ILEOTRANSVERSOSTOMY

From Big Medical Encyclopedia

ILEOTRANSVERSOSTOMY (Latin ileum an ileal gut + [colon] of transversum a cross colon + grech, stoma of companies, an opening, pass) — operation of imposing of an anastomosis between ileal and cross colonic guts. Operation is carried out as the final stage of a right-hand hemicolectomy (fig., 1, 2 and 4) or it is the independent intervention directed to switching off (fig., 3) or unloading (fig., 5) the right half of a large intestine (a bypass anastomosis).

the Diagrammatic representation of an ileotransversostomy (shooters specified the direction of movement of intestinal contents): 1 — a side sideways after a right-hand hemicolectomy; 2 — the end sideways after a right-hand hemicolectomy; 3 — a side sideways for unloading of the right half of a large intestine (the white arrow specified a tumor); 4 — the end in the end; 5 — with unilateral switching off of the right half of a large intestine in the presence of a tsekostoma (and); — a stump of an ileal gut; in — a tumor.

Indications most often tumors of the right half of a large intestine, multiple fistulas of the blind and ascending gut are. In a planned order And. usually carry out in one step from right-hand hemicolectomy (see). For the purpose of unloading or switching off of the right half of a large intestine And. make as palliative intervention at nonresectable tumors more often, at impossibility to execute radical operation or at complications of a basic disease (obturatsionny impassability, retroperitoneal abscess and so forth).

Contraindications — the started impassability of intestines with the expressed disturbances of blood circulation in a wall of an ileal gut (see. Impassability of intestines ) and peritonitis (see). In these cases the risk of emergence of insufficiency of seams of an anastomosis is very high, and therefore imposing of a temporary unloading ileostoma is more rational (pristenochny or full separate).

Technology of operation

Access — a median laparotomy, transrectal or pararectal cuts (see. Laparotomy ). After audit of an abdominal cavity determine the volume of surgical intervention. If the hemicolectomy is made, then after mobilization of the right half of a large intestine together with 20 — 25 cm of terminal department of an ileal gut the last is crossed between two clips. Then cross a cross colon in the planned site, take in a gleam of a distal piece three a line seam, and it is reasonable to impose the first row by means of devices UKL, UO or NZhKA (see. Staplers ). Otstupya on 2 — 3 cm from the created stump of a cross colon, impose an anastomosis between ileal and cross colonic guts a two-row manual seam. An anastomosis on type a side sideways most reliably and less dangerously though the experienced surgeon frequent more simply and quicker manages to impose an anastomosis the end sideways. M. A. Kimbarovsky (1948) offered an invaginatsionny anastomosis the end sideways. Ya. D. Vitebsky (1968) propagandizes a way of an invaginatsionny anastomosis the end sideways with a cross section of a wall of a cross colon. Some surgeons impose an anastomosis and on ooze the end in the end (fig., 4) or a side in the end.

At unilateral switching off of the right half of a large intestine, without removal it, at first also cross an ileal gut, it take in the distal end and make And. on one of the ways stated above.

At last, bypass ileotransverzoanastomoz for unloading of the right half of a large intestine impose on type a side sideways without crossing a heifer of intestines.

Complications

One of typical complications in time And. torsion of the bringing end of an ileal gut on is 360 °. For prevention of such mistake it is recommended before imposing of an anastomosis podshivany mesenteries of an ileal gut to a mesentery of a cross colon.

The heaviest postoperative complication — insufficiency of seams of an anastomosis, edge develops on 4 more often — the 7th day after operation.

Careful surgical technology, correction of disturbances of exchange processes, a rigid diet (a table 0) within 4 — 5 days is necessary for prevention of this complication (see. Clinical nutrition, tables of clinical nutrition ) and unloading of distal departments of intestines by means of a colonic tube.

An outcome

In the next months, and sometimes and years the ambassador I. acceleration of a passage on intestines, increase of a chair to 3 — 4 times a day, occasionally disturbance of the general food is possible. Usually in 3 — 6 months these phenomena pass and the chair is normalized.



Bibliography: Bazhenova A. P. and ° C of t-rovtsev of L. D. Colon cancer, M., 1969, bibliogr.; In and t of e with to and y Ya. D. Justification of the choice of a method of an anastomosis on a large intestine, Vestn, hir., t. 99, No. 6, page 55, 1968; L and t of t of m and N of N And. Belly surgery, the lane with it., Budapest, 1970; G about 1 i g h e of J. G. Surgery of the anus, rectum and colon, L., 1 975.

V. D. Fedorov.

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