Operation description

Bypass surgery is performed under general anesthesia, laparoscopic or laparotomy. After opening the abdominal cavity, the surgeon revises the internal organs and finds the location of the pathology. Further, a loop is formed with an indentation of about 20-25 cm from the edge of the tumor. The surgeon performs side-to-side anastamosis and stitches in layers. In conclusion, the ends of the intestine are sutured from the side of the affected area and the surgical wound is sutured. The duration of the operation is about 2-3 hours.

Postoperative period

After the completion of the operation, you must remain under the supervision of a doctor for about 10-14 days. During this period, anti-inflammatory therapy is carried out, diagnostics of the state of the intestine after surgery. In the first period, it is recommended to follow a diet, but in the future this is not required.

The Scientific and Practical Center for Surgery has modern diagnostic and surgical equipment that allows to carry out operations on the intestines of any complexity. The hospital of the surgery center is equipped with comfortable wards and friendly staff who make the stay of patients in the center more pleasant for such an unpleasant occasion. The center's surgeons have vast practical experience in performing the surgical treatment of intestinal diseases, and they also possess modern technologies for performing surgical intervention.

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The term "resection" (cutting off) means the 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 imposition of an anastomosis. The term anastomosis in this case means the surgical connection of the continuity of the intestine after removal of its part. In fact, this can be explained as stitching one part of the intestine to another.

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

Classification of resections

Operations to remove (resect) a part of the intestine have many varieties and classifications, the main of which are the following classifications.

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

• Removal of part of the large intestine;
• Removal of part of the small intestine.

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

• Among the sections of the small intestine there may be resections of the ileum, jejunum, or duodenal ulcer;
• Among the sections of the large intestine, resections of the cecum, colon, rectum can be distinguished.

By the type of anastomosis, which is applied after resection, there are:

Resection and formation of anastomosis

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

Indications for surgery

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

• Strangulated obstruction ("volvulus");
• Intussusception (introduction of one part of the intestine into another);
• Nodulation between intestinal loops;
• Cancer of the colon or small intestine (rectum or ileum);
• Intestinal necrosis.

Preparing for surgery

Preparation for resection consists of the following points:

• Diagnostic examination of the patient, during which the localization of the affected area of \u200b\u200bthe intestine is determined and the condition of the surrounding organs is assessed;
• Laboratory tests, during which the state of the patient's body, his blood coagulation system, kidneys, etc., as well as the absence of concomitant pathologies are assessed;
• Consultations of specialists who confirm / cancel the operation;
• Examination by an anesthesiologist, who determines the patient's condition for anesthesia, the type and dose of anesthetic substance that will be used during the intervention.

Surgical intervention

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

Intestinal resection can be completely different and depends on the main process that caused the lesions of the intestine and the intestine itself (transversely to the colon, ileum, etc.), in connection with which a variant of the anastomosis is also chosen.

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

Complications of resection

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

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

Diet for resection

The nutrition provided not after the operation will differ when resecting different parts of the intestine

The diet after resection is gentle and involves the intake of light, quickly absorbed foods, with minimal irritation to the intestinal mucosa.

Diet food 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 with these types of diets.

So, if a part of the small intestine was removed, then the ability of the intestine to digest chyme (a food lump moving along the gastrointestinal tract), as well as absorb the necessary nutrients from this food lump, will be significantly reduced. In addition, when the thin section is resected, the absorption of proteins, minerals, fats and vitamins will be disturbed. 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 the protein deficiency after resection, it is important that the protein consumed is of animal origin);
• It is recommended to use vegetable and butter as fats in this diet.

• Foods that contain a lot of fiber (for example, cabbage, radishes);
• Carbonated drinks, coffee;
• Beet juice;
• Foods that stimulate intestinal motility (prunes).

The diet when removing the large intestine is practically the same as after resection of the thin section. The absorption of nutrients itself during the resection of the thick section is not disturbed, however, the absorption of water, minerals, and the production of certain vitamins are disturbed.

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

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

Gentle massage of the abdominal wall will help start the intestines after surgery

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

Prognosis after surgery

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

• Type of underlying disease leading to resection;
• The type of surgery and the course of the operation itself;
• The patient's condition in the postoperative period;
• Absence / presence of complications;
• Correct adherence to the regime and type of food.

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

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

Compliance with the prescribed diet, as well as the correct diet, significantly improve further prognostic indicators of life. This is due to the fact that with proper adherence to dietary recommendations, the traumatic effect of food on the operated intestine is reduced, and the body's missing substances are corrected.

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

This article will tell you what lifestyle cancer patients should lead so that intestinal cancer after surgery does not recur and does not recur with renewed vigor. And also advice on proper nutrition will 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

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

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

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

Most patients after surgery complain of deterioration in the process of eating. Most often they complain of 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 its poor patency, they can cause pain sensations and be dangerous to health.

What should rehabilitation after colon cancer surgery include?

In the intensive care unit, a person returns from anesthesia to a normal state. After the end of the operation, the patient is prescribed analgesics to relieve discomfort and pain in the abdominal cavity. The doctor may prescribe injection anesthesia (epidural or spinal). To do this, with the help of droppers, pain-relieving drugs are injected into their body. A special drainage is placed in the area of \u200b\u200bthe operating wound, which is needed to drain the accumulated excess fluid, and after a couple of days it is removed.

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

For rehabilitation to be successful, after the intervention, patients are prescribed a special diet, 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, your diet should be prepared with your doctor or nutritionist.

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

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

Nutrition after colon cancer surgery

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

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

1. Food should be eaten in small portions five times a day.
2. Drink plenty of fluids between meals.
3. When eating, you should not rush, you need to chew food well.
4. Eat food of medium temperature (not very cold or very hot).
5. Achieve regularity and regularity in your meals.
6. Patients whose weight deviates from the norm, doctors advise to eat food to the fullest. Patients with a weight below normal, it is recommended to eat a little more, and those suffering from excess weight ─ a little less.
7. It is better to steam, boil or simmer food.
8. You should avoid foods that cause bloating (flatulence); and also from spicy or fried foods, if you have difficulty with them.
9. Avoid eating foods that are intolerant.

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

It is especially important to restore the consequences of a surgical operation, which lead to improper bowel function (inflammation processes in the area of \u200b\u200bthe artificial anus, a decrease in bowel diameter, inflammation of the colon, fecal incontinence, etc.).

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

Patients who are completely cured are not limited in anything, but they are advised not to engage in heavy physical work for six months after discharge from the hospital.

Relapse prevention

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

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

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

1. Constantly be on the move, that is, lead an active lifestyle.
2. Keep alcohol consumption to a minimum.
3. Quit smoking (if this bad habit exists).
4. 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 a special gymnastic exercise, which will strengthen the intestinal muscles.

It is important to know:

Anastomosis is also divided into several types:

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

2 Indications and preparatory measures

The bowel excision procedure is prescribed if one of the following pathologies is present:

1. Cancer of one of the sections of the intestine.
2. The introduction of one part of the intestine into another (intussusception).
3. The appearance of nodes between parts of the intestine.
4. Department of necrosis.
5. Obstruction or volvulus.

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

The complex of preparatory measures includes a thorough examination of the organ and an accurate determination of the localization of the pathogenic area. Additionally, they take blood and urine for analysis, and also check the compatibility of the body with one of the anesthetic drugs, since the resection is performed under general anesthesia. If there is an allergic reaction, another anesthetic drug is selected. If this is not done, then the problems can begin even before the beginning of the surgical intervention itself or during its implementation. An incorrectly selected anesthesia can be fatal.

≡ Digestion\u003e Gastrointestinal diseases\u003e Intestinal anastomosis: features, preparation, appointment

Bowel surgeries are considered one of the most difficult and require special professionalism of the surgeon. It is important not only to restore the damaged integrity of the organ, but also to do it so that the intestine continues to function normally, does not lose its contractile function.

Anastomosis of the intestine is a complex operation that is performed only in case of emergency and in 4-20% of cases leads to various complications.

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

Fistulas are the cause of colon cancer.

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

There are two types of bowel surgery requiring subsequent anastomosis - enteroctomy and resection.

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

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

Bowel anastomosis is a major surgical procedure. It is carried out under general anesthesia, and after it the patient needs long-term rehabilitation, and complications are not excluded. Bowel resection with anastomosis can be prescribed in the following cases:

1. Colon cancer. Colon cancer takes the leading place among cancers found in developed countries. The cause of its occurrence can be fistulas, polyps, ulcerative colitis, heredity. Resection of the affected area followed by anastomosis is prescribed at the initial stages of the disease, but it can also be performed in the presence of metastases, since it is dangerous to leave a tumor in the intestine due to possible bleeding and intestinal obstruction due to tumor growth.
2. Bowel obstruction. Obstruction may be due to a foreign body, swelling, or severe constipation. In the latter case, you can flush the intestines, but the rest will most likely have to be operated on. If the intestinal tissue has already begun to die off due to the transmitted vessels, part of the intestine is removed and anastomosis is performed.
3. Intestinal infarction. With this disease, the outflow 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.
4. Crohn's disease. This is a whole complex of different conditions and symptoms that lead to intestinal disruption. This disease cannot be treated surgically, but patients have to undergo surgery, since life-threatening complications can occur during the course of the disease.

Read: Feces with Mucus - Cause for Concern

The video will tell about colon cancer:

Preparation and procedure

Espumisan eliminates gases.

Such a serious procedure as an 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 Fortrans, which quickly and efficiently cleanses the entire intestine.

Before the operation, you must completely exclude fried foods, sweets, hot sauces, some cereals, beans, seeds and nuts.

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

The day before the procedure, the patient only has breakfast and starts taking Fortrans from lunchtime. It comes 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 in a couple of hours.

Fortrans is considered the most effective preparation for various procedures on the intestines. It allows it to be completely cleaned in a short time. The procedure itself is performed under general anesthesia. Anastomosis has 3 types:

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

Read: Classification, Treatment, and Symptoms of Hernia of the Esophagus. Therapies

Postoperative period and complications

Eating cereals will reduce the strain on the intestines.

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

In the first days after the operation, the patient is monitored in the hospital. Minor bleeding is possible. but they are not always dangerous. The seams are regularly inspected and processed.

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

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

Allowed liquid cereals, dairy products, after a while fiber (fruits and vegetables), boiled meat, mashed soups.

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

1. Infection. Doctors in the operating room comply with all safety rules. All surfaces are disinfected, however, even in this case, it is not always possible to avoid wound infection. With infection, there is redness and suppuration of the seam, fever, weakness.
2. Obstruction. After surgery, the intestines may stick together due to scarring. In some cases, the bowel becomes kinked, which also leads to obstruction. This complication may not appear immediately, but some time after the operation. It requires repeated surgery.
3. 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: Cholelithiasis. Symptoms of the disease and other important issues

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

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

Overview of Bowel Cancer Surgery

Small bowel cancer and cancer of the anus (cancer of the anus) are rare. If we are talking about bowel cancer, then, as a rule, they mean a malignant tumor of the colon (carcinoma (cancer) of the colon) and rectum (carcinoma of the rectum). These cancers are also called colorectal cancer. Although colorectal cancer can develop in all parts of the colon and rectum, it most often occurs in the lower region within 30-40 centimeters. Colon cancer is often predicted by fungal growths called intestinal polyps, which are often benign tumors. The main treatment for bowel cancer is surgery, that is, the removal of the affected area of \u200b\u200bthe large intestine along with its lymphatic and blood vessels. In the case of advanced cancer, when there is no prospect of recovery, surgery is generally refused, unless it is necessary to prevent complications such as intestinal obstruction. Bowel cancer surgery, with the exception of intestinal obstruction, is not an emergency surgery, there is enough time left for diagnosis and treatment planning. In this way, complications are avoided and the chances of recovery are improved. The following text contains information about the methods of surgical intervention for bowel cancer and the consequences after surgery that the patient may face.

Bowel Cancer Surgical Treatment: Indications and Purposes

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

The main goal of colon cancer surgery is to completely remove the tumor and thus cure the cancer. The task of surgical intervention, along with removal of the intestinal tumor, is also the removal of metastases (secondary tumors, for example, in the lungs and liver), examination of the abdominal cavity and its organs, as well as removal of the lymph nodes for diagnostic purposes to check for possible spread through the intestine. This, in turn, is essential for staging the cancer (staging) so that treatment can be planned and predicted later. In addition, bowel cancer surgery may be required if the adhesion creates a risk of intestinal obstruction (difficult intestinal transit).

Colon cancer curative and palliative surgery

If during surgery all tumor tissue is removed, including possible metastases in lymph nodes or other organs, then in this case we are talking about colon cancer treatment... With such a surgical intervention, along with the affected area of \u200b\u200bthe intestine, nearby healthy tissue is removed in order to reduce the risk of tumor reappearance (relapse). Since individual cancer cells may by this time already multiply and penetrate into nearby lymph nodes, they are also removed.

The situation looks different when it comes to palliative bowel cancer surgery at its progressive stage (for example, with metastases that cannot be removed). Here, specialists are trying to prevent the complications and pain of the patient associated with the tumor, while there is no chance of recovery. If the tumor grows, for example, inside the intestine, then it can obstruct the passage of intestinal contents, which in turn can lead to the development of life-threatening intestinal obstruction. In this case, the surgeon will try to shrink the tumor to such an extent that the narrow passage is eliminated. Palliative surgery also includes avoiding constriction by bypassing and placing an artificial anus (stoma).

Colon cancer surgery: preoperative stage

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

The most common examinations include:

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

Immediately before and during bowel cancer surgery, the following measures are taken:

• the intestines are thoroughly cleansed (with a special solution, which has a laxative effect and is usually taken orally);
• an antibiotic against infections is taken (bacteria in the intestinal flora can cause dangerous infections in the abdomen);
• the area of \u200b\u200bskin is shaved out where the incision should be made (for better disinfection);
• preventive measures are taken against thrombosis.

Colon Cancer Surgery: Methods

In bowel surgery, there are two main treatments for bowel cancer. When radical bowel cancer surgery not only the tumor is removed from the body, but also the adjacent healthy tissues. Unlike radical, with local bowel cancer surgery only the tumor itself is removed at a safe distance (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 the laparotomy method (opening the abdominal cavity) or minimally invasive.

Open and minimally invasive bowel cancer surgery

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

In the later stages of bowel cancer, due to the vastness of the operation, laparotomy is performed almost without exception. In other cases, the currently entrenched laparoscopic method of tumor removal in patients with 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 a traditional operation with opening the abdominal cavity. The main advantage of this method is that the operation is more gentle and the patient recovers faster.

Radical surgery for bowel cancer

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

Contactless operation (No-Touch)

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

Radical En-bloc operation

If the tumor is so large that adjacent 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. The purpose of this operation is also to prevent damage to the tumor.

Local removal of the tumor

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

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

If the 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 bowel cancer is excluded.

Bowel Cancer Surgery: Artificial Anus

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

When colon cancer long-term stoma can only be used in rare cases. However, in difficult cases, a temporary stoma may be necessary in order to relieve the bowel or intestinal suture after colon cancer surgery. If earlier during the operation small bowel cancer (for example, with tumors near the anus), along with the affected area of \u200b\u200bthe rectum, the entire sphincter was also removed, but now, in most cases, rectal cancer surgery is performed so as to preserve the sphincter apparatus. Experienced rectal surgeons need a safe 1 cm distance from the anus to prevent permanent ostomy.

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 the colostomy, the contents of the intestines are removed, thus creating conditions for faster healing of the intestines and sutures. This stoma is also called unloading stoma... A temporary artificial anus is placed, as a rule, in the form of double-barreled stoma... This means that the intestine (small or large intestine) is removed through the wall of the abdominal cavity to the outside, from above it is cut and turned out so that two holes in the intestine are visible. After a small operation to close the temporary stoma and the opening in the abdominal wall, natural digestion is restored in about 2-3 months.

Permanent (permanent) artificial anus

If the tumor is so close to the sphincter that it is not possible to preserve the anus, both the rectum and the sphincter are removed completely. In this type of bowel cancer surgery, a permanent (permanent) stoma is applied. With a permanent stoma, the healthy lower colon is brought out through an opening in the wall of the abdominal cavity and sutured to the skin there. Most patients have no problem with a permanent stoma after a period of habituation and appropriate instruction. Even regular bowel movements are not a problem for them.

For water sports (eg swimming pool) and sauna access, special patches or so-called caps are available for ostomy patients. In addition, for patients with an unnatural anus, there are no restrictions on their professional activity or choice of sport.

Bowel Cancer Surgery: Risks and Consequences

Like any other surgery, bowel cancer surgery can also come with risks and dangers. The first signals of serious complications after bowel cancer surgery include, for example, bleeding into the abdomen, problems with wound healing, or infection.

Other risks and complications after bowel surgery are:

• Insufficient anastomosis: Anastomosis is a connection between two anatomical structures. If the anastomosis is insufficient, the two stitched ends of the intestine or the suture between the intestine and the skin with an artificial anus can weaken or rupture. As a result, the contents of the intestine can enter the abdominal cavity and cause peritonitis (inflammation of the peritoneum).
• Digestive upset: Since the process of eating in the large intestine is largely complete, operations, in terms of the process of digesting food, are less problematic than in the small intestine. However, water reabsorption occurs in the large intestine, which, depending on the removed section of the large intestine, can lead to disruption of the stool hardening process. This leads to more or less severe diarrhea. Many patients (especially ostomy patients) after bowel cancer surgery also complain of digestive upsets 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): Surgery on the rectum may irritate and damage the nerves in the area to be operated, which may subsequently lead to patient complaints.
• Fusion (adhesions): In most cases, adhesions are harmless and painless, but sometimes, due to limited bowel mobility and intestinal obstruction, they can be painful and dangerous.

Colon Cancer Surgical Treatment: Postoperative Care

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

After a successful bowel cancer surgery, 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 (abdomen);
• x-ray examination of the lungs;
• computed tomography (CT) of the lungs and abdomen.

Bowel Cancer Surgical Treatment: Nutrition After Surgery

With regard to nutritional norms after surgical treatment of bowel cancer, patients practically do not need to give up their habitual consumption of food and drinks. However, due to digestive disorders (bloating, diarrhea, constipation, odors), it is recommended to regulate the stool. This is especially true for patients with an artificial anus. To avoid monotonous eating, the following tips should be taken into account:

Diet recommendations after colon cancer surgery

1. Eat small meals 5-6 times a day. Avoid eating large portions.
2. It is recommended to drink plenty of fluids between meals.
3. Eat slowly and chew well.
4. Avoid very hot and very cold foods.
5. Eat regular meals and skip dieting.
6. Eat enough food, meaning that underweight patients are advised to eat slightly more and overweight people are advised to eat slightly less.
7. Braising and steaming are gentle cooking methods.
8. Avoid very fatty, sugary and bloating foods, as well as fried, deep-fried, and spicy foods if you are not comfortable with them.
9. Avoid foods that you have been poorly tolerated several times.

Photo: www. Chirurgie-im-Bild. de We thank Professor Dr. Thomas W. Kraus for kindly providing us with these materials.

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

Types of intestinal anastomoses

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

• End-to-end anastomosis. The most common, but also the most difficult technique. Used after removing part of the sigmoid colon.
• Bowel anastomosis "side to side". The simplest type. Both parts of the intestine are turned into stumps and sutured at the sides. This is where the intestinal bypass belongs.
• End-to-side method. It consists in turning one end into a stump and sewing on the second from the side.

Mechanical anastomosis

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

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

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

Preparation for the operation

Careful preparation should be carried out before performing an intestinal anastomosis. It includes several points, each of which is mandatory. These are the points:

1. A slag-free diet must be followed. Boiled rice, biscuits, beef and chicken are allowed for use.
2. Before the operation, you need to have a bowel movement. Previously, enemas were used for this, now laxatives such as Fortrans are taken during the day.
3. Before the operation, fatty, fried, spicy, sweet and flour foods, as well as beans, nuts and seeds are completely excluded.

Insolvency

Failure is a pathological condition in which the postoperative suture "leaks" and the contents of the intestine go beyond it through this leak. The causes of intestinal anastomosis leakage are the divergence of the postoperative sutures. The following types of insolvency are distinguished:

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

Insolvency detection

The main signs of anastomotic leak are bouts of severe abdominal pain, accompanied by vomiting. Also noteworthy is the increased leukocytosis and fever.

Diagnosis of anastomotic leakage is performed using an enema with a contrast agent followed by a radiograph. A computed tomogram is also used. According to the research results, the following scenarios are possible:

• The contrast agent flows freely into the abdominal cavity. A CT scan shows fluid in the abdominal cavity. In this case, an operation is urgently required.
• The contrast agent accumulates delimited. There is slight inflammation, and the abdominal cavity is generally unaffected.
• No contrast agent leakage is observed.

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

Elimination of insolvency

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

• Delimited Insolvency. Removal of the abscess with drainage instruments is used. They also produce the formation of a delimited fistula.
• Insolvency 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 in addition to the operation. These measures include the use of antibiotics, the normalization of the heart and respiratory processes.

The surgical approach can also be different, depending on the time of diagnosis of the failure.

In case of early symptomatic failure (the problem was discovered 7-10 days after the operation), a second laparotomy is performed in order to find the defect. Further, one of the following methods of correcting the situation can be applied:

1. Disconnecting the colon and pumping out the abscess.
2. Separation of the anastomosis with the formation of a stoma.
3. An attempt at a secondary formation of the anastomosis (with / without disconnection).

If a stiff bowel wall is found (caused by inflammation), 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 fistulous tract.

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

1. Formation of a proximal stoma (if possible).
2. Influence on the inflammatory process.
3. Installation of drainage systems.
4. Formation of a delimited fistulous course.

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

Complications

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

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

Contraindications

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

• Postoperative peritonitis.
• Leakage of the previous anastomosis.
• Disturbance of mesenteric blood flow.
• Severe swelling or distension of the bowel.
• Exhaustion of the patient.
• Chronic steroid deficiency.
• General unstable condition of the patient with the need for constant monitoring of violations.

Rehabilitation

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

After the end of the operation, the patient is prescribed drugs that relieve pain and discomfort in the abdomen. They are not specialized gut medications, but are the most common pain relievers. In addition, drainage is used to drain the 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 is in good condition, he can leave the hospital within a week after the operation. The doctor removes the stitches 10 days after the operation.

Nutrition for anastomosis

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

Meals for intestinal anastomosis at first should consist of boiled or baked food, which should be served crushed. Vegetable soups are acceptable. The diet should include foods that do not interfere with normal bowel movement and smoothly stimulate it.

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

It is recommended to eat food in a quiet atmosphere, in small portions, 5-6 times a day. In addition, it is recommended to consume more fluids (up to 2-3 liters per day). The first months after the operation, the patient may suffer from nausea, vomiting, abdominal pain, constipation, diarrhea, flatulence, weakness, high fever. This is not to be feared, such processes are normal for the recovery period and pass over time. Nevertheless, with a certain frequency (once every 6 months or more often), it is necessary to undergo an irrigoscopy and colonoscopy. These examinations are carried out as prescribed by a doctor, in order to monitor the work of the intestines. In accordance with the data received, the doctor will adjust the rehabilitation therapy.

Conclusion

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

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

The purpose of creating such a structure:

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

Surgery can save many patients, make them feel pretty good, or help prolong life in the event of an inoperable tumor.

What types of anastomoses are used in surgery?

Anastomosis is distinguished by the connected parts:

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

The third option is an essential component of most bowel surgeries. Among this type, anastomoses are distinguished:

• small intestine,
• small intestinal,
• thick intestinal.

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

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

What should be the anastomosis?

The created anastomosis must correspond to the expected functional goals, otherwise it makes no sense to operate on the patient. The main requirements are:

• providing sufficient width of the lumen so that the constriction does not impede the passage of the contents;
• absence or minimal interference with the mechanism of peristalsis (contraction of intestinal muscles);
• complete tightness of the seams providing the connection.

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

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

The most commonly used classic seams are:

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

Description and characteristics of the essence of anastomoses

The formation of an intestinal anastomosis is usually preceded by the removal of a portion of the intestine (resection). Further, it becomes necessary to connect the leading and outgoing ends.

End-to-end type

Used for stitching two identical sections of the colon or small intestine. It is carried out with a two- or three-row seam. It is considered the most beneficial in terms of compliance with anatomical features and functions. But it's technically difficult to do.

The connection condition is the absence of a large difference in the diameters of the areas being compared. The smaller end is notched to fit perfectly. The method is used after resection of the sigmoid colon, in the treatment of intestinal obstruction.

End-to-side anastomosis

The method is used to connect parts of the small intestine or, on the one hand, the small intestine, and on the other, the large intestine. The small intestine is usually sutured to the side of the colon wall. Provides 2 stages:

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

Side to side type

It differs from the previous versions by preliminary "blind" closure with a two-row suture and the formation of stumps from connected intestinal loops. The end, above the stump, is connected with the lateral surface to the underlying section with a Lambert suture, which is 2 times the length of the lumen diameter. It is believed that technically it is the easiest to perform such an anastomosis.

It can be used both between homogeneous parts of the intestine, and for the connection of heterogeneous areas. Main indications:

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

The advantages of the method include:

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

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

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

Prevention of complications

Complications of anastomoses can be:

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

To avoid adhesions and intestinal contents entering the abdominal cavity:

• the area of \u200b\u200bthe operation is covered with napkins;
• the incision for stitching the ends is carried out after clamping the intestinal loop with special intestinal pulp and squeezing out the contents;
• the incision of the mesenteric edge ("window") is sutured;
• the patency of the created anastomosis is determined by palpation before the operation is completed;
• in the postoperative period, broad-spectrum antibiotics are prescribed;
• the rehabilitation course necessarily includes diet, exercise therapy and breathing exercises.

Modern ways to protect anastomoses

In the immediate postoperative period, the development of an anastomosis is possible. It is believed to be caused by:

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

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

In order to strengthen the sutures in abdominal surgery, autografts are used (hemming of one's own tissues):

• from the peritoneum;
• oil seal;
• fatty suspensions;
• mesenteric flap;
• serous-muscular flap of the stomach wall.

However, many surgeons limit the use of the omentum and peritoneum on the pedicle with a blood-supplied vessel only to the last stage of colon resection, since they consider the above methods to be the cause of postoperative purulent and adhesions.

Various drug-filled protectors are widely accepted to suppress local inflammation. These include glue with biocompatible antimicrobial content. It includes for a protective function:

• collagen;
• cellulose ethers;
• polyvinylpyrrolidone (biopolymer);
• Sanguirithrin.

As well as antibiotics and antiseptic:

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

Hyaluronic acid is incorporated into biocompatible self-absorbable films. A modification of its compound with 5-aminosalicylic acid (the substance belongs to the class of non-steroidal anti-inflammatory drugs) is proposed.

Postoperative atonic constipation

Coprostasis (fecal congestion) is especially common in elderly patients. Even short-term bed rest and their diet disrupt intestinal function. Constipation can be spastic or atonic. Loss of tone is relieved as the diet expands and physical activity increases.

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

With spastic constipation it is necessary:

• relieve pain with medications with an analgesic effect in the form of rectal suppositories;
• to lower the tone of the rectal sphincters with the help of antispasmodic drugs (No-shpy, Papaverina);
• to soften the feces, microclysters are made from warm vaseline oil on a furacilin solution.

• senna leaves,
• buckthorn bark,
• rhubarb root,
• Bisacodyl,
• castor oil,
• Gutalax.

Osmotic action is possessed by:

• glauber's and Karlovy Vary salt;
• magnesium sulfate;
• lactose and lactulose;
• Mannitol;
• Glycerol.

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

Early treatment of anastomositis

To relieve inflammation and swelling in the seam area, appoint:

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

If bowel obstruction forms

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

In case of chronic obstruction in the long-term postoperative period, intensive antibiotic therapy is prescribed, the removal of intoxication. The patient is examined in order to decide on the need for surgery.

Technical reasons

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

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

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

Types of bowel surgery

Most often, operations such as enterotomy and resection are performed on the intestines. The first type is chosen if a foreign body is found in the organ. Its essence lies in the surgical opening of the intestine with a scalpel or an electric knife. The suture is chosen depending on the intestinal section, the presence or absence of an inflammatory process in the area of \u200b\u200bintervention. 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 Lambert's suture, connecting the serous (covers the small intestine from the outside) and the muscular membrane.

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

Anastomosis methods

There are several ways to create an anastomosis. Let's consider them in detail.

End to end

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

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

It is used when resection of a large area is necessary or when there is a danger of strong tension at the site of the anastomosis. Both ends are closed with a double-row suture, and then the stumps are hemmed 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 sutures the edges of the wound with a continuous suture.

End to the side

This type of anastomosis consists in the fact that the stump of the abducting intestine is closed using the "side to side" technique, the contents of the organ are squeezed out and squeezed with intestinal pulp. Then the open end is applied to the intestine from the side, sewing with a continuous Lambert suture.

The next stage - the surgeon makes a longitudinal incision and opens the abducting 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 (means its complete removal, including the nearest lymph nodes, adipose tissue).

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

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

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

In 4-20% of cases (depending on the condition of the tissues, the professionalism of the doctor), complications arise: impaired patency, insufficiency of sutures, peritonitis. To minimize the risk, the surgeon should perform a thorough debridement of the suture and adjacent lumenal areas.

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

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

In contact with

Two correctly applied knots hold the sewn fabrics firmly, while using synthetic monofilament yarn requires up to 5-6 knots.

A single-row knotted suture with such a wire allowed us to achieve very good results in operations not only on the stomach, small and large intestines, but also on the esophagus, from which the idea of \u200b\u200bthis suture was borrowed (see p. 194). The strength of the sutures on the intestine is maintained even in cases where a sterile dehiscence or suppuration of the wound of the abdominal wall occurs and a row of wire sutures on the intestine becomes visible. A single-row knotted suture with a monofilament suture material (whether wire or other material) is one of the most significant advances in gastrointestinal surgery of the last decade.

Whichever seam is used, success does not depend on how many rows it is applied, but on compliance with two basic rules:

1) only fabrics with perfect blood supply can be stitched, and

2) the seam should be applied without the slightest tension.

You should always remember that the seam does not heal: chirurgus suit, natura sanat(“The surgeon only sews, but nature heals”). The purpose of the seam is. for the healing period to bring tissue closer together without the slightest tension with an impeccable blood supply.