ILEOPROCTOSTOMY

From Big Medical Encyclopedia

ILEOPROCTOSTOMY (Latin ileum ileal gut + grech, proktos rectum + stoma of companies, opening, pass; synonym: ileorektalny anastomosis, ileoproctostomy) — operation of imposing of an anastomosis between an ileal gut and a straight line. Unlike ileosigmostomiya (see) at And. an anastomosis impose lower than the level of the sacral cape (promontorium) for what will mobilize a proximal part of an ampoule of a rectum, previously having tied up an upper pryamokishechny artery.

This operation is applied as the second stage after removal of all colon concerning diffusion a polypose or multiple tumors, nonspecific ulcer colitis, etc. Sometimes And. the polypose is carried out as the first stage of operational treatment diffusion. In this case the colectomy is made in the second stage.

Technology of operation

Fig. 1. The diagrammatic representation of the finished ileorektalny anastomosis the end sideways.
Fig. 2. The diagrammatic representation of imposing of an ileorektalny anastomosis the device KTs-28 (the place of a seam is specified by an arrow).
Operation is always carried out in a planned order, under the general anesthesia. Access — the lower median laparotomy. At first prepare the site of an ileal gut for an anastomosis, and then will mobilize a rectum, making a lyre-shaped section of a pelvic peritoneum and exempting from a fatty tissue a wall of a gut on a circle throughout 3 — 4 cm. Apply an anastomosis the end in the end and the end sideways (fig. 1) more often, however depending on anatomic conditions and features of earlier undergone operations also other options, for example a side sideways can be used. The anastomosis forms two-row noose silk sutures or seams from synthetics, at the same time it is more preferable to use atraumatic needles (especially during the imposing of an outside number of seams). Some surgeons recommend to put an internal number of stitches special staplers of the KTs-28 type (fig. 2), SPTU (see. Staplers ), however their use at the expressed cicatricial and inflammatory changes of a wall of a rectum is inexpedient. In these cases the manual seam certainly is preferable (see. Intestinal seam ) as less traumatic and allowing to adapt selectively fabrics according to features of their changes on a circle of the created anastomosis. Operation comes to an end with immersion of an anastomosis under a pelvic peritoneum after drainage of retrorectal space through counteropening on a crotch and carrying out through an anus above an anastomosis of a soft rubber tube for removal of gases and intestinal contents.

Complications

From postoperative complications insufficiency of seams of an anastomosis with development of phlegmon of pelvic cellulose and peritonitis is most dangerous. In the presence of the drainage tube brought to a zone of an anastomosis through counteropening on a crotch it is possible to diagnose and treat timely this complication. At emergence from a drainage tube of pus and intestinal contents imposing of a double-barreled ileostoma is reasonable. It unloads an anastomosis, promotes elimination of inflammatory process in pelvic cellulose and to healing of defect of an anastomosis.

At a favorable postoperative current at patients with And. gradually (within 2 — 3 months) the number of defecations is reduced to 4 — 5 times a day, and the kcal gains kashitseobrazny character.


Bibliography: Vasilyev A. A. Clinic and surgical treatment of nonspecific ulcer colitis, M., 1967, bibliogr.; P and in to and V. L. N and d river. Polyps and diffusion polyposes of direct and thick guts, M., 1969, bibliogr.; Yudin I. Yu. Nonspecific ulcer colitis, L., 1968, bibliogr.; G about 1 i f? h e of of J. Page of Surgery of the anus, rectum and colon, L., 1975.

V. D. Fedorov.

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