Differentiated approach to choice of method for the small bowel transplant shifting into the small pelvis cavity
Abstract
Objective. To improve the results of reconstructive-restoration operations after colectomy with a super-low anterior rectal resection due to optimization of the method, which provide a free shifting of a small bowel transplant into a small pelvis cavity.
Маterials and methods. There were elaborated a new methods of shifting of the small bowel transplant while conduction of reconstructive-restoration operations after colectomy with a super-low anterior rectal resection, mucosectomy of surgical anal channel, which must be accompanied with mobilization of a small bowel mesentery root, transection of vascular arcade of upper mesenterial artery (UMA) and her direct vessels. These procedures were applied in 32 patients in combination with the known methods in complex аnatomical peculiarities of the small bowel mesentery, its ileal part localization, and the UMA architectonics.
Results. The complications in early postoperative period, caused by the small bowel transplant shifting into the small pelvis cavity in the patients operated were absent. In late postoperative period in 1 (3.1%) patient an ischemic reservoiritis have occurred, which was not caused by the shifting procedure peculiarities.
Conclusion. The elaborated new methods of the small bowel transplant shifting after resection of ileal terminal portion promotes enhancement of its length and improvement of mobility. Differentiated approach for application of a new elaborated methods for shifting of a small bowel transplant in complex of known methods have guaranteed the transplant transposition into the small pelvis cavity in complex anatomic environment, caused by reduction of length of the ileum terminal portion without tension to a small bowel mesentery, as well as the essential risk for its ischemia and necrosis occurrence.
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