Operations on the large and small intestine



Operations on the small and large intestine

One of the most common operations on the hollow organs of the abdominal cavity is the formation or imposition of fistulas. Fistulas( stomas) of the upper sections( stomach, jejunum) of the gastrointestinal tract are imposed to feed the patient with obstruction of the esophagus( tumor, scar post-burn strictures, atresia).Fistulas on the ileum and large intestine are imposed for the purpose of discharge of intestinal contents in case of obstruction in the main tumor genesis of the distal intestine.

Depending on the technique of execution, fistulas of hollow organs are divided into two groups:

1) a tubular fistula, is a channel in the wall of an organ lined with a serous membrane from the inside. A tube is usually inserted into the channel through which the patient is powered. A distinctive feature of the tubular fistula is the possibility of their independent closure, for this it is sufficient to remove the rubber tube and the fistula is obliterated,

therefore the tubular fistula is called temporary.

3) a lip-shaped fistula is formed by connecting the mucous membrane of the anterior wall of the hollow organ with the skin, i.e.the walls of this fistula is the mucous membrane.

In order to eliminate a lip-shaped fistula, additional surgical intervention is required - closure of the fistula. Because of this, lip-shaped fistulas are called permanent.

Features of suturing wounds of the small intestine.

1. A stab wound is closed with a purse-string suture, immersing the injury site inside the suture.

2. A two-row Albert suture is used for suturing a small wound of a small size( less than 1/3 of the diameter of the intestine).

It should be remembered that if damage is less than 1/3 the length of the circumference of the hollow organ, wound closure is possible. When this indicator is exceeded, resection of the small intestine is performed.

2 sero-muscular suture “holders” are placed on the intestine so that when they are stretched to the sides, the wound hole is located in the direction transverse to the long axis of the intestine, in order to avoid narrowing of the intestinal lumen after suturing.

The first row of marginal, nodal stitches is placed through all layers of catgut, 3 mm from the wound edge, 3-5 mm between the sutures. The main objectives of this series of stitches are: convergence of the wound edges, hemostasis. The first row of stitches penetrates the intestinal lumen, therefore, before applying the second row of sero-serous stitches, members of the surgical team need to work their hands, change tools and napkins.

Then, over the first row of stitches, the second row of gray-serous nodal stitches is superimposed. The distance between the seams is 2.5 mm. Closure of the wound of the small intestine ends checking the patency of the intestinal lumen.

Features of suturing wounds of the colon.

On both sides of the intestinal wound, suture sticks are applied to hold the intestine in a position where no intestinal contents leak from the wound and give the wound direction transverse to the long axis of the intestine. The colon wound is sutured with a three-row suture:

1) the first row is a through marginal suture;

2) second row - sero-muscular suture, providing contact between the serous surfaces and immersion of the marginal suture;

3) third row - sero-muscular suture for additional peritonealization of previous sutures.

Injuries, gangrene, due to pinching or thrombosis of the mesenteric vessels, tumors of the intestine are indications for bowel resection.

When performing this operation, it is necessary to adhere to three basic rules:

1) resect the intestine within healthy tissue. Usually with injuries, gangrene of the intestine from the affected segment of the intestine retreat 7-10 cm in the proximal and distal directions. In cancer, the line of intersection of the intestine can move aside and to a greater distance;

2) resection of the intestine should be carried out taking into account its blood supply, i.e.bowel stumps should be well supplied with blood. Otherwise, necrosis of the intestinal wall may develop;

3) resection lines should pass only along the sections of the intestine covered with peritoneum from all sides. This rule applies only to colon resection, since the small intestine is covered with peritoneum on all sides.

The main stages of the bowel resection surgery:

1. Mobilization of the segment to be removed. At this stage, produce ligation of the vessels and the intersection of the mesentery.

2. Gut resection.

3. Formation of the inter-intestinal anastomosis.

Depending on the overlay variant, the following types of inter-intestinal anastomoses are distinguished:

· "end to end" - the most "physiological", becausedoes not disturb the natural passage of food. However, when this anastomosis is applied, a narrowing may occur. To prevent this complication, it is recommended to perform resection along lines directed under the
angle of 45 ° to the mesenteric edge of the intestine and use a single-row suture;

· “side-to-side” - this type of anastomosis can be performed in two versions: isoperistaltic and antiperistaltic. In the case of isoperistaltic anastomosis, the stump of the stitched bowel pieces “look” in different directions and the direction of peristalsis of the afferent loop coincides with the direction of the peristalsis of the discharge loop. With this type of anastomosis, narrowing is practically not observed, however, congestion may occur in the stump area;

· “end to side” - this anastomosis is more often used to connect sections of the intestine of different diameter, i.e.in the formation of fistula between the small and large intestine.

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Intestinal Surgery

The Friedrichshafen Clinic provides both therapeutic and surgical treatment for various diseases. Modern equipment and the latest methods of treatment allow qualified and experienced doctors of a medical institution to perform complex bowel surgery .as a result of which the quality of life of patients is significantly improved.

Operations on the small intestine at the Friedrichshafen Clinic

The main operations on the intestines, namely its digestive section, are as follows in our clinic:

Enterotomy at the Friedrichshafen Clinic

Intestinal operations using the enterotomy method. The technique is an opening of the lumen of the small intestine, which closes after all the necessary manipulations. Such operations on the intestines of the are necessary if the patient needs to remove a foreign body( gallstone, ascaris conglomerate, a benign tumor( adenoma, lipoma, leiomyoma, fibroma) or resection. Intestinal operations using this technique are performed under a commonanesthesia, as the incision of the intestine is made with a scalpel or electrocautery in the peritoneal region. Such operations on the intestines in our clinic are carried out only if it is impossible to eliminate the problem in another way.

An enterostomy operation is characterized by an intestinal lumen opening to eliminate the existing problem with further maintaining the small intestine in an open state with outward drainage for drainage of the bile duct or in the case of duodenal diverticulum.her plot. In other words, this procedure is called partial enterectomy. In our clinic, operations on the intestines are often performed to excise the initial section of the small intestine with a peptic ulcer, and excision of other parts of the organ is carried out only in parallel with the removal of the pancreatic head. Most often, resection in our clinic is prescribed to patients with strangulated hernias, intestinal obstruction, mesenteric artery thrombosis or vein. This is due to the fact that with the progression of these diseases one of the sections of the small intestine necrotizes( dies) and needs to be excised.

An operation on the intestine with an ileostomy overlay consists of removing the end of the small intestine through a separate opening. During this procedure, the small intestine is connected to the abdominal wall, as a result of which a hole is created to exit the contents of the intestine. Such bowel surgery is required for diverticulitis, as a result of the removal of the large intestine, an injury to the abdominal cavity. Depending on the bowel excretion, there are two types of myeloma:

  • single-sided( the end of the healthy intestine is brought out and stitched to the skin);
  • double-barreled( a loop of the small intestine is brought out through the abdominal wall and twisted so that both its ends are visible).As a rule, after a few weeks is transferred back into the abdominal cavity. Designed for unloading the lower part of the organ of the digestive tract.

Colon Surgery at the Friedrichshafen Clinic

The following most frequent bowel surgery for colon treatment is performed at our clinic:

  • Operations on the intestines of the with a distal resection of the sigmoid colon are performed during malignant tumors, torsions, extensive lesions and briquettes of the intestinal section. Operations on the intestines of this type are performed under general anesthesia and last 2–3 hours, they are simultaneous, during which the abdominal wall is opened with a lower midline or oblique incision. After all manipulations are performed during intestinal surgery, the end of the large intestine is brought into the surgical wound for resection, after which the anastomosis is applied end-to-end( by the open or closed method).
  • Intestinal surgery using the segmental resection of the sigmoid colon is performed when a specific part of the colon is affected. Access is carried out by transrectal laparotomy with an additional incision through which the intestine is brought to the abdominal wall.

Hemicolectomy

Left-sided hemicolectomy is an operation on the intestine during which the left half of the transverse( colon, descending) or the entire sigmoid colon is removed. In most cases, the method of left-sided hemicolectomy is used for cancer in the left half of the colon. Operations on the intestines with this method are performed under general anesthesia, because such an operation on the intestines requires an incision along the abdomen. After careful preparation of the intestine, the abnormal area is removed and an anastomosis is applied( cross-linking with the lateral parts of the transverse colon and sigmoid osatka).

Right-sided hemicolectomy is performed to remove the entire right half of the large intestine with a small portion( 10-15 centimeters) thin. For serious ailments, such as transverse colon cancer, the volume of tissue to be removed may expand. Access to the body is carried out by laparotomy, followed by removal of the intestine with the imposition of the anastomosis. The recovery period after surgery on the intestines is about two weeks.

. Colon resection.

. The transverse colon is resected when a malignant neoplasm is detected in a patient. When operating the patient, the doctor removes the right half of the colon through the access of the midline laparotomy. The procedure begins with the mobilization of the right half of the colon, after which the intersection of the colon and small intestine is performed. Then an anamostosis( side to side, end to side) is applied and the posterior peritoneum is sutured. At the end of the intestinal surgery, the doctor sucks the wounds of the anterior abdominal wall in layers.

In the Friedrichshafen clinic, the intestinal surgery is performed after the diagnosis, as precisely as possible, indicating the localization of the organ anomaly.

Intestinal surgery, many years of experience! Top clinic in Germany.

Dr. med. Karl Winkler
Deputy Head.doctor

Dr. med. Thomas Günther
Senior Doctor

Dr. med. Inga Münckle
Senior Doctor

Dr. med. Gunda Milonig
Senior Doctor

Ursula Vecht

Secretariat I had a large tumor removed from my liver in March. In Russia, such operations are not carried out, there is not yet expensive equipment. Even in Germany, this is considered to be a difficult operation, since the liver does not tolerate surgical interventions. Only a month has passed, and I have practically recovered, I am already working and should not adhere to strict diets. I remember with gratitude all the specialists who worked with me in Germany. I wish you all good health!

Prof. Dr. med. Christian Arnold

One of the common operations on the hollow organs of the abdominal cavity is the formation or imposition of a fistula. Fistulas( stomas) of the upper sections( stomach, jejunum) of the gastrointestinal tract are imposed to feed the patient with obstruction of the esophagus( tumor, scar post-burn strictures, atresia).Fistulas on the ileum and large intestine are imposed for the purpose of discharge of intestinal contents in case of obstruction in the main tumor genesis of the distal intestine.

Fistulas of hollow organs based on the technique of execution are divided into two groups:

1) tubular fistula, is a channel in the wall of the body, lined from the inside with a serous membrane. A tube is usually inserted into the channel through which the patient is powered. A distinctive feature of the tubular fistula is the possibility of their independent closure, for this it is enough to remove the rubber tube and the fistula is obliterated, in connection with this the tubular fistula is called temporary.

3) a lip-shaped fistula is formed by combining the mucous membrane of the anterior wall of the hollow organ with the skin, ᴛ..the walls of this fistula is the mucous membrane.

In order to eliminate a lip-shaped fistula, additional surgical intervention is required - closing of the fistula. Because of this, lip-shaped fistulas are called permanent.

Features of suturing wounds of the small intestine.

1. A stab wound is closed with a purse-string suture, immersing the injury site inside the suture.

2. A two-row Albert suture is used for suturing a small wound of a smaller size( less than 1/3 of the diameter of the intestine).

It should be remembered that if damage is less than 1/3 of the circumference of the hollow organ, wound closure is possible. When this indicator is exceeded, resection of the small intestine is performed.

2 sero-muscular suture-holders are placed on the intestine so that when they are stretched to the sides, the wound hole is located in the direction transverse to the long axis of the intestine, in order to avoid narrowing of the intestinal lumen after suturing.

The first row of marginal, nodal stitches is placed through all the layers with catgut, 3 mm from the wound edge, 3-5 mm between the sutures. The main objectives of this series of stitches are: convergence of the wound edges, hemostasis. The first row of stitches penetrates the intestinal lumen; therefore, before applying the second row of sero-serous stitches, it is extremely important for members of the surgical team to work their hands and change tools and napkins.

Then a second row of gray-serous nodal joints is superimposed over the first row of sutures. The distance between the seams is 2.5 mm. Closure of the wound of the small intestine ends checking the patency of the intestinal lumen.

Features of colon wound closure.

On both sides of the gut wound, suture-retainers are placed to hold the gut in a position where no intestinal contents leak from the wound and give the wound a direction transverse to the long axis of the gut. The colon wound is sutured with a three-row suture:

1) the first row is a through marginal suture;

2) the second row - sero-muscular suture, which provides the contact of serous surfaces and immersion of the marginal suture;

3) the third row - sero-muscular suture for additional peritonization of previous sutures.

Injuries, gangrene, due to pinching or thrombosis of the mesenteric vessels, tumors of the intestine are indications for bowel resection.

When performing this operation, it is extremely important to adhere to the three basic rules:

1) perform resection of the intestine within healthy tissue. Usually with injuries, gangrene of the intestine from the affected segment of the intestine retreat 7-10 cm in the proximal and distal directions. In cancer, the line of intersection of the intestine can move aside and to a greater distance;

2) resection of the intestine should be carried out taking into account its blood supply, ᴛ.ᴇ.bowel stumps should be well supplied with blood. Otherwise, necrosis of the intestinal wall may develop;

3) resection lines should be made only along the sections of the intestine, covered with peritoneum on all sides. This rule applies only to colon resection, since the small intestine is covered with peritoneum on all sides.

The main stages of the bowel resection surgery:

1. Mobilization of the segment to be removed. At this stage, produce ligation of the vessels and the intersection of the mesentery.

2. Gut resection.

3. Formation of the inter-intestinal anastomosis.

Considering the dependence of the application of the overlay, the following types of inter-intestinal anastomoses are distinguished:

“end-to-end” is the most “physiological” becausedoes not disturb the natural passage of food. In this case, the imposition of this anastomosis may be a narrowing. To prevent this complication, it is recommended to perform resection along lines directed at an angle of 45 ° to the mesenteric edge of the intestine and use a single-row suture;

· Sideways — this type of anastomosis should be performed in two versions: isoperistaltic and antiperistaltic. In an isoperistaltic anastomosis, the stump of the stitched gut trims is “viewed” in different directions and the direction of peristalsis of the afferent loop coincides with the direction of peristalsis of the discharge loop. With this type of anastomosis, narrowing is practically not observed, however, congestion may occur in the stump area;

· “end to side” - this anastomosis is often used to connect different intestinal sections of different diameter, ᴛ.ᴇ.in the formation of fistula between the small and large intestine.

Operations on the small and large intestine - the concept and types. Classification and features of the Small and Large Intestine Operations category,.

Sources: http: //studopedia.ru/ 1_91317_operatsii-na-tonkoy-i-tolstoy-kishke.html, http://www.klinikum-friedrichshafen.com /gastrojenterologija/ operacii-na-kishechnike.php, http

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