Left-sided hemicultomy technique. How does the procedure of right-hand hemicultomy? Left-sided hemicultomy technique operation

Left-sided and right-sided hemicultomy - radical operations to remove part of a large intestine from some one side. Such intervention is considered simple, but it implies a long course of rehabilitation and a change in the patient's lifestyle, therefore it is appointed only on vital indications.

Who is shown hemicultomy

In order for the patient to prescribe resection of half the intestines, we need serious grounds. And usually it is heavy pathologies that cannot be cured conservatively. In the first place is a colon cancer. Oncology affected part of the intestine is immediately removed to prevent the spread of metastases.

Hemicultomy is also shown in the presence of polyphscent polyps in the thick intestine with malignation and when the neglence of certain diseases: Crohn's disease, ulcerative colitis, perforation or diverticulosis of the colon, inversion of the sigmoid gut.

Curious! In an adult, the length of the large intestine is 1.5-2 meters. It turns out that with hemicultomy, approximately the meter of the organ is excised.

There is no absolute contraindications to emergency hemicultomy, because when the person's condition is critical, have to go on risk even if there are some concomitant problems. The planned operation can postpone if the patient has severe diseases of cardio-vascular system, kidney or liver failure, diabetes In the decompensated stage.

Preparation of the patient to surgery

The preparatory period before hemicultomy can be divided into two lines. The first is the necessary preoperative surveys (fluorography, ECG), testing (OAM, UAC, biochemistry) and expert advice. The second is the behavior of the patient himself and the adherence to them of medical appointments.

What do doctors do

A colonoscopy is prescribed from specific surveys, which allows you to visually assess the state of the intestinal part to be removed, as well as take a piece of mucosa to the biopsy in order to determine the cellular type. With insufficient results of the study, irrigoscopy is additionally carried out. Especially severe states (colon cancer) require also computed tomography.

What does patient makes

Patient 3-5 days before the operation, it is necessary to start a slicing diet. It will allow the intestine to make the intestine as much as possible to simplify the work of doctors and minimize the risks of infection during the intervention. We will have to exclude:

• bold;
• roast;
• smoked;
• sauces;
• nuts;
• black tea and coffee;
• sdoba;
• alcohol;
• mushrooms;
• garlic;
• fresh fruits and berries.

Ideal will be 2 days before the operation eating a salad, which is called the "pancake" or "brush". It will make it possible to clean the intestinal walls from the remaining slags. The recipe is very simple: rubbed carrots, beets and fresh salad leaves on a large grater. In the original recipe used white cabbage, but it causes gas formation, which is undesirable to hemicultomy. Salad refueling vegetable oil and lemon juice.

How the operation is carried out

Right-sided or left-sided hemicultomy can be carried out in two ways: open (laparotomy) and closed (laparoscopy). The second is preferable, because This is the minimum loss of blood and rapid recovery. But laparoscopy can be contraindicated or impossible in the absence of endoscopic equipment in the hospital.

Lapotomy

The operation is carried out under common mask anesthesia. The patient lies on the back. The incision is carried out in the front wall of the peritoneum. The affected half of the intestines is isolated, mobilized from neighboring organs and vessels (from the spleen bend and the mesenteric artery, if it is left-sided hemichectomy, and from the hepatic bending and the iliac-colon artery, if the right-sided).

A mobilized affected part of the intestines is shifted on both sides and cut off. The remaining cults are crosslinked with the imposition of an anastomosis - a special connection for strength and recovery of patency. In some cases low part The remaining intestines are embedded, and the second is derived through the peritoneum with the formation of temporary colostit.

Laparoscopy

Laparoscopic hemicultomy is carried out either under general anesthesiaOr under epidural anesthesia. The patient also lies on the back. An endoscope is administered to the peritoneum through the punctures (tube with a camera to remove the image to the monitor) and surgical instruments. The technique of intestinal mobilization and its excision is about the same as with open intervention.

After laparoscopic hemicultomy, several small seams remain (2-3 cm), which are quickly delayed, reducing the period of rehabilitation.

Why remove half the intestines

This is a legitarious question that people who have pathology (tumor, polyps, twisting) are asked only on a small sequish area. Why not hemicultomy only affected zone? There are several explanations for it.

1. The right and left half of the colon is supplied with blood from different large arteries: from the upper and lower mesenter, respectively. And when, during surgery, one of the vessels is bandaged, "devies" the entire half of the intestines, and leave necrotic sites there is no point.
2. The boundary of the division of the thick intestine on the right and left parts is the cross-colon. It is movable and easier to impose anastomosis.
3. The removal of half the intestines gives higher results when cancer. Because from the moment of study on the localization of the tumor until the day of the hemicultomy, metastasis may have time to spread. Therefore, a part of the intestines is removed "with a margin."

Features of the postoperative period

Patients after laparotomic hemicultomy are forced to observe the bed regime, at least 3 days so that the seams are not separated. If it was laparoscopy, then you can even get up the day after the operation. Both types of hemicultomy require drainage installation, which is removed only after 2-3 days.

By the way! Patients who needed hemicultomy went to the operation in an already weakened or even exhausted state. Therefore, recovery will also leak hard.

After the operation, it is impossible to drink and eat. Only the next day a small amount of fluid is allowed. Liquid food is gradually introduced. Due to the reduction in the intestinal length, the patient will have to observe the diet all life. It eliminates products requiring a multi-hour digestion (pork, lamb, beef, bean, cabbage, some root, nuts).

Violation of digestion will torment the patient about 3-4 weeks until the body adapts to new conditions. But it is advisable to avoid constipation so that too solid powerful masses are not pressed on the inner seams. To this end, the doctor usually prescribes lightweight preparations.

Possible complications of hemicultomy

Both left-sided, and right-sided hemicultomy can cause the same complications, to the early of which include injury to nearby organs (ureter, duodenum), internal bleeding, discrepancy of seams, infection and inflammation abdominal cavity. Also immediately after the operation, paresis (violation of the intestinal) of the intestine can develop.

Attention! Some complications are dangerous in that it is possible to eliminate them. surgically. And to carry out another operation on the body of a weakened patient is a big risk.

If no force majeure during the operation did not happen immediately, and the patient successfully prescribed home, it is important to comply with all the prescriptions and appointments of the doctor. Because for full recovery After the right or left hemicotomy is required 4-6 months. And during this time, the complications can also be used to develop: adhesive processes, ulcers on anastomose, scar stenosis of the intestine, hernia.

Anemia, body weight loss, immunity reduction is not complications, but typical consequences that rarely manage to avoid. All this gradually passes. After half a year, we can talk about the resistant adaptation: both physiological and psychological. A person gains weight, gets used to a new food regime, learns to listen to the titles of the body to changes in the diet.

type of service: Healing, service category: Operations and manipulations of general agrogic

Clinics of St. Petersburg, where this adult service is provided (54)

Clinics of St. Petersburg, where this service is provided for children (1)

Specialists providing this service (19)

Left-sided hemicultomy is the removal of the left half of the transverse colon, downward colon and either the entire sigmoid intestine or its parts.

Left-sided hemicultomy is most often performed about the cancer of the left half of the colon. Also, the testimony can be considered the diverticulosis of the left half of the colon, left-sided megalolon, Lvto-sidedly thick stasis and inflammatory diseases In the left half of the colon.

Preparation for the operation

Preparation to all operations on the thick intestine is similar. The patient falls into the hospital of the day for 2 - 3 to surgery. The plan of the preoperative examination includes:

Clinical analysis of blood and urine

Blood chemistry ( common protein, bilirubin, urea, glucose, ast, alt, creatinine)

Hepatitis Analyzes B, C, HIV

Analyzes on syphilis

Definition of blood group

Electrocardiogram

Fluorographic study

Colonoscopy

Irrigoscopy

In the case of a patient any chronic diseases Required certificates, conclusions and discourts from hospitals

Further, within 2 - 3 days, the patient receives a slicing high-calorie diet. Since it is assumed to open the gossip of the intestine and to reduce the likelihood and infection of the abdominal cavity and postoperative seams, days for 3 are administered orally antibiotics (alfanormix, polymixin, etc.). On the eve of the operation, the operating field shaves, the patient does not eat anything on this day, drinks the laxative or the cleansing enemas are put. Immediately before the operation, the patient put a probe in the stomach, the urinary catheter and the operation will end and the operation itself begins.

Course of operation

This operation is carried out under general anesthesia. The position of the patient on the back with the legs lined with the legs placed on special stands.

In the middle line of the abdomen, a cut is performed as shown in the picture on the left. After opening the abdominal cavity, a thorough inspection of the organs located in it is carried out. After that, disseminate the peritoneum and begin to release the removed sector of the intestine from bundles, vessels and adhesions (drawings below).

After preparing the intestine to remove, first on the rim, then crosslinking devices and the intestine is removed to the sigmoid intestine.

After that, it is superimposed anasta scaming on the side in the side when the transverse colon and the residue of the sigmoid intestine are stitched with its side parts. First, two cults are sewed. After that, there is an opening of their lumen and the formation of self-definition.

Then, making sure in the passability of anastamose and the collapse of it either by the gland or fat suspension and thoroughly checking the absence of bleeding, the abdominal cavity is layered undergraduate.

Complications

The main complications include:

Bleeding

Insolvency anastomosis

Paretic intestinal obstruction

Postoperative infectious complications (peritonitis, suppuration postoperative wound etc.)

Recovery period

The recovery period, in principle, is practically no different from this period with other community operations. The first day operated on is in the intensive therapy (resuscitation) separation. If the state allows and the functions of the main organs recovered, then the patient is translated into a common chamber. From the hospital, the extract is made by about 10-13 days. Fully recovery occurs after 1.5-2 months. In case the operation was made about the oncological disease, chemotherapy is most likely required. Sometimes the operations end with the imposition of colostomas. In this case, the recovery period includes training in special Stoma-centers.

Hemicultomy is a surgical procedure used for treatment various diseases Colonse. Used in abdominal surgery, oncology and proctology. The history of resection of the colon begins in 1832, when Dr. Rabord reported on the first successful surgery with interchess anastomosis. The first laparoscopic hemicultomy was carried out in the United States in 1990 by Dr. Jacobs.
Depending on the removable part of the colon, left-sided and right-sided hemicultomy are distinguished. Both operations are performed by open method or laparoscopically. With a hemicultomy open, the removal of half the intestines is carried out through a large incision in the abdominal wall. When using laparoscopic technology, the colon resection is performed through small holes under the control of the camcorder using endoscopic equipment. The advantage of the open method is the lack of necessity in expensive laparoscopic equipment, better conditions For visual inspection, the possibility of obtaining tactile information on the status of the abdominal organs, lower prices. The advantages of laparoscopic hemicultomy include a reduction in recovery time, less intense pain syndrome, lack of large scars, reduced risk of infectious complications and postoperative hernia, as well as early restoration of the intestinal function.

After left-sided hemicultomy.

After surgery, the patient is delivered to the department of separation or separation of anesthesiology and resuscitation, where it is under the supervision of its condition. Continuation of infusion therapy, the introduction of antibiotics and analgesics leading the prevention of deep veins thrombosis. In a day, the patient can use transparent liquids. When the body raises it and the intestine begins to function, the diet gradually expands. Otherwise, continue infusional therapy, appoint parenteral nutrition. The activation of the patient begins the next day after the operation.
Sometimes in the postoperative period, patients develop intestinal paresis. To eliminate the car, sufficient required infusion therapy, adequate anesthesia, correction of electrolyte imbalance and early activation. In patients with vomiting and bloating, relief may appear after the introduction of a nastastric tube, although this exercise does not eliminate the intestinal paresis. The introduction of drugs enhances the intestinal peristalsis, so it is best to use epidural analgesia for anesthesia. Sometimes, when parires requires medical intestinal stimulation, but its implementation should begin only with the ineffectiveness of other methods, and not from the first day of the postoperative period. Separations are used for stimulation (the use of the drug is limited side effects), Metoklopramid and Alvimopan. A few days later, drainage is removed from the abdominal cavity.
After laparoscopic hemicultomy, the seams are removed by 6-7 days, and after the open procedure - for 9-10 days. Then the patient goes home. After the trip, short daily walks with a gradual increase in duration are recommended. It is allowed to descend and climb the stairs, in the initial recovery period, the patient needs the help of another person. Immediately after unloading, it is possible to raise weight up to 5 kg, after a month the weight of the cargo can be gradually increased.
The shower can be taken two days after a laparoscopic operation (if the patient is able to do it). Cuthes must be carefully cleaned, without soap and thoroughly dried. With open hemicultomy, hygienic procedures should be postponed before the seams are removed. Performance is usually restored after 6-8 weeks. If the colon resection was performed for malignant tumorafter receiving results histological research The patient may need chemotherapy.

Hemicultomy is an operation to remove the right or left affected portion of the intestine. Such surgical intervention is performed at oncological diseases organ, ulcerative colitis, intestinal obstruction, polypose, crown disease.

During the operation, resection of half of the intestinal length is performed. Depending on how half the colon is amazed, distinguished by right-sided and left-sided hemicultomy. The technique of performing the operation depends on the characteristics of the disease, blood supply to the organ, the state of the nodes, the presence of malignant foci. The main contraindication to surgical interference is the inoperable tumor.

Right-sided hemicultomy is performed if the affected area is located:

• in the departments of the iliac;
• in the transverse and longitudinal intestine;
• in the colonist.

A distinctive feature of the operation is the removal of half the intestine. Even with a small size of the neoplasm in surgical practice, it is customary to remove half the intestines. Such an approach is due to some features. The peculiarities of the intestinal blood supply are necessarily taken into account - the right and left branches of the organ supply various branches of the arteries. Blood access to the right half of the intestine provides upper mesenteric artery. If you take a ligation of the branch, then the entire right half of the intestines will cease to function.

In the transverse and colon form a intestinal anastomosis. When oncology, remove the maximum sections of the lymph, connected to the tumor. Lymph nodes are located in the retroperitoneal part and in the mesentery.

Hemicultomy left half of the gut

Left-sided hemicultomy is carried out during the localization of pathology in the left departments:

1. sigmoid gut;
2. colon;
3. cross-colon.

The blood supply to the left half of the intestines provides lower mesenteric artery. With oncology, the entire affected segment is removed, as well as the retroperitoneal parts adjacent to remote areas. The operation is often appointed by older people with the damage to the mucous membrane of the colon and during the "colitis" diagnosis.

Indications

Hemicultomy is considered to be a radical operation. Appointed in vital indications:

• breakthorn;
• formation of nodes in the intestines;
• irreversible circulatory disorders in the intestinal wall;
• polyposis;
• ulcerative colitis;
• crohn's disease.

Contraindications

With multiple remote metastasis, the operation is not carried out. Also, the operation is not carried out at:

• common patient condition;
• heart failure;
• severe stage of diabetes;
• renal failure;
• liver failure;
• acute infection.

Very often, the pathological process is accompanied by anemia, water-salt imbalance, exhaustion. But they are not contraindications to the operation. Moreover, in the process operational intervention These status are adjusted. In such a case, postoperative complications are minimized.

Preparation for the operation

Before the beginning surgical intervention Approved relevant studies. Blood tests, urine, markers for the presence of infectious diseases are surrendered. The patient is required to perform fluorography, ultrasound procedure peritoneal organs, computed tomography.

Pre-patient inspect the therapist and narrow specialists. If necessary, the patient is carried out transfusion of blood or plasma, infusion of salt and acid solutions. In the preparatory period, the doctor may appoint a metabolite reception that improves metabolism.

In heart failure, glycosides are prescribed and corrective heart activities. It is required to normalize arterial pressure hypotensive means.

Special attention should be paid to the nutrition of the patient of the person who will have hemicultomy. Food must contain proteins and vitamins. It is required to eliminate food rich in fiber - raw fruits and vegetables, nuts, beans.

On the eve of the operational intervention, pre operate intestinal training is carried out. Cleaning should be carried out to suppress microflora organs can be assigned antibiotics of an unusable group.

Gemicultomy surgery

Surgical intervention is carried out under general anesthesia - Miorlaxants are used. Procedure surgery:

1. The incision is performed among the middle or lateral. It provides the necessary access to the organ and does not violate its functions.
2. Inspection and the assessment of the status of the peritoneum is performed - the doctor determines the transmission and presence of pathologies.
3. With right-sided intervention, a portion of the ileum is mobilized, as well as the departments of the blind, ascending colon and right part Cross-colon. The blood supply to the departments is covered with vascular dressing. With a left-sided resection operation, left parts of the transverse, lower colon and sigmoid gauge are exposed.
4. Receidation is performed - clamps are imposed on the cross-rim section. This part is excreted and removed together with mesenter, gland, fiber and lymphs. End of the intestines are treated with an antiseptic preparation.
5. Anastomosis is created, the intestinal walls are sewn.
6. Drainage is installed in the anastomosis zone. In special cases, artificial fistula on the sigmoid gut can be imposed.

For intestinal obstruction Complications are performed by discharge alarm, hemocolectomy and embossing worships.

Laparoscopic hemicotomy

Surgical intervention with an endoscope is a similar radical operation. In this case, large cuts are not conducted abdominal wall. In the process of laparoscopy, the intestine tissue is less traumatized, and the recovery period proceeds much faster. The method is especially shown highly weakened patients.

Endoscopic equipment is introduced through 4-5 punctures. The main stages of surgical intervention do not differ from the radical method. The crosslinking device is also entered through the puncture. Anastomosis is created at the end of the operation. The segment of the intestine is removed through a section of a 3 centimeter long.

With a large tumor it is impossible to perform anastomosis inside the peritoneum. Then the operation is carried out in an open way. Laparoscopy and radical method can be combined.

Postoperative period

After the operation of hemicultomy, complications may occur:

• peritonitis;
• bleeding;
• parishes;
• thromboembolia;
• ulcers.

To prevent the development of dangerous complications, all medical recommendations are required. Often cancer patients are operated on in a weakened state. Recovery after the operation occurs in such patients is very hard. In special cases, chemotherapy is assigned, which exacerbates the recovery period.

Immediately after surgery, anemia, asthenic disorders, weight loss, constipation or diarrhea are observed. The patient's condition is adjusted by the appropriate medicinal medicines. The patient must be under constant medical inspection.

A diet after surgery should be gentle, difficult-scale products and fiber are excluded from the diet. You can use well-strained porridge, kissel, dairy products, padded purees and soups.

6 months after the operation, persistent adaptation occurs. The sick person adds physical forces to the mass of the body, physical forces are gradually restored. If remote metastases are missing for 5 years, the patient is considered cured.

1

An assessment of the results of treatment of 15 patients in a remote period from 7 to 12 years after the fulfillment of left-sided hemicultomy with the correction of the colon's binder apparatus is carried out. Operations were performed by patients with constipation resistant to drug therapy due to slow casual transit. The diagnosis was made after the polyposition irrigography, studying the time of the thick-body transit with X-ray process markers, was excluded the organic pathology of the colon and rectum. After surgery, all patients note a regular independent chair. In 3 operated patients, there are sometimes problems in the form of periodic constipation, but these patients easily adapt quite easily and achieve regular stools with small doses of laxatives and diets. Postoperative complication In the form of early adhesions of fine obstruction, it was noted in 1 patient, there were no other complications. Left-sided hemicultomy with the correction of the colon's ligament apparatus is a body-growing operation aimed at normalizing the chair in patients with a slow-intestinal transit. Postoperative results largely depend on the selection of patients. The operation is effective in constipation of slow transit. Remote results are traced for a period of 7 to 12 years, all patients talk about satisfaction with the results of our operation and improving the quality of life.

cHRONIC STORAGE OF SLEKED TRANSIT

left-sided hemicultomy

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Introduction

Chronic constipation, resistant to conservative methods of treatment, represent a serious problem of gastroenterology, and a group of patients remains that surgical treatment can be shown.

Popps can be associated with many reasons, one of which is the slow transit of the contents of the colon. The constipation of a slow transit (ZMT) is significantly more often observed in women and can be combined with the elongated type of colon structure, characterized by beggars, disorders of fixation of its various departments. In experimental studies and multiple clinical observations there are data indicating the connection of constipation with the elongated type of colon structure.

The purpose of our work was the analysis of the results of conservative and surgical treatment According to the proposed methodology and assessment of the quality of life of patients with constipation of slow transit.

Patients and techniques

For the period from 1999 to 2004, in our clinic on chronic constipation, a survey and treatment of 342 patients were examined, of which 195 patients were most approached by the classification of C3 Roman criteria III. Age varied ranging from 17 to 70 years (median 47.3 ± 16.8 years), 173 (88.72%) of women and 22 (11.28%) men. The births were in 144 women, and 56 of them, after delivery, there was a deterioration in the rhythm of the chair and the appearance of constipation. Of this amount, 15 (7.7%) of women with ZMTs aged from 17 to 44 years have been operated on, the average age was 29.9 ± 7.6 years. The survey of patients included a colonoscopy to eliminate organic pathology. Patients with constipation were performed irrigography, and if there were signs of the lengthening of the colon (germinations, doubling, impairment of fixation, loops, etc.) in combination with persistent chronic constipation, functional studies were conducted to estimate the time of segmental thick transit (VTT) x-ray markers Am Metcalf. To determine the position of markers, bone orientations and gas shadows described by P. Arhan were used in the picture. As extreme normal VTT values, S. Chaussade works are taken. Transit was regarded as a slow, if the total VTTT exceeded 85 hours, transit on the right departments - more than 25 hours, on the left - more than 35 hours, and in the rectosigmoid department - more than 40 hours.

A functional study of the rectum was carried out to eliminate the proctogenic cause of constipation - determined the tone of the sphincters, the volume of expulsion, inhibitory reflex.

When the patients questioning, we used the KESS evaluation system, allowing to significantly determine how the degree of decompensation of constipation and the effectiveness of the conservative and surgical methods Treatment.

To assess the quality of life (QG) patients before and after operational treatment We used the SF-36 questionnaire. The indicators of each scale varied between 0 and 100, where 100 were full of health, all scales were formed by two indicators: spiritual and physical well-being. The results were represented in the form of ratings in points of 8 scales compiled in such a way that a higher evaluation indicates more high level Kzh.

Conservative therapy was prescribed to all patients with chronic constipation. Applied fractional (up to 5 times a day) The power mode in compliance with the drinking mode (up to 1.5 liters per day) with the inclusion of biocofe, juices. Fruits, vegetables, oils, food fibers, bran, included in the food diet. Drug therapy included antispasmodics (Dicetell, Duspatalyn, but SHAP), Prokinetics (Motilium, Coordinity). The laxatives used limitedly and mainly osmotic action (Duhalak). Aubiotics (chilac, bifiform, lines, bifidumbacterin) were prescribed.

Most patients after spent therapy noted the improvement of both the rhythm of the intestinal work and general statusbut in a number of patients a persistent effect was not achieved even after 3-4 courses conservative treatment. After treatment, all SMT symptoms have resumed in these patients. Such patients were recommended surgical treatment.

Patients selection for surgical treatment were made with an assessment of the initial functional and anatomical indicators (Table 1). Indications for surgical treatment of patients were the signs of expressed elongation of all colon departments, an increase in the time of the thick-body transit (Fig. 1), resistant constipation, no effect from conservative therapy.

Table 1 Signs of the extended type of colon structure according to irrigography in 15 operated patients before surgery

Dolichosigma				Doubling hepbea
Loops of the sigmoid gut				Doubling the spleen bend
Transverszoptosis				Mobile blind intestine

Fig. 1a. Fig. 1b.

Fig. 1. Time of thick-current transit (VTTT) by Metcalf A. M. After 72 hours (Fig. 1a) and 144 hours (Fig. 1b) from the start of receiving markers. The arrows indicate the accumulations of x-rays of radiation markers in the ascending, transverse, downward departments (Fig. 1a) and in the rectosigmoid division of the colon (Fig. 1b).

Research in the preoperative period in 15 patients showed a significant increase in the time of the thick-current transit compared to normal indicators, so the average VTT value was 106.9 ± 4.5 hours in patients with ZMT, with normal rates of 67 hours by S.Chaussade (P<0,001).

results

After standard intestinal training, 15 patients were operating on the technique developed by us. Performed the median laparotomy, mobilized the blind and rising intestine and the hepatic bend by dissection of parietal peritoneum and embryonic ligaments. The mobilization of the transverse colon was carried out by separating it from gastrointestinal bundles with the preservation of a large gland. Then mobilized the spleen bending, downward and sigmoid, often represented by a large loop located in the right iliac region. As a result, the colon is completely mobilized to the rectum and when disgraced at the same place no longer been placed. Next, the mobilized hazard was laid around the perimeter of the abdominal cavity so that the transverse intestine occupied the place of descending and sigmoid. The blind and the rising intestine was fixed behind the lateral ride from the bottom up 3-4 seams to the ileum muscle. The lateral edge of the dissected parietal peritoneum was laid in separate seams to the intestine. The newly formed transverse intestine was recorded by the design of individual seams for 14 - 15 cm to the root mesentery. The excess part of the transverse intestine, the downstream and the sigmoid gut, was resteed. Anatomose was superimposed by 2-row seams. The colon was fixed in the left side channel with separate seams to the parietal peritoneum (Fig. 2).

Fig.2. Patient G., 22 years old. a) irrigograph of the colon to operational treatment; b) 6 months after surgical correction (horizontal position of the patient); c) 6 months after surgical correction (vertical position of the patient)

For 4 days of the postoperative period, patients began to eat, walk. An independent chair was 5-6 days after surgery. On the 10th day of the postoperative period in patients, the patients had a complete restoration of the engine-evacuator activity of the gastrointestinal tract. There was no fatal outcomes, one patient had a postoperative complication - early adhesive fine obstruction, which was eliminated with relaparotomy. The average postoperative bed-day amounted to 12.5 ± 1.6 days.

Remote treatment results are traced in all 15 operated patients within 7 to 12 years. All patients noted an improvement after surgery: a regular independent chair appeared, all patients abandoned the enema, 12 patients ceased to use the laxatives, 3 periodically use plant laxatives in small doses. The results of conservative and surgical treatment, calculated on the KESS system are reflected in Fig. 3.

Fig. 3. Dynamics of SMT symptoms in 15 patients at the treatment stages (KESS)

1. Duration of constipation. 2. Using laxatives. 3. The quality of the chair (at the current treatment). 4. unsuccessful evacuation attempts. 5. The feeling of incomplete emptying after the chair. 6. Stomach pain. 7. Scotching. 8. Clear / finger help. 9. The time required for the stool (minutes / attempts). 10. Evacuation difficulties (pain during defecation). 11. Stool's consistency (without laxatives)

As can be seen in fig. 3, after conservative treatment, there was an inaccurate improvement in the state of patients and the decrease in the SMT symptoms (p\u003e 0.05). The condition of patients has significantly improved after the surgical treatment of patients with ZMT (P<0,01).

Indicators of life quality also improved in patients after surgical treatment (Fig. 4).

Fig. 4. Changing the quality of life in 15 patients with ZMT after surgical treatment. 1 -physical functioning; 2 - role-playing activities; 3 - bodily pain; 4 - general health; 5 - vitality; 6 - social functioning; 7 - emotional state; 8 - Mental Health

Study of the quality of life in the operated patients, estimated on the SF-36 scale, revealed that there is a reliable improvement in all the parameters under study (P<0,01).

Discussion

In 1908, W. A. \u200b\u200bLane has developed a technique for a chronic constipation operation, which is now a recognized standard in many countries and lies in total or subtotal colostomy, the imposition of ceke-detective or ilectal anastomosis. However, the operation is associated with the development of a number of complications, leading of which are diarrhea and incontection, ulcerative proctitis, water-electrolyte disorders, etc. Such states, according to different authors, are developing in 15-30% of the operated patients, and the number of postoperative complications reaches 32.4%, which causes surgeons to resort to repeated operations, an example of which the simplify the subfickered tank is used. Subtotal resection of the colon with the cecorectal anastomosis also in some cases leads both diarrhea and recurrence of chronic constipation.

There are works showing that when ZMT is most suffering from the left half of the colon and, in particular, its nervous apparatus. Based on these literature and your own experience, we see the feasibility of removing the left half and leaving the right half of the colon with the operation about the ZMT. It should also be noted that there is no ideal operation on the constipation of slow transit constipation, and excessive "radicalism" in the attempts of surgical correction of this disease can lead to the development of even more severe state. Here, in our opinion, the Golden Middle is needed. The task of surgeons should be reduced to a thorough selection of patients for surgical treatment. Operations should be subject to patients with ZMT, in which there are pronounced signs of lengthening the colon, gentler, disorders of the colon fixation. Our operation is aimed at eliminating the elongated type of colon and allows you to create optimal conditions for the functioning of the remaining severity of the colon and in most cases leads to the normalization of the stool.

It should be noted that the operation is not an alternative to conservative treatment. The surgical method for these patients is only a stage of treatment that eliminates the anatomical prerequisites of the ZMT. In the future, these patients should be observed and treated with gastroenterologists, compliance with the recommendations associated with the regime, nutrition character and lifestyle.

Reviewers:

• Uvarov Ivan Borisovich, Doctor of Medical Sciences, head. Branch of Coloproctology No. 5 GBUZ Clinical Oncology Dispensary No. 1, Health Department of the Krasnodar Territory, Krasnodar.
• Vinichenko Aleksey Viktorovich, Doctor of Medical Sciences, Surgeon-Oncologist Branch of Coloproctology No. 5 GBUZ Clinical Oncology Dispensary No. 1, Health Department of the Krasnodar Territory, Krasnodar.

Bibliographic reference

Gumenyuk S.E., Potemoin S.N., Potemoin S.N. Left-sided hemicultomy with the fixation of colon in patients with refractory constipation of slow transit // Modern problems of science and education. - 2012. - № 4;
URL: http://science-education.ru/ru/article/view?id\u003d6804 (date of handling: 12.12.2019). We bring to your attention the magazines publishing in the publishing house "Academy of Natural Science"