments. A delimited fistula is also formed.
- Incompetence when the intestine is disconnected. In this situation, the patient is re-examined after 6-12 weeks.
- Failure with the appearance of sepsis. In this case, supportive measures are carried out as a complement to the operation. These measures include: the use of antibiotics, normalization of heart function and respiratory processes.
The surgical approach may also vary depending on when the deficiency is diagnosed.
In case of early symptomatic failure (the problem was discovered 7-10 days after surgery), a repeat laparotomy is performed to find the defect. Then one of the following ways to correct the situation can be used:
- Disconnecting the intestine and pumping out the abscess.
- Disconnection of the anastomosis with the formation of a stoma.
- An attempt at secondary anastomosis (with/without disconnection).
If rigidity of the intestinal wall (caused by inflammation) is detected, neither resection nor stoma formation can be performed. In this case, the defect is sutured/abscess pumped out or a drainage system is installed in the problem area in order to form a delimited fistula tract.
If the failure is diagnosed late (more than 10 days from the date of surgery), they automatically speak of unfavorable conditions during relaparotomy. In this case, the following actions are taken:
- Formation of a proximal stoma (if possible).
- Impact on the inflammatory process.
- Installation of drainage systems.
- Formation of a delimited fistula tract.
A sanitation laparotomy with wide drainage is performed.
Complications
In addition to leaks, anastomosis may be accompanied by the following complications:
- Infection. It may be due to the fault of both the surgeon (inattention during surgery) and the patient (failure to comply with hygiene rules).
- Intestinal obstruction. Occurs as a result of bending or sticking together of the intestines. Requires repeat surgery.
- Bleeding. May occur during surgery.
- Narrowing of the intestinal anastomosis. Impairs cross-country ability.
Contraindications
There are no specific guidelines for when intestinal anastomosis should not be performed. The decision on the permissibility/inadmissibility of an operation is made by the surgeon based on both the general condition of the patient and the condition of his intestines. However, a number of general recommendations can still be given. Thus, colon anastomosis is not recommended in the presence of an intestinal infection. As for the small intestine, preference is given to conservative treatment in the presence of one of the following factors:
- Postoperative peritonitis.
- Failure of the previous anastomosis.
- Violation of mesenteric blood flow.
- Severe swelling or
- Patient exhaustion.
- Chronic steroid deficiency.
- The general unstable condition of the patient with the need for constant monitoring of disorders.
Rehabilitation
The main goals of rehabilitation are to restore the patient’s body and prevent a possible relapse of the disease that caused the operation.
After the operation is completed, the patient is prescribed medications to relieve pain and discomfort in the abdominal area. They are not specialized drugs 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 speed up the healing of the intestines and postoperative sutures, it is recommended to wear a special bandage.
If the patient’s condition is consistently good, he can leave the hospital within a week after the operation. 10 days after the operation, the doctor removes the stitches.
Nutrition during anastomosis
In addition to taking various medications, nutrition plays an important role in the intestines. Patients are allowed to eat without the help of medical staff several days after the operation.
During intestinal anastomosis, food for the first time should consist of boiled or baked food, which should be served in crushed form. Vegetable soups are acceptable. The diet should include foods that do not interfere with normal bowel movements and smoothly stimulate it.
After a month, it is allowed to gradually introduce other foods into the patient’s diet. These include: porridge (oatmeal, buckwheat, pearl barley, semolina, etc.), fruits, berries. As a source of protein, you can introduce dairy products (kefir, cottage cheese, yogurt, etc.) and light boiled meat (chicken, rabbit).
It is recommended to take food in a calm environment, in small portions, 5-6 times a day. In addition, it is recommended to consume more fluid (up to 2-3 liters per day). The first months after surgery, the patient may suffer from nausea, vomiting, abdominal pain, constipation, diarrhea, flatulence, weakness, and high fever. There is no need to be afraid of this; such processes are normal during the recovery period and will pass over time. Nevertheless, it is necessary to undergo irrigoscopy and colonoscopy at certain intervals (every 6 months or more often). These examinations are carried out as prescribed by a doctor in order to monitor the functioning of the intestines. In accordance with the data received, 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 a person’s subsequent lifestyle. However, most often this operation is the only way to eliminate the pathology. Therefore, the best way out of the situation would be to monitor your health and maintain a healthy lifestyle, which will reduce the risk of developing diseases that require an anastomosis.
Medicine knows many different surgical procedures. With their help, internal organs can be given a second life. One of the surgical interventions is intestinal anastomosis. What is it and what is its meaning? Let's figure it out.
The main task of any surgeon is to save the patient’s life. In this case, everything must be done to return the patient to a full life to perform physical activity and to work without any restrictions.
Intestinal anastomosis is used during a surgical procedure to connect two hollow organs to each other. Most often, this technique is used in certain areas. First, the doctor assesses the viability of the area and prepares it for intestinal peristalsis. The area is also checked for various inflammatory processes and the presence of additional pathologies. After which the limits of the operated area are identified.
The main goal of this procedure is to restore intestinal patency.
Types of Anastomosis
What is an intestinal anastomosis may have become a little clearer. It has several types as follows.
- End to end. This type of procedure is the most effective and simplest. The main nuance is the presence of a slight difference in the connecting sections in size. A small size is performed on the area with a smaller diameter. This process will increase the lumen in the organ.
- Side to side. In this situation, the doctor makes an incision in both stumps lengthwise. Then he squeezes out the contents and sews them together with a seam. Moreover, its length is twice as large as the original value of the lumen. This method is recommended if there is a high risk of tension at the site of the anastomosis.
- End to side. This technique involves taking the open end of one intestine and applying it to the side of the second section. In this case, on the second, a stump is formed. From the side, a certain area of the wall opens side to side. After that, the slightly open end of the intestine is applied to the incision and sewn with a suture.
Any type of anastomositis is performed on the area of the small and large intestines. There are no special nuances in these operations. But there is one main difference. The small intestine is sutured with a single-layer suture, and the large intestine must be sutured with multi-layer sutures.
Colon anastomosis is a serious type of surgery. It requires a long and thorough restoration of the body and the functionality of the intestinal canal. Therefore, the patient after anastomositis should undergo a special rehabilitation course. This includes breathing training, physical therapy, and a strict diet. All these recommendations must be followed in their entirety.
One of the main rules is to follow a diet. It should be gentle so as not to injure the stomach and intestinal tract. Therefore, the diet should consist of soups and liquids for one to two months.
To avoid the development of peritonitis or other serious complications, the doctor must carry out thorough sanitation in the area of the surgical intervention and the suture. External cuts must be treated very well several times a day.
To avoid adhesions, the patient must control the patency of the intestinal canal. To be sure that everything is going well, you need to regularly perform x-ray examinations.
Possible Adverse Effects
Intestinal anastomoses are serious procedures. They require the doctor to be attentive. After all, any surgical intervention can cause complications, and this is no exception.
Adverse consequences after anastomosis are usually considered to include:
- peptic ulcer disease. Arise against the background of difficulties with healing in the suture area;
- divergence of seams. The contents of the intestinal canal can put pressure on the walls, as a result of which peristalsis can lead to divergence of areas;
- obstruction. This type of complication is considered the most common and occurs in forty percent of patients;
- internal bleeding;
- postoperative peritonitis. It appears due to the ingress of infectious agents due to poor treatment of seams.
After the operation, the patient should know that now throughout his life it is worth regularly visiting the doctor and listening to his recommendations. This will avoid adverse consequences.
Indications for intestinal anastomosis
Anastomosis of the small and large intestine is a serious surgical process. Therefore, it is prescribed only for special indications in the form of:
- colon cancer. This type of disease occupies one of the leading places among all cancer diseases. The cause of development may be fistulas, polyps, ulcerative colitis, or hereditary predisposition. Resection of the affected area with subsequent anastomosis is carried out in the early stages of the disease;
- obstruction of the intestinal canal. This process can occur due to the entry of a foreign body into the intestinal canal, the formation of a tumor, or the development of constipation. If in the latter case it will be enough to rinse the intestinal cavity, then in the rest you will have to perform an operation;
- infarction of the intestinal canal. This type of disease is characterized by a violation of the outflow of blood or its complete cessation. This condition is quite dangerous, as it can lead to necrosis of tissue structures;
- Crohn's disease. This includes a whole complex of various conditions and signs that lead to disruption of the intestinal region. This disease cannot be treated with surgery, but patients have to undergo surgery to prevent complications from developing.
Whether or not to carry out the procedure on the small and large intestine is decided only by the doctor based on the indications. In some cases, an anastomosis allows you to start living a normal life again, but it is not always necessary.
Preparatory activities
To perform an anastomosis of the intestinal tract, it is necessary to carefully prepare for them. A few years ago, preparation consisted of performing cleansing enemas and following a strict diet.
Before surgery, it is necessary to completely exclude fried and fatty foods, sweets and starchy foods, hot sauces, cereals, beans, seeds and nuts from the menu. They cause excessive fermentation in the intestines and an increase in the amount of gas.
Can be used:
- boiled rice;
- beef or chicken;
- biscuits.
The day before surgery, they start taking Fortrans. For breakfast you need to eat something light in the form of soup. The drug intake begins in the afternoon. It is sold in powder form, which must first be dissolved in water. First you need to take one liter. Then another liter an hour later. The procedure continues until the patient drinks four liters. After some time, the patient's stomach twists and diarrhea begins.
What to do after surgery
After surgery, the patient remains in the hospital for several days. This can last from seven to fourteen days. It all depends on how the operation went and whether complications arose.
On the first day you are allowed to drink only water. The doctor performs procedures to prevent infection. If there is slight bleeding, it is enough to treat with alcohol. If the bleeding is severe, hemostatic agents are prescribed.
A day later, soups with vegetable and chicken broth, compotes and fruit drinks are introduced into the diet. This diet continues for four to five days. Upon discharge, the diet is expanded. You can already eat vegetable purees, oatmeal and rice porridge, a little bread with butter.
If the patient experiences constipation after an anastomosis, the doctor may prescribe laxatives. You should not take them for a long time, as intestinal function may be disrupted.
Anastomosis of the intestinal canal is considered a serious and difficult procedure. But if all recommendations are followed, the risk of complications is minimized.
The term “resection” (cutting off) means surgical removal of either the entire affected organ or part of it (much more often). Bowel resection is an operation during which the damaged part of the intestine is removed. A distinctive feature of this operation is the application of anastomosis. The concept of anastomosis in this case refers to the surgical connection of the continuity of the intestine after removal of part of it. In fact, it 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 methods 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 being the following classifications.
According to the type of intestine where 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 one more classification (by sections of the small and large intestine):
- Among the sections of the small intestine there may be resections of the ileum, jejunum or duodenum;
- Among the sections of the large intestine, resections of the cecum, colon, and rectum can be distinguished.
Based on the type of anastomosis that is performed after resection, there are:
Resection and anastomosis formation
- End to end type. With this type of operation, the two ends of the resected colon are connected or two adjacent sections are connected (for example, colon and sigmoid, ileum and ascending colon, or transverse colon and ascending colon). This connection is more physiological and repeats the normal course of parts of the digestive tract, however, 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 sections are connected and a strong anastomosis is formed, without the risk of developing obstruction;
- “Side to end” type. Here, an intestinal anastomosis is formed between the two ends of the intestine: the efferent, located on the section to be resected, and the adductor, located on the adjacent section of the intestine (for example, between the ileum and the cecum, transverse colon and descending).
Indications for surgery
The main indications for resection of any part of the intestine are:
- Strangulation obstruction (“volvulus”);
- Intussusception (invasion of one part of the intestine into another);
- Nodulation between intestinal loops;
- Cancer of the colon or small intestine (rectum or ileum);
- Necrosis of intestinal sections.
Preparing for surgery
The preparation for resection consists of the following points:
- Diagnostic examination of the patient, during which the location of the affected area of the intestine is determined and the condition of surrounding organs is assessed;
- Laboratory studies, during which the condition of the patient’s body, his blood coagulation system, kidneys, etc. is assessed, as well as the absence of concomitant pathologies;
- Consultations with specialists who confirm/cancel the operation;
- Examination by an anesthesiologist, who determines the patient’s condition for anesthesia, the type and dose of anesthetic that will be used during the intervention.
Carrying out surgery
The course of the operation itself usually consists of two stages: direct resection of the required section of the intestine and further anastomosis.
Resection of the intestine can be completely different and depends on the main process that caused damage to the intestine and the intestine itself (transverse colon, ileum, etc.), and therefore your own option for anastomosis is selected.
There are also several approaches to the intervention itself: classic (laparotomy) incision of the abdominal wall with the formation of an operating wound and laparoscopic (through small holes). Recently, the laparoscopic method has been the leading access used during the intervention. This choice is explained by the fact that laparoscopic resection has a much less traumatic effect on the abdominal wall, and therefore contributes to a faster recovery of the patient.
Complications of resection
The consequences of bowel removal can vary. Sometimes the following complications may develop in the postoperative period:
- Infectious process;
- Obstructive obstruction - with scar damage to the operated intestinal wall at the junction;
- Bleeding in the postoperative or intraoperative period;
- Hernial protrusion of the intestine at the access point on the abdominal wall.
Diet during resection
Nutrition provided after surgery will differ during resection of different parts of the intestine.
The diet after resection is gentle and involves taking light, quickly digestible foods with minimal irritating effects on the intestinal mucosa.
Dietary nutrition can be divided into a diet used for resection of the small intestine and for removal of part of the large intestine. Such features are explained by the fact that different parts of the intestine have their own digestive processes, which determines the types of food products, as well as the tactics of eating for these types of diets.
So, if part of the small intestine has been removed, the ability of the intestine to digest chyme (a bolus of food moving through the gastrointestinal tract) and also to absorb essential nutrients from this bolus will be significantly reduced. In addition, resection of the thin section will disrupt the absorption of proteins, minerals, fats and vitamins. In this regard, in the postoperative period, and then in the future, the patient is recommended to take:
- Lean types of meat (to compensate for protein deficiency after resection, it is important that the protein consumed is of animal origin);
- It is recommended to use vegetable oils and butter as fats in this diet.
- Products containing a large amount of fiber (for example, cabbage, radishes);
- Carbonated drinks, coffee;
- Beet juice;
- Products that stimulate intestinal motility (prunes).
The diet after removal of the large intestine is practically no different from that after resection of the small intestine. The absorption of nutrients itself during resection of the thick section is not impaired, but the absorption of water, minerals, and the production of certain vitamins is impaired.
In this regard, it is necessary to formulate a diet that would compensate for these losses.
Advice: many patients are afraid of resection precisely because they do not know what they can eat after intestinal surgery. and what not, considering that resection will lead to a significant reduction in the amount of 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 convince the patient and reduce his possible fear of surgery.
A light massage of the abdominal wall will help to restart the intestines after surgery.
Another problem for patients is the postoperative decrease in 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 gentle dietary regimen and strict bed rest are 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 adherence to the diet and type of nutrition.
Different types of the disease, during the treatment of which resection of various parts of the intestine were 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 and also give rise to various metastatic processes.
Operations to remove part of the intestine, as described above, have their differences and therefore also affect the further prognosis of the patient’s condition. Thus, surgical interventions, which include, along with the removal of part of the intestine and work on blood vessels, are characterized 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 proper nutrition, significantly improves further prognostic indicators of life. This is explained by the fact that if dietary recommendations are followed correctly, the traumatic effect of food on the operated intestine is reduced, and substances missing in the body are corrected.
Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for independent treatment. Be sure to consult your doctor!
Bowel cancer after surgery
This article will tell you what kind of lifestyle cancer patients should lead so that bowel cancer after surgery does not recur and does not recur with renewed vigor. Advice on proper nutrition will also be given: what should the patient do during the rehabilitation period, and what complications can occur if you do not adhere to the recommendations prescribed by the doctor?
Complications and possible consequences
Colon cancer surgery is risky and dangerous, like other surgical interventions of this complexity. Doctors call the first signs that are considered harbingers of postoperative complications the leakage 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 of a deterioration in the process of eating. They most often complain about flatulence and defecation disorder. 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 motility of the intestinal muscles and poor patency, they can cause pain and be dangerous to health.
What should rehabilitation after surgery for bowel cancer include?
In the intensive care unit, a person returns from anesthesia to a normal state. After 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, drugs that relieve pain are introduced into their body using droppers. 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.
Patients are allowed to eat without the help of medical staff several days after the operation. The diet must include liquid porridge and well-mashed soups. Only after a week is the patient allowed to move around the hospital. In order for the intestines to heal, patients are recommended to wear a special bandage, which is needed to reduce the load on the abdominal muscles. In addition, the bandage allows for equal pressure in the abdominal cavity over the entire area, and it promotes 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 patient’s preferences. But, in any case, you need to plan your diet with your doctor or nutritionist.
If during the operation the patient had a stoma (artificial opening), 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 will remain in hospital for no more than 7 days. The sutures or clips that the surgeon placed on the wound opening are removed after 10 days.
Nutrition after bowel cancer surgery
Regarding the diet after surgical treatment of intestinal oncology, we can say that patients can adhere to their usual diet. But if there are symptoms of digestive disorders (belching, indigestion, constipation), it is recommended to correct the dysregulation of stool, which is very important for patients with an artificial anus.
If after surgery you suffer from frequent loose stools, doctors advise eating foods low in fiber. Gradually, the patient’s previous diet is restored, and food products that previously caused problems in the functioning of the organ are introduced into the menu. To restore your diet, you should consult a nutritionist.
- Food should be consumed in small portions five times a day.
- Drink plenty of fluids between meals.
- When eating, you should not rush, you need to chew your food well.
- Eat food at medium temperature (not too cold and not too hot).
- Achieve systematicity and regularity in your meals.
- Doctors advise patients whose weight deviates from the norm to eat food to the fullest extent. Patients who are below normal weight are recommended to eat a little more, and those suffering from excess weight - a little less.
- It is better to steam, boil or stew food.
- You should avoid foods that cause bloating (flatulence); as well as from spicy or fried foods if you find them difficult to tolerate.
- Avoid eating foods to which you are intolerant.
The main question that worries people after being discharged from the hospital is whether they will be able to work after surgery? After surgical treatment of intestinal oncology, the patient’s ability to work depends on many factors: the stage of tumor development, the type of oncology, as well as the profession of the patients. After major operations, patients are not considered capable of work for a couple of years. But, if a relapse does not occur, they can return to their old job (we are not talking about physically demanding professions).
It is especially important to restore the consequences of surgery, which lead to improper functioning of the intestines (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: take a general stool and blood test; undergo regular examination of the surface of the colon (colonoscopy); X-ray of the chest organs. If relapse does not occur, diagnosis should be carried out at least once every 5 years.
Patients who are completely cured are not limited in any way, but are advised not to engage in heavy physical work for six months after discharge from the hospital.
Prevention of relapse
The chance of relapse 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 relapse). A neoplasm that appears again is classified as a relapse. Relapses of malignant tumors are often treated with conservative methods, using antitumor drugs and radiation therapy.
The main prevention of tumor recurrence is early diagnosis and urgent surgical intervention for local oncology, as well as full compliance with ablastic standards.
There are no specific recommendations for secondary prevention of relapse of this cancer. But doctors still advise following the same rules as for primary prevention:
- Constantly be on the move, 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 is important to know:
Bowel resection surgery: consequences and rehabilitation
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 this treatment has a fairly good prognosis. In addition to the fact that the anastomosis is durable, the risk of obstruction is minimized.
- "Side to end." The formation of an anastomosis is carried out between the two ends of the intestine: the abducent, located on the resected section, and the adductor, located on the adjacent section of the intestine (for example, between the ileum and the cecum, transverse colon and descending).
- "End to end." The 2 ends of the resected intestine or 2 adjacent sections are connected. This anastomosis is considered most similar to the natural position of the intestine, that is, the position before surgery. If severe scarring occurs, there is a chance of obstruction.
2 Indications and preparatory measures
The intestinal excision procedure is prescribed if one of the following pathologies is present:
- Cancer of one of the intestines.
- The insertion of one section of the intestine into another (intussusception).
- The appearance of nodes between parts of the intestine.
- Necrosis of departments.
- Obstruction or volvulus.
Depending on the diagnosis, the operation may be planned or emergency.
The set of preparatory measures includes a thorough examination of the organ and precise determination of the localization of the pathogenic area. Additionally, blood and urine are taken for analysis, and the body’s compatibility with one of the anesthetic drugs is checked, since the resection is carried out under general anesthesia. If an allergic reaction is present, another anesthetic drug is selected. If this is not done, then problems may begin even before the surgical intervention itself or during its implementation. Incorrectly selected anesthesia can cause death.
≡ Digestion > Gastrointestinal diseases > Intestinal anastomosis: features, preparation, purpose
Intestinal operations are considered one of the most complex and require special professionalism of the surgeon. It is important not only to restore the damaged integrity of the organ, but also to do this so that the intestines continue to function normally and do not lose their contractile function.
Intestinal anastomosis is a complex operation that is performed only in cases of extreme necessity and in 4-20% of cases leads to various complications.
What is intestinal anastomosis, and in what cases is it prescribed?
Fistulas are a cause of colon cancer.
Anastomosis is the joining of two hollow organs and their suturing. In this case, we are talking about stitching together two parts of the intestine.
There are two types of intestinal operations that require subsequent anastomosis - enteroctomy and resection.
In the first case, the intestine is cut to remove the foreign body from it.
During resection, you cannot do without an anastomosis; in this case, the intestine is not just cut, but part of it is also removed, after which only two parts of the intestine are stitched together in one way or another (varieties of anastomosis).
Bowel anastomosis is a major surgical procedure. It is performed under general anesthesia, and after it the patient requires long-term rehabilitation, and complications are possible. Bowel resection with anastomosis may be prescribed in the following cases:
- Colon cancer. Colon cancer occupies a leading place among cancer diseases found in developed countries. The cause of its occurrence may be fistulas, polyps, ulcerative colitis, and heredity. Resection of the affected area followed by anastomosis is prescribed in the initial stages of the disease, but can also be carried out in the presence of metastases, since leaving the tumor in the intestine is dangerous due to possible bleeding and intestinal obstruction due to tumor growth.
- Intestinal obstruction. Obstruction may occur due to a foreign body, tumor, or severe constipation. In the latter case, you can rinse the intestines, but for the rest, you will most likely have to undergo surgery. If the intestinal tissue has already begun to die due to compressed vessels, part of the intestine is removed and an anastomosis is performed.
- Intestinal infarction. With this disease, the flow of blood to the intestines is disrupted 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 intestinal dysfunction. This disease cannot be treated surgically, but patients have to undergo surgery, since life-threatening complications can arise during the course of the disease.
Read: Stool with mucus is a cause for concern
This video will tell you about colon cancer:
Preparation and procedure
Espumisan eliminates gases.
Such a serious procedure as intestinal anastomosis requires careful preparation. Previously, preparation was carried out using enemas and diet.
Now the need to follow a slag-free diet remains (for at least 3 days before the operation), but the day before the operation the patient is prescribed the drug Fortrans, which quickly and efficiently cleanses the entire intestine.
Before surgery, you should completely avoid fried foods, sweets, hot sauces, some cereals, beans, seeds and nuts.
You can eat boiled rice, boiled beef or chicken, and simple crackers. You should not break your diet, as this can lead to problems during surgery. Sometimes it is recommended to drink Espumisan before surgery. to eliminate gases.
The day before the procedure, the patient only has breakfast and starts taking Fortrans from lunch. 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, painless watery stools begin within a couple of hours.
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 types:
- "End to end." The most effective and frequently used method. It is only possible if the parts of the intestine being connected do not have a big difference in diameter. If it consists of slightly smaller parts, the surgeon slightly incises it and increases the lumen, and then sews the parts together 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 sutures both parts of the intestine, makes incisions and stitches them side to side. This surgical technique 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 stitched tightly, making a stump and first 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 side of the deaf intestine so that its diameter coincides with the second part of the intestine and the edges are sutured.
Read: Classification, treatment and symptoms of hiatal hernia. Types of therapy
Postoperative period and complications
Eating cereals will reduce the load on the intestines.
After intestinal surgery, the patient must undergo a mandatory rehabilitation course. Unfortunately, complications after intestinal resection are very common even with highly professional surgeons.
In the first days after surgery, the patient is observed in the hospital. Minor bleeding is possible. but they are not always dangerous. Seams are regularly inspected and processed.
For the first time after surgery, you can only drink still water; 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 bowel movements for at least the first 3-4 days.
Proper nutrition is especially important during 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, and puree soups are allowed.
Complications after surgery can occur both due to the fault of the patient himself (non-compliance with the regime, poor diet, increased physical activity), and due to 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, and weakness are observed.
- Obstruction. The intestines may stick together after surgery due to scarring. In some cases, the intestine becomes bent, which also leads to obstruction. This complication may not appear immediately, but some time after the operation. It requires repeated surgery.
- Bleeding. Abdominal surgery is most often accompanied by blood loss. Internal bleeding is considered the most dangerous after surgery, since the patient may not notice it immediately.
Read: Gallstone disease. Symptoms of the disease 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 nutrition rules.
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Review of surgical treatment methods for colon cancer
When it comes to bowel cancer, it usually means a malignant tumor of the colon (colon carcinoma) and rectum (rectal carcinoma). Further in the article we present to your attention an overview of methods surgical treatment of intestinal cancer. and also talk about the possible consequences for patients who have suffered one of the listed operations .
General information about bowel cancer surgery
Small bowel cancer and anal cancer (cancer of the anus) are rare. When it comes to bowel cancer, it usually means a malignant tumor of the colon (colon carcinoma) 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 area between 30-40 centimeters. Precursors of colon cancer are often mushroom-shaped growths, so-called intestinal polyps, which are often benign tumor-like formations. The main treatment for colon cancer is surgery, which means removing the affected area of the colon along with its lymphatic and blood vessels. In cases of advanced cancer, when there is no prospect of recovery, surgery is generally abandoned, except in cases where it is necessary to prevent complications such as intestinal obstruction. Colon cancer surgery, with the exception of intestinal obstruction, is not an emergency surgery; there is sufficient time for diagnosis and treatment planning. This way it is possible to avoid complications and improve the chances of recovery. The following text contains information about the methods of surgical intervention for intestinal cancer and the consequences after surgery that the patient may encounter.
Surgical treatment of colon cancer: Indications and goals
Bowel cancer operations are carried out in many clinics (university clinics, district hospitals) and bowel cancer centers. Bowel Cancer Centers are clinics that have been awarded a certificate for their special 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 purpose of surgery, in addition to removing the intestinal tumor, is also to remove metastases (secondary tumors, for example in the lungs and liver), examine the abdominal cavity and its organs, and 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 treatment can be further planned and predicted. In addition, bowel cancer surgery may be required if the fusion poses a risk of intestinal obstruction (complicated intestinal transit).
Curative and palliative operations for bowel cancer
If surgical intervention removes all tumor tissue, including possible metastases in lymph nodes or other organs, then in this case we are talking about curative surgery for bowel cancer. With this type of surgery, along with the affected area of the intestine, nearby healthy tissue is removed to reduce the risk of tumor reappearance (relapse). Since individual cancer cells may by this point have already multiplied and invaded nearby 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 tumor-related complications and pain for the patient, but there is no chance of recovery. If a tumor grows, for example, inside the intestine, it can obstruct the passage of intestinal contents, which in turn can lead to life-threatening intestinal obstruction. In this case, the surgeon will try to reduce the tumor to a size that will eliminate the narrow passage. Palliative operations also include avoiding narrowing through bypass anastomosis and installing an artificial anus (stoma).
Surgical treatment of intestinal cancer: preoperative stage
Before surgery for intestinal cancer, a very thorough examination must be carried out to determine 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) to assess the spread of the tumor and predict the preservation of sphincter function after surgery for intestinal cancer;
- Ultrasound examination (US) of the abdominal organs to assess possible tumor growth outside the affected organ;
- a chest x-ray (chest x-ray) to rule out or detect metastases in the lungs;
- determination of the level of CEA (carcinoembryonic antigen, CEA) before surgery for intestinal cancer serves as an initial indicator of subsequent monitoring of the course of the disease, as well as assessing 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 and during bowel cancer surgery, 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 from 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 intestinal cancer: Methods
In bowel surgery, there are two main methods of treating bowel cancer. At radical surgery for bowel cancer Not only the tumor is removed from the body, but also the healthy tissue adjacent to it. Unlike radical, with 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, bowel cancer surgery can be performed using laparotomy (opening the abdominal cavity) or minimally invasive.
Open and minimally invasive surgical treatment of colon cancer
Small tumors that have not yet penetrated into the deeper layers of the intestine can be removed during colonoscopy. If there are doubts about complete removal of the tumor tissue, then a conventional bowel cancer operation is performed. "Routine" bowel cancer surgery can be performed as a minimally invasive keyhole procedure ( laparoscopy) or with opening of the abdominal cavity ( laparotomy).
In the later stages of intestinal cancer, due to the extensiveness of the operation, laparotomy is performed almost without exception. In other cases, the currently established laparoscopic method of tumor removal in patients suffering from intestinal cancer is used. Although this method is widely used, it is advisable to perform such an operation by an experienced surgeon. The laparoscopic method of tumor removal gives almost the same result as traditional surgery with 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 colon 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), when performing a radical operation, for the sake of reliability, the tumor is removed with a reserve (i.e., including healthy tissue around the tumor) along with adjacent lymph nodes, lymphatics and blood vessels. Radical surgery is often critical to successfully removing the tumor without the risk of the disease returning (recurrence). Often the decision about the size of the intestinal section to be removed is made during surgery.
Contactless operation (No-Touch)
To avoid dissemination of tumor cells during surgery, the blood and lymph vessels associated with the tumor are first ligated, and then the tumor-affected section of intestine is cut off from the healthy section of intestine. Carefully, so as not to touch the tumor and not damage it (the so-called No-Touch technology, the affected section of the intestine, including lymph nodes, lymphatic and blood vessels, is cut off and removed from the abdominal cavity. The purpose of non-contact surgery is to prevent destruction tumors and thereby the spread of cancer cells in the body.
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 using the “en bloc” technique (“block removal”). The purpose of this operation is also to prevent damage to the tumor.
Local tumor removal
When removing a cancerous intestinal tumor locally, only the tumor itself is subject to surgery, taking into account a safe distance. This 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).
If subsequent histological examination confirms that the tumor has been completely removed and the risk of recurrence is minimized, the need for subsequent radical surgery for intestinal cancer is eliminated.
Surgical treatment of intestinal cancer: Artificial anus
An artificial anus (stoma or anus praeter) is a connection between a healthy intestine and an opening in the wall of the abdominal cavity through which the contents of the intestine are discharged. This method can be used both temporarily and for a long time.
At colon cancer A long-term stoma can only be used in rare cases. However, in difficult cases, a temporary stoma may be necessary to relieve pressure on the bowel or intestinal suture after bowel cancer surgery. If earlier during surgery small bowel cancer(for example, for tumors near the anus), along with the affected area of the rectum, the entire sphincter was also removed, but now 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 the creation of a permanent stoma.
Temporary artificial anus
A temporary artificial anus (temporary colostomy) is placed during bowel cancer surgery to relieve stress on the operated bowel and stitches. Through a colostomy, the contents of the intestine are removed, thus creating conditions for faster healing of the intestines and sutures. This type of stoma is also called unloading stoma. A temporary artificial anus is applied, usually in the form of double-barreled stoma. This means that the intestine (small or large intestine) is brought out through the wall of the abdominal cavity, cut at the top and turned inside out so that two holes in the intestine are visible. After a minor operation to close the temporary stoma and hole in the wall of the abdominal cavity, natural digestion is restored in about 2-3 months.
Permanent (permanent) artificial anus
If the tumor is located so close to the sphincter that saving the anus is not possible, both the rectum and the sphincter itself are completely removed. In this type of bowel cancer surgery, a permanent stoma is performed. In a permanent stoma, the healthy lower part of the colon is brought out through an opening in the abdominal wall and sutured to the skin. Most patients have no problems with a permanent stoma after a period of getting used to it and appropriate instruction. Even regular bowel movements do not cause them any particular problems.
For water sports (for example, visiting the pool) and visiting the sauna, special patches or so-called caps are available to patients with an ostomy. In addition, for patients with an unnatural anus, there are no restrictions in their professional activities or choice of sports.
Surgical treatment of bowel cancer: Risks and consequences
Like any other surgery, bowel cancer surgery may also have its 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 include:
- 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 seam between the intestine and the skin with an artificial anus may weaken or rupture. As a result, intestinal contents can leak into the abdominal cavity and cause peritonitis (inflammation of the peritoneum).
- Digestive disorder: Since the process of eating in the large intestine is basically completed, operations, from the point of view of the process of digesting food, are less problematic than on the small intestine. However, water is reabsorbed in the colon, which, depending on the portion of the colon removed, may interfere with the hardening of stool. This leads to more or less severe diarrhea. Many patients (especially patients with an ostomy) after bowel cancer surgery also complain of digestive disorders such as bloating, constipation and odors. As a result, patients change their usual diet, which can lead to a monotonous diet.
- Fecal incontinence, bladder dysfunction, sexual dysfunction (impotence in men): When performing surgery on the rectum, the nerves in the operated area can be irritated and damaged, which can subsequently cause patient complaints.
- Fusion (adhesions): In most cases, adhesions are harmless and painless, but sometimes, due to limited intestinal mobility and intestinal obstruction, they can cause pain and be dangerous.
Surgical treatment of bowel cancer: Postoperative care
Metastases (secondary tumors) or relapse (recurrence of a tumor in the same place) can only be detected in a timely manner if regular monitoring is performed after surgery.
After a successful bowel cancer operation, the following postoperative examinations are offered, in particular:
- regular colonoscopy;
- determination of the tumor marker CEA (carcinoembryonic antigen, CEA);
- ultrasound examination of the abdominal organs (stomach);
- X-ray examination of the lungs;
- computed tomography (CT) of the lungs and abdomen.
Surgical treatment of bowel cancer: Nutrition after surgery
As for nutritional norms after surgical treatment of intestinal cancer, there is practically no need for patients to give up their usual consumption of food and drinks. However, due to digestive disorders (bloating, diarrhea, constipation, odors), it is recommended to regulate bowel movements. This is especially true for patients with an artificial anus. To avoid a monotonous diet, you should take into account the following tips:
Recommendations for proper nutrition after bowel cancer surgery
- Eat 5-6 times a day in small portions. Avoid eating large portions.
- It is recommended to drink a sufficient amount of liquid between meals.
- Eat food slowly and chew well.
- Avoid eating very hot or very cold foods.
- Stick to regular meals and avoid dieting.
- Eat enough food, i.e. underweight patients are advised to eat a little more, and overweight people - a little less than usual.
- Stewing and steaming are gentle cooking methods.
- Avoid very fatty, sweet and bloating-causing foods, as well as fried, fried and spicy foods if you cannot tolerate them.
- Avoid foods that you have been unable to tolerate on several occasions.
Photo: www. Chirurgie-im-Bild. de We thank Professor Dr. Thomas W. Kraus for kindly providing us with these materials.
60. Bowel resection with side-to-side anastomosis. Suturing an intestinal wound.
Bowel resection– removal of a section of intestine.
Indications:
a) all types of necrosis (as a result of strangulation of internal/external hernias, thrombosis of mesenteric arteries, adhesive disease)
b) operable tumors
c) injuries of the small intestine without the possibility of suturing the wound
Operation stages:
1) lower-median or mid-median laparotomy
2) revision of the abdominal cavity
3) determination of the exact boundaries of healthy and pathologically altered tissues
4) mobilization of the mesentery of the small intestine (along the intended line of intestinal intersection)
5) bowel resection
6) formation of an interintestinal anastomosis.
7) suturing the mesenteric window
Operation technique:
1. Mid-median laparotomy, we go around the navel on the left.
2. Revision of the abdominal cavity. Removing the affected loop of intestine into the surgical wound, covering it with napkins with saline solution.
3. Determination of the boundaries of the resected part of the intestine within healthy tissues - proximally at 30-40 cm and distally at 15-20 cm from the resected section of the intestine.
4. In the avascular zone of the mesentery of the small intestine, a hole is made, along the edges of which one intestinal-mesenteric-serous suture is placed, piercing the mesentery, the marginal vessel passing through it, and the muscular layer of the intestinal wall. By tying a suture, the vessel is fixed to the intestinal wall. Such sutures are placed along the resection line from both the proximal and distal parts.
You can do it differently and perform a wedge-shaped dissection of the mesentery in the area of the removed loop, ligating all the vessels located along the cut line.
5. At a distance of about 5 cm from the end of the intestine intended for resection, two clamps for coprostasis are applied, the ends of which should not go to the mesenteric edges of the intestine. One crushing clamp is applied 2 cm below the proximal clamp and 2 cm above the distal clamp. The mesentery of the small intestine is crossed between the ligatures.
H 
Most often, a cone-shaped intersection of the small intestine is made; the slope of the intersection line should always start from the mesenteric edge and end on the opposite edge of the intestine to preserve blood supply. We form the intestinal stump in one of the following ways:
a) suturing the intestinal lumen with a continuous continuous Schmieden suture (furrier suture) + Lambert sutures.
b) suturing the stump with a continuous continuous suture + Lambert sutures
c) ligation of the intestine with catgut thread + immersion of the intestine in a pouch (simpler, but the stump is more massive)
6. An interintestinal anastomosis is formed “side to side” (applied when the diameter of the parts of the intestine being connected is small).
Basic requirements for the application of intestinal anastomoses:
a) the width of the anastomosis must be sufficient to ensure unimpeded passage of intestinal contents
b) if possible, the anastomosis is performed isoperistaltically (i.e., the direction of peristalsis in the adductor section should coincide with that in the efferent section).
c) the anastomosis line must be strong and provide physical and biological tightness
Advantages of forming a side-to-side anastomosis:
1
. deprived of the critical point of suturing the mesentery - this is the place where the mesenteries of the intestinal segments are compared, between which an anastomosis is applied
2. anastomosis promotes a wide connection of intestinal segments and ensures safety against the possible occurrence of intestinal fistula
Flaw: accumulation of food in the blind ends.
Technique for forming a side-to-side anastomosis:
A. The afferent and efferent sections of the intestine are applied to each other with isoperistaltic walls.
b. The walls of the intestinal loops over a length of 6-8 cm are connected by a series of interrupted silk seromuscular sutures according to Lambert at a distance of 0.5 cm from each other, retreating inward from the free edge of the intestine.
V 
. In the middle of the line of serous-muscular sutures, the intestinal lumen is opened (not reaching 1 cm to the end of the serous-muscular suture line) of one of the intestinal loops, then in the same way - the second loop.
d. Sew the inner edges (posterior lip of the anastomosis) of the resulting holes with a continuous upholstered Reverden-Multanovsky catgut suture. The seam begins by connecting the corners of both holes, pulling the corners together, tying a knot, leaving the beginning of the thread uncut;
d 
. Having reached the opposite end of the connected holes, secure the seam with a knot and use the same thread to connect the outer edges (anterior lip of the anastomosis) with a screw-in Schmieden suture. After stitching both outer walls, the threads are tied with a double knot.
e. Change gloves and napkins, process the seam and suture the anterior lip of the anastomosis with interrupted seromuscular sutures of Lambert. Check the patency of the anastomosis.
and. To avoid intussusception, the blind stumps are fixed with several interrupted sutures to the intestinal wall. We check the patency of the formed anastomosis.
7. We suture the mesenteric window.
Surgeries on the intestines are considered one of the most difficult. The surgeon must not only eliminate the pathology, but also maintain maximum functionality of the organ. To connect hollow organs during surgical interventions, a special technique is used - anastomosis.
Types of intestinal surgeries
Most often, operations performed on the intestine include enterotomy and resection. The first type is chosen if a foreign body is detected 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 section 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 mucous membrane, as well as with a Lambert suture, connecting the serous (covers the small intestine from the outside) and muscular membranes.
Resection means surgical removal of an organ or part of it. Before performing it, the doctor assesses the viability of the intestinal wall (color, ability to contract, presence of an inflammatory process). After the doctor marks the boundaries of the resected area, he selects the type of anastomosis.
Methods of anastomosis
There are several ways to perform an anastomosis. Let's look at them in detail.
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 the one that has a smaller diameter, the surgeon makes a linear incision to increase the lumen of the organ. Upon completion of resection of the sigmoid colon (this is the final region of the colon before transition to the rectum), this particular technique is used.
After intestinal surgery, the patient must undergo a course of rehabilitation: breathing exercises, therapeutic exercises, physical and dietary therapy. Together, these components will greatly increase the chances of effective recovery of the body.
It is used when resection of a large area is necessary or when there is a risk of severe tension at the anastomotic site. Both ends are closed with a double-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 closes the edges of the wound with a continuous suture.
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 compressed with intestinal sphincter. The open end is then applied to the side of the intestine, sewn using a continuous Lambert suture.
The next stage is when the surgeon makes a longitudinal incision and opens the efferent 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 anamostosis is optimal for many interventions, even such complex ones as extirpation of the esophagus (meaning its complete removal, including the nearest lymph nodes and fatty tissue).
Intestinal anastomoses with any type of connection are used on the small and large intestines. But in the first case, a one-story suture is necessarily chosen (that is, all layers of tissue are captured), in the second - only two-story interrupted sutures (the first row consists of simple sutures through the thickness of the walls being stitched, and the second without puncture of the mucous membrane).
The main purpose of the anastomosis is to restore the continuity of the intestine after resection and 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 hemicolectomy (removal of half of the colon with the formation of a bone fracture - an unnatural anus brought to the anterior abdominal wall), it allows you to preserve most of the functionality of the intestine.
Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for independent treatment. Be sure to consult your doctor!
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