COLOPEXIA

From Big Medical Encyclopedia

COLOPEXIA (colopexia; lat. colon a colon + grech, pexis an attachment) — operational fixing of various departments of a large intestine at some anomalies of development of intestines (the general mesentery, incomplete turns, etc.). Indication to To. the wedge, manifestations as hron, locks, torsions blind, sigmoid colonic and other guts are such.

Patients to To. prepare as well as to other intestines operations (see. Intestines, operations ). Operation is carried out under the general anesthesia using muscular relaxants.

Fig. 1. Diagrammatic representation of some stages of an astsendotsekopeksiya: and — the inner edge (1) of a section of a parietal peritoneum is hemmed to the outside film (3) of the blind and ascending guts; — the outer edge (2) sections of a peritoneum hem (4) guts to a free tape.
Fig. 2. The diagrammatic representation of fixing of intestines at operations for its incomplete turn: and — at a possibility of bringing down of a caecum to the right ileal area the caecum (1) is fixed to a parietal peritoneum (2) and sborivatsya by separate seams (3) the mesentery of a small bowel (is shortened); — at impossibility of bringing down of a caecum to the right ileal area its dome (1) is fixed to a sigmoid colon (2), the duodenum (3) is fixed to a parietal peritoneum and separate seams (4) sborivatsya a mesentery of thin and thick guts.

Depending on a type of anomaly of intestines and its mesentery apply various types K. At the mobile caecum having the general mesentery with the ascending gut apply an astsendotsekopeksiya. The most rational method of this operation is the podshivaniye of the blind and ascending guts to a side abdominal wall after a section of a parietal peritoneum (fig. 1). At incomplete turns of intestines move a gut to usual situation, use sborivayushchy mesorrhaphies and a typhlopexy, sometimes in combination with fixing of a mobile duodenum to a parietal peritoneum (fig. 2). At the isolated lengthening of a mesentery of a sigmoid colon and bent it to torsions fixing it is carried out by imposing of sborivayushchy seams — operation of a mesosigmoidopexy on Gagen-Thorn, edges it is applied seldom because of small efficiency. It keeps value as a temporary measure at the emergency interventions concerning torsion of a sigmoid colon without gangrene of its wall. As major importance in genesis of torsion of a sigmoid colon has hl. obr. not length of a mesentery, and lengthening of the gut (dolichosigma), further in a planned order is shown to such patients a resection of a sigmoid colon.

Operations K. usually carry out through wide midsection of a front abdominal wall, especially in cases of the general mesentery of all large intestine and at the expressed forms of incomplete turn of intestines. Only at wide median laparotomies (see) it is possible to have an opportunity to make audit and careful fixing of intestines in both side channels and in a zone of a root of a mesentery. Astsendopekopeksiya carry out also through cuts of the right half of an abdominal wall (pararectal, slanting, etc.). The reliable colonopexy cannot be provided by a simple podshivaniye it to a parietal peritoneum. Therefore in a zone of the main bends of a gut it is necessary to fix it the seams which are carried out through tapes of a colon (teniya) and taking a fascia and a muscle of an abdominal wall. Direct contact of a wall of a gut with a naked fascia provides more reliable fixing of a gut.

After operation emergence of dynamic impassability, development of peritonitis and wound complications is possible. Long-term results of operation satisfactory.

See also Intestines, operations .


Bibliography: Gevorkyan I. X. and Mirza-Avakyan G. L. Mobile caecum, M., 1969, bibliogr.; Lyonyushkin A. I. Proctology of children's age, M., 1976, bibliogr.; T about sh about in-sky V. and In and x and t and l of the Lake. Acute processes in an abdominal cavity at congenital anomalies at children, the lane from Czeches., M., 1957.


V. D. Fedorov.

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