ENTEROENTEROANASTOMOZ (Greek enteron a gut + anastomosis the mouth, an exit) — an artificial anastomosis between two sites of a small bowel. Operation of imposing E. it was for the first time executed in 1854 by J. G. F. Maisonneuve for the purpose of creation of a bypass anastomosis for elimination of outside intestinal fistula. AA. it is used for recovery of passability of a small bowel after its resection, and also in the absence of an opportunity or need of removal of the changed site of a small bowel interfering normal advance of intestinal contents (see the Stomach, operations; Intestines, operations). Besides, imposing E. is a component of reconstructive and plastic surgeries — with its help switch off the segment of a small bowel used for recovery of outflow of bile (see Holetsistoenterostomiya) or passability went. - kish. a path (see P ankreatoduodenektomiya, the Gullet artificial). As palliative operation creation E. apply hl. obr. at inoperable stenoses of a gut. According to strict indications E. impose for the purpose of functional switching off of extensive departments of a small bowel at treatment of obesity (see).
Operation of creation E. make under the general anesthesia, special preparation, except standard for hollow abdominal organs operations, it is not required (see. Preoperative period). The anastomosis is imposed on healthy fabrics with good blood supply, it is tight also without tension of seams. Therefore after opening of an abdominal cavity (see the Laparotomy) operation is begun with definition of exact borders of the changed fabrics of a gut. At an inoperable tumor or inflammatory infiltrate of a small bowel for imposing of an anastomosis use sites at distance not less than 10 cm above and lower than border of visible changes (fig. 1, a). Continuity of an intestinal tube after a resection recover by sewing together of the remained departments a side sideways, the end in the end and the end sideways (fig. 1, in, d). Enteroenteroanastomoz apply also to creation of a bypass anastomosis at reconstructive and recovery operations. In this case distinguish a technique E. according to Brown when the site of a jejunum, necessary for plastics, is switched off from a passage of intestinal contents by imposing E. a side sideways without crossing of a jejunum; and the technique of an U-shaped anastomosis across Ru — a jejunum is completely crossed with a section
of Fig. 1. The diagrammatic representation of a bypass enteroenteroanastomoz a side sideways at a neudalimy tumor of a small bowel (a) and different types of the enteroenteroanastomoz imposed after crossing of a small bowel (— a side sideways; in — the end in the end; — the end sideways); the arrow specified the direction of the movement of intestinal contents through the created anastomosis.
Fig. 2. The diagrammatic representation of stages of imposing of an enteroenteroanastomoz the end in the end: and — imposing of gray and serous noose sutures on a back wall of an anastomosis between two handles taken on clips; — the imposing of an internal number of seams on a back wall of an anastomosis made by noose catgut sutures through all layers of a wall of a gut; on clips the seams of the first and second row imposed as handles on corners of an anastomosis are taken.
mesenteries to a root and bandaging of vascular arcades then take in the taking-away end, and the bringing loop of a jejunum anastomose the end sideways below the place of crossing, having switched off thus the site of a jejunum of necessary length. Formation of any type E. carry out preferential two-row seam: an internal row is imposed through all layers of an intestinal wall continuous or noose sutures a catgut, an outside gray and serous row — noose sutures silk or synthetic to twisting (see. Intestinal seam).
At an anastomosis the anastomosed ends of a gut compare the end in the end so that the site deprived of a serous cover corresponding to the place of an attachment of a mesentery was at the level of the middle of a back row of seams, and then connect at the edges serous and muscular seams handles, between to-rymi put an outside number of noose gray and serous sutures throughout all back wall of an anastomosis (fig. 2, a). The area of mesenteric edge should be strengthened a seam of matratsny type. After this edge of cuts of a gut sew among themselves on all circle noose or continuous sutures a catgut through all layers of an intestinal wall (fig. 2, b). Over this number of seams put seroserozny noose sutures, and then take in a window in a mesentery (fig. 3).
At an anastomosis Beck sideways at first connect walls of both loops of a gut noose gray and serous sutures, to-rye impose 1 cm above the place of an attachment of a mesentery. Parallel to this number of seams open gleams of both loops of a gut and put a continuous suture through all layers, comparing mucous membranes (fig. 4, a). Diameter of an anastomosis shall be slightly wider than diameter of a gut. After that finish imposing of noose gray and serous sutures on a front wall of an anastomosis (fig. 4, b). The window in a mesentery which remained after a resection is taken in for prevention of a possibility of infringement of a loop of a gut in it. In isoperistaltic comparison of loops there is no need since their antiperistaltic arrangement does not interfere with the correct function of an anastomosis.
Principle of imposing E. the end sideways follows from the first two ways. The trailer piece of a gut is compared perpendicularly to the anastomosed loop of a small bowel, receding from its mesentery a little, and put a back outside row of gray and serous stitches. Then parallel to this number of seams open a gleam of a loop of a gut on the extent corresponding to diameter of the anastomosed trailer piece of a gut and put an internal number of stitches through all layers of an intestinal wall on all circle of an anastomosis. Formation of an anastomosis is completed imposing of a front outside number of gray and serous seams. Though the anastomosis a side is sideways technically simpler, however at it danger of formation of the blind pockets causing development of inflammatory process is not eliminated. At recovery of a continuity of an intestinal tube apply an anastomosis the end in the end providing optimum fiziol. conditions for advance of intestinal contents. The interintestinal anastomosis a side can be sideways also imposed by means of a stapler of NZhKA, and an anastomosis the end in the end and the end sideways — by means of the device KTs (see Staplers). Use of devices * reduces time of operation.
At observance of the technology of imposing of soustiya of complications, as a rule, it is not observed, insufficiency of an anastomosis can arise at extremely weakened patients or at the wrong assessment zhiznespo-
Fig. 3. The diagrammatic representation of recovery of integrity of a mesentery during the imposing of an enteroenteroanastomoz the end in the end after a resection of the site of a small bowel: edges of a dissect mesentery are sewed noose sutures, the tied-up vessels of a mesentery are visible.,
Fig. 4. Diagrammatic representation of the main stages of imposing of an enteroenteroanastomoz side sideways: and — on a back wall of an anastomosis noose gray and serous sutures (2) which extreme threads are not cut off and taken on clips as handles are put; through all layers of a wall of a gut put a continuous catgut suture (2), at first on a back wall, and then with transition to a front wall of an anastomosis; to avoid weakening of seams, thread is fixed a clip (3); — after imposing of a continuous catgut suture put gray and serous noose sutures on a front semi-circle of an anastomosis.
sobnost of a loop of the gut chosen for E. Anastomosites and cicatricial strictures of an anastomosis arise only at the wrong technology of imposing E. The remote forecast depends on a disease, apropos to-rogo imposing E is made.
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