Surfing wounds of the small intestine. Sunshine

Indications. Unit or multiple wounds of the intestinal wall.

Fixation and anesthesia, as in the previous case.

Technique operation. Depending on the magnitude and number of injuries, they come differently. Matching the contents of the extracted intestinal loop to the side and isolating the damaged area of \u200b\u200bthe loop with clips, proceed to the closure of wounds. In this case, careful isolation abdominal cavity From contamination by looking with sterile napkins of intestinal loop. Small wounds are closed by overlaying serous-muscular seam. When it is tightened by tweezers, the edges of the wound in the intestinal lumen are pushing, so that there were a complete contact of serous shells. Longitudinal large wounds are sewn through a two-row intestinal seam over Lambler or Shmkden. At the same time, in the escaner, the narrowing of the gum of the intestine is sewn in the transverse direction.

With extensive and multiple intects of the intestine, resection and imposition of intestinal anastomosis are processed.

Resection of gut

Indications. Perforation or necrosis of the intestinal wall; Danger of necrosis due to infringement; Fine sobbing or invagination; Tumors I. foreign bodies. The operation is performed by domestic animals of all kinds.

Tools. Scalpels, scissors, needles, needle holder, suture material, intestinal clamps, ligature needle Deshan, arterial clamps.

Anesthesia. Anesthesia.

Technique operation. Larotomy place is determined by the localization of the lesion. Usually, small animals use a paramediable incision, and in large - most often in the area of \u200b\u200bthe hungry fossa or on other sections of illeg. The principle of rectification of the intestine for all animals is one, is distinguished by some technical details caused by animal and topography. The main condition that must be respected is resection within disgusting tissues and sufficient ensuring the blood supply to the guts.

An intestinal loop extracted after laparotomy isolate from the abdominal cavity with gauze wipes and pushed the contents of the intestine with their fingers. After that, there are intestinal clamps on the healthy part of the intestine from the intended section of resection. Sometimes an additional pair of clamps isolate the directly affected part of the intestine. There are 2 ligatures on the vessels of the mesenix. When excised a significant portion of the intestinal ligature loop, they are applied to the main trunk that feeds this segment of the intestine. The sections of the intestine in the oblique direction dissect with scissors or scalpel near each clamp so that the intestine mesentery of the intestine is excised at a greater length. It will provide better nutrition and permeability. The mesentery dissect between ligatures. The mucous membrane is carefully freed from the residues of the content, slightly wiping with small tampon, impregnated with alcohol.

Depending on the magnitude of the intestinal lumen differ 2 methods of connecting it ends.

Stitching the end to the end (axially owner) is used with a sufficient lumen, which is easy to implement in large animals. The cults of the guts apply one to another side surfaces and connect them with a continuous seam through all the layers of Schmiden, turning over the intestine so that it is sewn throughout the coupling ends. In conclusion, the 2nd floor is imposed on top of this seam, but already in Lamber. After that, sew mezhek (2--5).

Stitching side in the side (side odds) is used in resection of intestines with narrow lumen. Extracted and isolated napkins intestinal loop on the places of resection are pierced by arterial clamps. Next need to prepare a stuffing cult. In large animals, you can press the intestine on both ends of the excised plot of zanda with forceps. The scene is tied by two ligatures, between which the intestine is excised. The resulting cults are sewn of the lamber. In small animals, the culture of the intestines close to the continuous two-storey seam of the lamber after it is clamped with a tweezers through which the threads are transferred.

The intestine converted to the opposite sides is applied by side surfaces to each other and stitched continuous seams, without piercing the mucous membrane. Then, on both surfaces with the connected seams of the intestine, the longitudinal openings are made, coinciding along the length and direction of the superimposed seam at a distance of 0.5--0.8 cm from it, and proceed to a continuous end-to-end seam on the rear (internal) edges of the wounds of both cuses. The same thread continues to sew through Lamberr, connecting the front edges of the wound continuous suture. In conclusion, we impose the final continuous seam on the serous and muscle shell on Lambler.

Intestinal seam (Lambon, Albert, Schmiden, Matteuka).

Intestinal seam- This is a method of connecting an intestinal wall.

The basis of the intestinal seam is the principle equipment of the intestinal wall: 1st case - serous-muscular and 2nd case - submemberous-mucous. When the wound is injected into the wound, the mucous-submisient layer is shifted.

Classification of intestinal seams:

but) by number of rows:

1. Single row (Lambere, Z-shaped)

2. Multarrone (small intestine: single-row - double row, thick intestine: double-row-three-row seam)

b) in the depth of taking fabrics:

1. Dirty (infected, non-sterile) - penetrating the intestinal lumen (seam of froli, seam of Mateshuk)

2. Clean (aseptic) - the thread does not pass mucous membranes and is not infected with intestinal content (seam of the lamber, brine, Z-shaped)

at) by applying methods:

1. Separate nodes

2. Continuous seams (a simple challenge and challenge with Zancht (seam of reversed-Muluongovsky) - more often on the back of the anastomosis, seam Schmiden (frown, oiling) - more often on the anterior lip of anastomosis)

d) according to the method of overlay: 1. Manual seam 2. Mechanical seam

e) by the duration of the existence of suture material:

1. The non-disseminating seam (teetes in the intestinal lumen): Kapron, silk, etc. Synthetic threads (superimposed as a second or third row as pure seams).

Materials: Capron, silk and other synthetic materials.

2. Sleeping (resorvated in time from 7 days to 1 month, are used as dirty seams of the first row)

Materials: Vincle (Golden Standard Sinking Swims), Dexon, Ketgut.

Suture material for intestinal seam: Synthetic (Vicker, Dexon) and Biological (Ketgut); Monofilament and polyfilament. Biological suture material in contrast to synthetic has an allergenic effect and is better infected. Polyfilament threads are able to sorbitize and accumulate microbes.

Needles for intestinal seam: Chilling, preferably atraumatic (provide low trauma tissues, reduce the magnitude of the wound channel from the passage of the thread and needle).

Seam Lambon - nodular gray-serous seam single-row.

Equipment: The needle is enhanced at a distance of 5-8 mm, it is carried out between the serous and muscle shell and is flushed at a distance of 1 mm in one edge of the wound and rolled at 1 mm and rolls out at 5-8 mm on another edge of the wound. The seam is tied up, while the edges of the mucous membranes remain in the lumen of the intestine and they fit well to each other.

In practice, this seam is performed as serous-muscular, because When flashing one serous shell Thread often breaks.

Shelo Mateshuk- A nodular serous-muscular or serous-muscularly submembered single-row.

Equipment: Valka needles are produced from the cut slicing side of the hollow organ on the border between the mucous membranes and the sublifting or muscle and sublifted layers, the rolling from the serous shell, on the other edge of the wound, the needle is carried out in the opposite direction.

Seam in black (frolic) - knitty serous muscular one-row.

Technique: Fucks produce 0.6 cm from the edge, and rolling on the edge between submucms and muscle layers, without punishing the mucous membrane; On the second side of the Fucks are made on the border of the muscular and submembraty layer, and the otkol, without piercing the mucous membrane, 0.6 cm from the edge of the cut.

Shov Schmiden - a continuous single-row-cutting inlet, warns the turning of the mucous membrane during the formation of an anastomosis front lip: the needles are always done on the side of the mucous membrane, and the ducks from the serous cover on two edges of the wound.

Alberta seam -double row:

1) The inner row is a continuous edge of uphawable seam through all layers: jolly needles from a serous surface, rods - from the mucous membrane on one edge of the wound, jolly side of the mucous side, rolling from the serous shell on the other edge of the wound, etc.

2) Outdoor row - lanch seams in order to immerse (peritonize) internal series of seams.

One of the basic principles of modern Surgery of the GCT is the need for peritonization of the anastomosis line and shelters the dirty intestinal seam near the pure seams.

Requirements for intestinal seam:

a) tightness (mechanical strength - impermeability for liquids and gases and biological - impermeability for microflora of intestinal lumen)

b) must have hemostatic properties

c) should not narrow the intestinal clearance

d) must ensure good adaptation of the same layers of the intestinal wall

60. Section of intestines with anastomaosis "side in side". Eashes in intestinal wound.

Resection of gut - removal of the segment of the intestine.

Indications:

a) all types of necrosis (as a result of infringement of the inner / external shelf, thrombosis of mesenteric arteries, adhesive disease)

b) Operable tumors

c) wound fine intestine without failure wound

Stages of operation:

1) Lower Currency or Middle Middle Lapotomy

2) the audit of the abdominal cavity

3) determining the exact boundaries of healthy and pathologically changed tissues

4) mesentery mobilization thin gut (on the intended intersection line)

5) gut resection

6) Formation of intercircuit anastomosis.

7) Easying the mesentery window

Technique surgery:

1. Middle-median laparotomy, the navel bypasses the left.

2. Audit of the abdominal cavity. The removal of the integrated loop of the intestine into the operating wound, look at it with napkins with saline.

3. Determination of the boundaries of the proportioned part of the intestine within healthy tissues - proximally by 30-40 cm and distally 15-20 cm from the resectible portion of the intestine.

4. In the awesome mesentery of the small intestine, they make a hole, along the edges of which are imposed on one intestinal-mesenosous-serous seam, piercing a mesenter passing in it the edge vessel, muscular layer intestinal wall. Testing the seam vessel is fixed to the intestinal wall. Such seams are superimposed along the resection line both by proximal and distal departments.

You can enroll differently and perform a wedge-shaped mesentery on the area of \u200b\u200bthe loop removed, bandaging all the vessels located along the cut line.

5. At a distance of about 5 cm from the end of the intestine, which is designed for resection, apply two clamps for coprostase, the ends of which should not go to the waste seaside edges. 2 cm below the proximal clamp and 2 cm above the distal clamp are superimposed by one crushing clip. Cross the mesentery of the small intestine between ligatures.

Most often make a cone-shaped crossing of the small intestine, the slope of the intersection line should always start from the mesenteric edge and end on the opposite region of the intestine to preserve blood supply. We form a culture of the intestine in one way:

a) stitching the intestinal lumen by a cross-cutting continuous chmidin chumper (speed-cutting) + overlay of lanch seams.

b) Eashabilization of the cult with a challenged continuous seam + the imposition of lanch seams

c) gutding ketgutoy thread + dive in the intestine in the kitty (easier, but the cult is more massive)

6. Form intercircuit anastomosis "side in side" (superimposed with a small diameter of the integral sections of the intestine).

Basic requirements for the imposition of intestinal anastomoses:

a) the width of the anastomosis should be sufficient to ensure the infinitive advancement of intestinal content

b), if possible, the anastomosis is imposed of isoperistal (i.e., the direction of the peristaltics in the leading site should coincide with those in the discharge site).

c) the anastomosis line should be durable and provide physical and biological tightness

Advantages of the formation of anastomosis "side in side":

1. Decide the critical point of the decay of the mesentery is the place of comparison of the mesensers of the intestinal sections, between which the anastomosis is imposed

2. Anastomosis contributes to a wide connection of the integration of the intestine and ensures safety for the possible appearance of intestinal fistula

Failure: Cutting food in the blind ends.

Technique for the formation of anastomosis "side in side":

but. The leading and discharge departments of the intestine are applied to each other by the walls of isoperistal.

b. The walls of the intestinal loops for 6-8 cm are connected by a number of nodal silk serous-muscular seams along Lambler at a distance of 0.5 cm from each other, retreating by the free edge of the intestine.

B. In the middle of the length of the overlay line of serous-muscular seams, the intestinal lumen is revealed (without reaching 1 cm to the end of the serous muscular seam line) one of the intestinal loops, then just also - the second loop.

G. Stitching the inner edges (the rear lip of anastomosis) of the resulting holes with a continuous overhaul Ketgutov suture of reverted-Multanovsky. The seam is beginning to connect the corners of both holes, pulling the corners with each other, tie the node, leaving the beginning of the thread is not cut off;

D. Reaching to the opposite end of the connected holes pinches the seam by the knot and move using the same thread to the compound of the outer edges (anterior lip of the anastomosis) of the chmiden inlet. After stitching both outer walls, the threads are tied by a double knot.

E. Change gloves, napkins, processed seams and feed the front lip of anastomosis with nodal serous-muscular seams of the lamber. Check the permeability of anastomosis.

g. Blinding cultures in order to avoid invagination are fixed by several nodal seams to the wall of the intestine. Check the permeability of the formed anastomosis.

7. We erect the mesentery window.

but) surfing of small wounds: serous-muscle brine seam + on top of the lanch seams

b) surfaction of significant wounds, diversity of the edges of the intestine:

1) wound excision and wound translation into transverse

2) Double-row seam: cross-cutting continuous ketgutic oiled seams Schmiden (speed) + serous muscular seams of lamber

3) Control on Patency

NB! The transverse embossing of the longitudinal wound provides good intestinal lumen only when the longitudinal wound does not reach the diameter of the intestinal loop.

61. Section of intestines with anastomaosis "End to End". Eashes in intestinal wound.

Start of operation - see question 60.

Anastomosis "End at the end" is most physiological.

Anastomoz formation technique "End to End":

1. The rear walls of the cut-off loop bring together and are flashing at the required level by two keys (one from above, another bottom).

2. Between the keys with an interval of 0.3-0.4 cm impose nodular serous muscular seams of the lanch.

3. Soft clamps are removed, the rear lip of the anastomosis is firmware with a ketguite continuous through seam with a chuck (suture of Muluongovsky).

4. The same thread is transferred to the anterior lip of the anastomosis and sowed it through Schmiden's sutures. Tie tie.

5. Change gloves, napkins, processed seams and feed the front lip of anastomose with nodal serous muscle seams of the lamber. Check the permeability of anastomosis.

Tools:anatomical tweezers, hemostatic clamps, a needle holder, snoring needles of small diameter (curved or straight), thin absorbing (ketgut, etc.) and non-painting (silk, kapron, etc.) suture material. If necessary, the soft intestinal rods.

Model:torso with an open abdominal cavity, or isolated complex internal organs (Fixed formalin), or insulated loop of the small intestine.

Case walls of the small intestine (mucous membrane, intake, muscular and serous shell), the infection of the content and specificity of the function (intensive blood circulation, high intracean pressure, peristalistic, digestive enzymes) determine the special requirements for the seam, which is superimposed on the intestinal wall. It should provide (1) tightness, (2) strength, (3) Do not interfere with the peristaltic, (4) not to narrow the clearance, (5) to ensure reliable hemostasis, (6) not to infect the surface of the serous shell.

With a small intestinal wall defect (up to 1 cm long), all these requirements can be implemented by applying single row brishetaround the wound (Fig. 34). At the same time use non-radiation

Fig. 34. 1 - brown seam; 2 - Z-shaped seam

Holding the wall of the gut by an anatomical tweezers, lay the stitches around the circle at a distance of 0.5 cm from the edge of the wound, with a length of 0.2 cm with gaps of 0.4 cm. The needle should enter the serous shell, go through the muscular and exit back from the serous: With visual control, the needle should contour the roller in the intestinal wall. If the needle is shifted - it passed only under the serous shell, if at all it does not care - "failed" into the clearance and became infected. When performing the first stitch, the thread stretches up to half of the day or a little more, with each subsequent stitch thread stretch to the end, without tightening the edges of the wound. As you move around the wound, you should change the position of the needle in the needle holder (sew, as convenient - "on yourself" or "from ourselves"), holding the needle tweezers. After applying stitches throughout the circumference, the ends of the thread are associated with one node, but do not delay it. Assistant anatomical tweezers captures the edge of the wound and immerses it as the node is tightened (the ends of the thread are better tightened up). Then the tweezers are then smoothly removed (it is recommended to turn it slightly around the axis, so that the folds of the intestinal wall are slipped out of its branches and do not fall between the stitches of the brush seam) and finally tighten the node. The node is secured by the second (fixing) node.

For proper fulfillment The wound edge brine is completely immersed, and the serous shell is collected in the folds, which are tightly adjacent to each other.

With unsuccessful manipulation of the removal of the tweezers between the folds of the serous shell, the plots of the mucous membrane can be. In this case, the imposition of additional 2-shaped seam(Fig. 34.2).

The stitches of the seam are also carried out through serous and muscle shells (aseptic seam!) Not closer to 0.5-0.7 cm from the node of the brush seam; They should be located on both sides of it and be parallel to each other in the form of a crossbar 2. After flashing

two stitches (lower crossbar) of the serous muscular seam long thread should be transferred in the oblique direction above the node of the brush seam. After that, the intestinal wall is stitching in the same direction with two stitches (upper crossbar).

When the wound injury is more than 1 cm long, usually use double-row seams.If the wound is 2.0-2.5 cm in size in the longitudinal direction, it must be translated into transverse to avoid the escape of the lumen. To do this, at the level of the middle of the length of the intestinal wound at a distance of 0.7-1.0 cm from its edges, apply kept: flashing serous and muscle shell with a non-reprocessive ligature. The ends of the threads are not tied, but are captured by hemostatic clips. With their help, the assistant gently stretches the edges of the wound, translating it into the transverse, and in this position fixes to the end of the injection operation (Fig. 35.1).

Fig. 35. 1 - seam holders on the wall of the gut; 2 - Sooch Schmiden

The first row of the seam is a nodal or continuous edge end-to-end seam. It provides tightness, strength, hemostasis. But it will be infected, because passes through the intestinal lumen. Most often impose an overtaking continuous seam according to Schmiden, "Rocking" (Fig. 35.2). At the same time, the absorbing suture material is used (more often Ketgut), the length of the ligature is about 30 cm. Rates from the angle of wounds by 0.4 cm, and from its edge - by 0.3-0.5 cm, the needle is carried out by a serous shell in The intestinal lumen and the mucous side remove the needle on the serous sheath of the opposite edge of the wound. The thread is stretched so that a short end of 6-8 cm long and the short ends of the ligature remain in the place of the ins. The wound wound in the wound in the wound.

Subsequent stitches are carried out through the entire thickness of the intestinal wall by 0.3-0.4 cm from the edge of the wound alternately from the mucous side of each edge of the wound, the distance between the stitches is 0.5 cm. For convenience after each stitch, the needle position changes

in the needle holder (the needle's edge turned to the left, then right), the needle holds a tweezers. After each stitch, the assistant extends the thread to the thick contact of the edges of the wound and fixes it with an anatomical tweezers: watches the edges to write inside.

Fig. 36. 1 - Completion of Schw Schmiden: binding the last loop with a free end of the thread; Lambon seams on over Schw Schmiden; 2 - Lammer's nodal seams completely immersed seam Schmiden

After the wound eats, one end of the thread remains, with which it is necessary to form a node and fasten the seam. To do this, when flashing the last stitch, it is not stretched to the end to the end, it is necessary to leave the latter loop, in length equal to the remaining free end of the thread. Browsing both half of the loop (i.e., connecting them into one thread), they associate them with a simple knot with the free end of the thread (Fig. 36,1). Thread nodes at the beginning and at the end of the seam are cut at 0.2-0.3 cm from the node.

With the proper execution of the overall seam when tightening the stitches of the edge of the edge of the wound "are screwed" into the intestinal lumen, and the seam has the appearance of the Christmas tree. Serous shells of edges wounds repeatedly touch each other.

Sailing sterility is provided by the overlay of the second row nodular aseptic peritonezing serous muscular seams (Lam-Bera)(Fig.36,1). At a distance of 0.6-0.8 cm from the inner seam line in the direction perpendicular to it, the serous and muscular shell of the intestinal wall is pierced. Packs are produced at the same level, but already 0.2-0.3 cm from the edge of the inner seam. Stitch length (Valka-Pokolov) approximately 0.3-0.4 cm. The thread should be stretched to half its length.

On the other side of the inner seam, in the same level, the intestinal wall is stitched in the reverse order: the jolly at a distance of 0.2-0.3 cm, and the ducks at a distance of 0.6-0.8 cm from the inner seam line.

The nodal serous-muscular seams are applied at about 0.4-0.5 cm from each other. When tightening the seams, the folds of the serous muscular layer are formed, in the depth of which the inner seam is immersed. At the same time, serous shells on both sides of the inner seam are tightly in touch. The nodes are tied and immediately cut at a level of 0.2-0.3 cm above the node. With properly superimposed seams, the crawls of the serous shell are tightly in contact, the inner seam is completely immersed and not visible (Fig. 36.2).

Removing threads-holding is made after the overlapping of the second row of seams. At the same time, it must be borne in mind that they were in the operating wound on the "dirty" stage of the operation (with the open intestine) and therefore infected.

One of the ends of the threads are waiting at the level of its exit from the intestinal wall and remove both ends. In this case, a section of the thread passes through the intestinal wall, which was in its thicker and was not infected.

Moscow medical Academy them. I.M. Suchenova

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The abdominal cavity is opened by the median cut and inspect all the guts; Damaged temporarily wrapped in a napkin and postpone. After the revision, consistently process detected wounds.

With a small bridge, the wound is enough to impose a brine serous-muscular neck around it. When tightening the edge of the edge of the wound with tweezers is immersed in the intestinal lumen.

Cutting wounds in a length of several centimeters are sutured by a double row suture:

1) internal, through all layers of the intestinal wall - Ketgut with the introduction of edges in Schmiden;

2) Outdoor, serous-muscular - impose nodal silk seams. You can also use single-row serous muscular seam. In order to avoid narrowing the intestine, longitudinal wounds should be sewn in the transverse direction.

With multiple closely arranged wounds of one loop, it is restessing (Fig. 21).

Fig. 21. Investigating wound scheme

A - overlay seams-keys;

B - the imposition of Schu Schmiden on the edges of the wound (the first series of seams);

C - the imposition of lanch seams (the beginning of the imposition);

D - lamber seams tying (second seams).

Theoretical questions for the lesson:

1. Determination of the concept of "intestinal seam".

2. Indications for the imposition of intestinal seams.

3. Classification of intestinal seams.

4. General requirementsSend to intestinal seams.

5. Biological basis of Lammer seam.

6. Stages of operational reception of resection of the small intestine.

7. Types of mobilization.

8. Errors and complications during the transaction surgery of the small intestine.

Practical part of the lesson:

1. Master the vessel dressing technique in mesentery.

2. Master the applying technique of various types intestinal seams.

3. Master the appliances of the applix of the anastomoses by the end to the end, the end in the side and side in the side.

Questions for self-controlling knowledge

1. Classification of intestinal seams.

2. What stitches are the first row seams?

3. Name the types of aseptic seams.

4. Which of the types of anastomoses is the most physiological?

5. How does the inner lip of the anastomosis?

6. Name the order of the seams on the outdoor lip of the anastomosis.

Surfing the colon It is performed in cases of damage, with small and medium-sized wounds. Small single chicken wounds The colon and the basic part of the straight, covered visceral peritoneum are subject to ears. They can be sewn with a brine, but unlike wounds of the small intestine - with the subsequent imposition of two rows of serous muscular seams. The largest wounds of the colon wound require a three-row seam in cross to the intestinal axis direction: the first row is a continuous oxide ketguette seam through all layers, then after changing the napkins, tools and gloves, the second and third rows of serous muscular seams are superimposed. The seam line is advisable, in addition, to get it in front of a blanket, fat pendants, parietal peritoneum).

In cases where the holes are somewhat and they are located on a small stretchIt is advisable to produce resection of the colon with the subsequent imposition of the unloading fistula (colostomy) and the use of a three-row seam.

The use of three-row seam on the colon It is reasonable and appropriate, given the following considerations. The edge traumatic necrosis on the colon on the soil of the imposition of the first row of seams (through all layers) is not limited to the mucous membrane, and captures often the submool layer and even the muscular shell up to the serous surface. Such a deep nature of the regional necrosis leads to the fact that after rejection of dead tissues from the lumen, an outer (second) series of seams (serous muscular) is exposed, which is infected as a result. To protect this second row of seams and delivering it from the abdominal cavity, a third series of seams is needed - serous-muscular (I. D. Kirpatovsky, 1964).

Along the way should be mentioned that individual the authors are used for resection fine And even the colon is a single-row inneruine seam (V. P. Mateshuk and E. Ya. Saburov, 1962).

. a - opening of the lumen of the small intestine in the center of the brush seam; B - Introduction to the small intestine of the rubber tube.

With extensive, as well as highly located outstretchish rectum wounds, applied from the side of the lumen, tactics may be different. A. M. Ameninee (1965) offers the following two options.

Dissection of sphincter and the walls of the intestine to the tailbone from behind and to the channel of the wound up; Then the removal of the tailbone and wide disclosure of the intestine. Careful treatment (excision of contaminated edges and bottom) and the overlap of the three-storey seam on the wound with the subsequent restoration of the disseminated intestine and the sphincter.

Outdoor (parasacral) access to the place of injury, processing (excision) wounds with subsequent three-storey sewing it. Drainage or ointment tampon; Outdoor wounds stuck to drainage. The question of imposing an unnecessary rear passage to the sigmoid intestine is solved individually.

. in, g - removal of the outer end of the rubber tube through the puncture abdominal wall and fixing the rubber ring to the skin.

With extensive damage to the rectum (intra and extrears) it is advisable to perform the imposition of an artificial rear passage to the sigmoid gut. AT postoperative period There should not be used enemas and gas pipes that can be broken by the primary bonding of the edges of the wound.

Speaking about intestinal operationsIt is necessary to recall the mechanical seam, which was widely used in the abdominal surgery. With the help of numerous crosslinking devices, it is possible to quickly and aseptically impose anastomoses of various types.

In conclusion, it should be emphasizedthat the submembricted layer has the greatest mechanical strength of the intestine of the largest mechanical strength, so the seams through all the layers (including through the mucous membrane) are no stronger than the seams only serous-muscularly sublimated; The flashing of the sublifted layer increases the strength of the serous muscular seams by 2-3 times, and the flashing and mucous membrane does not increase the strength of the seams due to the teething of the mucous membrane (N. P. Rakevich, 1963).

In the postoperative period There should not be used enemas and gas pipes that can be broken by the primary bonding of the edges of the wound.