Pathogenesis of failure in the anastomosis integrity and a prophylactic program in surgical treatment of the colon diseases.

Keywords: intraintestinal pressure; a large-bowel anastomosis; reconstructive operation; stoma.

Abstract

Objective. To establish the impact of intraintestinal pressure on the intestinal anastomosis integrity and to propose a prophylactic measures of its insufficiency in surgical treatment of the colon diseases.

Materials and methods. Intraintestinal pressure was measured in 30 patients, using Waldman method during 72 h postoperatively - before and after the transanal lavage (every 4 h). Primary operation - resection of sigmoid colon with formation of a one-barrel colostomy. The restoration intervention was performed in 3 mo with formation of a large-bowel anastomosis in accordance to the method elaborated (n=17), hand-made two-layered large-bowel anastomosis (n=3), and the apparatus large-bowel anastomosis (n=10).

Results. There was noted the intraintestinal pressure raising during first 24 - 36 h up to (5.3 ± 0.1) mm Hg with its further lowering during 12 - 20 h down to (2.1 ± 0.3) mm Hg. In 20 min after the transanal drain lavage the intraintestinal pressure have lowered by (3.0 ± 1.3) mm Hg, and in 3 - 5 h - gradually raised. While application of a hand-made two-layered large-bowel anastomosis its insufficiency was observed (n=1) and anastomositis (n=1); and in the apparatus large-bowel anastomosis formation - anastomositis (n=1). While disorder of the intestinal suture healing the intraintestinal pressure have raised in 16 - 60 h up to (11.4 ± 0.2) mm Hg with peak at (16.3 - 17.1) mm Hg, which persisted 12 -18 h. Prophylactic measures were directed towards lowering of intraintestinal pressure and elimination of unfavorable local and general factors.

Conclusion. While persisting noncorrected, the intraintestinal pressure in the 16.3 - 17.1 mm Hg borders during 12 - 18 h leads to complicated course of postoperative period. Direct and nondirect methods of decompression of the interintestinal anastomoses constitutes a basic prophylactic principle for it.

Author Biographies

V. I. Rusyn, Uzhgorod National University

Rusyn V. I., MD, Dsci(Med), professor
Professor of Surgical Diseases Chair of Medical Faculty
Uzhgorod National University,.
88018, Ukraine, Transcarpathian region, Uzhgorod, str. Kapushanska, 22,
Transcarpathian Regional Clinical Hospital named after Andrii Novak.
+38 (0312) 61-35-70
kaf-surgery@uzhnu.edu.ua.
ORCID: https://orcid.org/0000-0001-5688-9951

S. M. Chobey, Uzhgorod National University

Chobey S. M., MD, Dsci(Med), professor
Professor of Surgical Diseases Chair of Medical Faculty
Uzhgorod National University,
88018, Ukraine, Transcarpathian region, Uzhgorod, str. Kapushanska, 22,
Transcarpathian Regional Clinical Hospital named after Andrii Novak.
+38 (0312) 61-35-70
kaf-surgery@uzhnu.edu.ua, dr.chobey@gmail.com
ORCID: https://orcid.org/0000-0002-1231-8169

O. O. Dutko, Uzhgorod National University

Dutko O. O., MD, Post-graduate student
Surgical Diseases Chair of Medical Faculty
Uzhgorod National University.
88018, Ukraine, Transcarpathian region, Uzhgorod, str. Kapushanska, 22,
Transcarpathian Regional Clinical Hospital named after Andrii Novak.
+38 (0312) 61-35-70
kaf-surgery@uzhnu.edu.ua, dutko.sasha93@gmail.com
ORCID: https://orcid.org/0000-0002-4063-8194

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Published
2020-06-26
How to Cite
Rusyn, V. I., Chobey, S. M., & Dutko, O. O. (2020). Pathogenesis of failure in the anastomosis integrity and a prophylactic program in surgical treatment of the colon diseases. Klinicheskaia Khirurgiia, 87(3-4), 40-43. https://doi.org/10.26779/2522-1396.2020.3-4.40
Section
General Problems of Surgery