Marble anastomosis. Anastomosis to the alimentary canal

There are three options for arterial anastomoses: end to end, end to side, side to side. The choice of option depends on the experience and specific requirements of a particular reconstructive procedure. Depending on the circumstances of the intervention, minor modifications of these options are possible.

End to end artery anastomosis

End-to-end anastomosis of the artery requires mobilization of two vessels. This configuration of the anastomosis is accompanied by a narrowing of the lumen with the risk of significant stenosis subsequently. In practice, end-to-end anastomoses are most often used in surgery. large vessels(aorta or iliac arteries).

If it is necessary to perform an end-to-end anastomosis of an artery between two small-caliber vessels, their ends are cut off in an oblique direction and anastomosed. This option is especially useful when using complex grafts consisting of two veins or a vein and an artificial prosthesis. Changing the angle of the anastomosis allows you to eliminate the discrepancy in the diameter of the vessels without significant disruption of hemodynamics along the suture line.

End to side artery anastomosis

IN reconstructive surgery arteries, end-to-side anastomosis is most often used, although hemodynamically it is somewhat worse than end-to-end anastomosis.

The length and angle of end-to-side arterial anastomosis have been the subject of research both in vitro and in vivo. With minor variations perfect length the anastomosis should approach double the diameter of the vessel. The angle at which the graft connects to the vessel is critical because small shear forces generated along the heel-to-toe region of the anastomosis are a cause of intimal hyperplasia. In vitro studies have demonstrated that small vessels (eg, popliteal) require an acute angle. It has been established that an anastomosis applied at an angle of 30 degrees gives good results with shunting below knee joint. For larger vessels in which intimal hyperplasia does not lead to the same hemodynamic effects, less acute angles can be used. Anatomical conditions dictate the need to use wider angles for some anastomoses (eg, axillofemoral bypass and transposition subclavian artery to sleepy). Such anastomoses are often performed at an angle of 75-90 degrees without significant hemodynamic disturbances or problems with patency.

Side to side anastomosis

This is the rarest type of anastomosis. The best example Arteriovenous fistulas for hemodialysis and subsequent shunts at the level below the popliteal artery can serve. In most cases, the technique for performing this type of anastomosis is similar to that for end-to-side arterial anastomosis.

Additional techniques for arterial anastomoses

Arteriovenous fistulas

The patency of vascular prostheses depends on the blood flow velocity, since when it decreases below the threshold, thrombosis develops. Although the rate may vary, the materials from which the grafts are made have a much higher threshold than autovenous grafts. Flow in low-velocity grafts below the popliteal artery can be increased by reducing the diameter, but grafts less than 6 mm in diameter are prone to occlusion due to increased resistance. The only solution in this case is to increase blood flow by creating an additional venous fistula in the area of the distal anastomosis or near it.

Although this technique of arterial anastomosis is designed to increase blood flow, recent randomized clinical trials comparing limb salvage after femorotibial bypass with or without arteriovenous fistula have shown no significant difference.

Venous flaps and cuffs

The insertion of a vein flap or cuff between the graft and the small caliber recipient artery at the distal anastomosis was originally developed to speed up technically difficult anastomoses. The technique was first described in 1970, after which many different configurations have been described, including the Miller collar, Taylor flap, St. Mary's (St. Mary's), Linton's flap and Karakagil's cuff.

The venous cuff reduces the discrepancy in elasticity in the area of the anastomosis of the artery and the prosthesis, helps maintain biphasic arterial blood flow and changes the hemodynamics in the anastomosis area. In addition, the cuff acts as a “reservoir” of endothelium and can stimulate its migration along the prosthesis. It has been shown that the elasticity of the strip cut from the venous wall to create a Miller cuff is higher in the longitudinal direction than in the transverse direction. Studies of the hemodynamics of the anastomosis using cine angiography have shown that venous cuffs induce the formation of a large vortex that forms immediately after the systolic peak. This vortex is very stable and persists until the end of diastole. Blood flow through a traditional end-to-side arterial anastomosis is laminar. However, flow separation zones at the toe, heel, and bottom of the anastomosis create shear forces that may explain myointimal hyperplasia in these areas. In the area of anastomosis with a cuff, the zones of action of shear forces are located in the area of the cuff, and not the artery. Additionally, the repeated generation and dissipation of the vortex means that there is no single area of constant shear forces. At the same time, the development of myointimal hyperplasia is delayed.

Clinically, venous cuffs improve patency and limb preservation after replacement of arteries below the knee joint, but not of larger diameter vessels above the knee.

There have been recent reports that cuffed grafts at distal anastomoses have similar patency rates as venous collars, but these are uncontrolled data and should be interpreted with caution.

Key Points

Venous autografts represent the best choice for bypassing arteries below the inguinal ligament. There is no difference in patency between the reverse technique and the in situ technique.
Evidence suggests that intensive follow-up of autovenous grafts may improve arterial anastomosis patency rates, although definitive conclusions must await results from a randomized clinical trial.
Application of surface femoral vein to eliminate infectious complications during aortic replacement has become an integral technique.
Dacron and PTFE grafts perform similarly in femoropopliteal bypass surgery. There is evidence to support heparin-coated Dacron grafts for lower extremity arterial bypass grafting.
There is some evidence to support the use of rifampicin-coated grafts for the prevention of infectious complications. However, most authors support the use of covered grafts only in high-risk patients.
Venous cuffs improve the patency of grafts below the knee joint.

The article was prepared and edited by: surgeon

In almost all intestinal diseases requiring surgical intervention, an intestinal anastomosis is performed at the end of the operation. This allows you to restore the functionality of the organ, bringing the patient’s standard of living as close as possible to the period when there was no disease. Even if half of the large intestine is removed, this method gives a chance for the organ to resume functioning. However, this procedure does not always go smoothly, in some cases carrying with it the consequences of anastomotic leakage.

Intestinal anastomosis is a necessary surgical measure performed after certain types of surgery.

Types of intestinal surgeries

The type of intestinal surgery depends on the disease of the organ, as well as on the circumstances requiring surgical intervention. If the intestine ruptures, it must be stitched up. This operation is called enterorraphy. When a foreign body enters the intestine, enterotomy is used, when the intestine is opened, cleared of the foreign object and sutured. If it is necessary to create a stoma, a colostomy, jejunostomy, or ileostomy is performed, when a hole is made in the desired part of the intestine and brought to the surface of the peritoneum. If a tumor develops and it is impossible to remove it, an artificial canal is placed between the intestines past the neoplasm by applying an interintestinal anastomosis.

The anastomosis technique is used to remove the affected area of the intestine in order to restore the viability and functionality of the organ. The need for intestinal resection may be prompted by:

growing tumors;
gangrene;
caused by infringement;
volvulus;
vessels;
ulcerative colitis;
actinomycosis.

What is anastomosis?

This is a fusion procedure ( natural way) or stitching (an artificial process) two hollow organs, creating a fistula between them. Natural processes occur mainly between capillaries, blood vessels, and have a beneficial effect on blood circulation throughout the body and internal organs person. Artificial anastomoses are applied between hollow organs, if necessary, using surgical thread, special instruments and the skillful hands of an experienced surgeon. An intestinal anastomosis can be laid between the intestines to connect them in case of removal of part of the intestine, or when creating a bypass channel in the case of intestinal obstruction

. If the operation is performed at the junction of the stomach and small intestine, in this situation a gastroenteroanastomosis is performed. Depending on the location, the interintestinal anastomosis is divided into small-intestinal, small-colic, and large-colic. On small intestine single-layer seams are made - all balls of fabric are stitched. Colon

sewn with two-layer interrupted seams. The first row is sutures through all layers of tissue, the second row of sutures is done without touching the mucous membrane.

Overlay methods

End to end This method of anastomosis is used when the diameter of the connected parts of the intestine is almost the same. IN in this case

the smaller end is cut slightly and thus enlarged to the size of the second end, then these parts are sewn together. This type of anastomosis is considered the most effective and is ideal for similar operations on the sigmoid colon.

Side to side method

This method is used in case of large-scale intestinal resection or when there is a threat of strong tension in the anastomotic area. In this case, both ends of the intestine are sutured with a double suture, but incisions are made on their lateral parts, which are then sutured side to side with a continuous suture. The lateral fistula between the intestines should be twice as long as the diameter of the lumen of the ends.

End to side This type of anastomosis is used for more complex operations

when significant bowel resection is required. It looks like this. One end of the intestine is tightly sutured, creating a stump. The two ends of the intestine are then sutured side by side. An incision is made in the side of the stump, equal to the diameter of the hole in the second sewn end of the intestine. The end hole is sutured to the side incision on the stump.

Leakage of intestinal anastomosis Despite all the positive aspects of this procedure, there are cases when the imposed intestinal anastomosis shows its failure. This manifests itself in different ways and at the beginning the consequences can be completely invisible, without revealing any symptoms. However, bloating, increased heart rate, and fever may then appear. The patient then develops peritonitis or discharge through the formed fistula. These consequences of anastomotic failure may be accompanied by septicemic shock (the patient’s blood pressure drops, the skin turns pale, urine does not flow into the bladder, acute heart failure, semi-fainting occurs).

The diversity of causes that are the causative agents of the symptoms that appear indicates that anastomotic failure can occur in all operated patients. Therefore, after surgery, every patient needs active health monitoring. If the patient does not show positive dynamics, and his condition worsens, you should sound the alarm and figure out what’s wrong. IN similar situation An x-ray is ordered immediately chest and peritoneum, extensive analysis of the cellular composition of the blood, computed tomography, irrigoscopy with contrast agent. If the anastomosis fails, the level of leukocytes in the blood often rises, and x-rays show dilation of the intestinal loops.

Unsuccessful intestinal anastomosis is eliminated by repeated surgery followed by drug therapy.

The best is the enemy of the good, and the first

The impression is the best, why spoil it?

Ideal anastomosis

The ideal intestinal anastomosis is one that is sealed, and leaks (relatively rare) are a deadly disaster. In addition, the anastomosis should not be narrowed; it ensures the normal functioning of the gastrointestinal tract even in the first days after its formation.

Every experienced surgeon believes that it is his technique of performing anastomoses, which he learned from his teachers and reinforced by his own experience, that is “the best.” In practice, many methods are used: end to horse, end to side or side to side; single- or double-row suture, interrupted or continuous, using braided or monofilament, absorbable or non-absorbable sutures; and we even know infected surgeons obsession anastomosis with a three-row interrupted suture. To all of the above, let's add staplers. What should you give preference to?

Pros and cons

A large number of experimental and clinical trials allows us to draw the following conclusions.

Leaks (inconsistencies). Dehiscence of anastomoses occurs regardless of the methods of their formation, even if they are applied without tension and with good blood supply to the anastomosed intestine.

Strictures (narrowings). Single-row anastomoses are less susceptible to cicatricial narrowing than multi-row anastomoses. Strictures are also often complicated by end-to-end anastomoses performed with a circular stapler.

Failures.In general, staplers are more prone to intraoperative misfires.

Speed.Mechanical anastomoses with staplers are on average faster to perform than with hand stitches. The fewer layers, the faster you apply! 1" anastomosis, and a continuous suture takes less time than an interrupted suture. In general, the application of two purse string sutures a stapled anastomosis requires the same amount of time as a single-row manual continuous suture.

We prefer a single-layer anastomosis with a continuous suture with a double suture or two single 3/0 or 4/0 monofilament sutures (PDS or Maxon). We do not use intestinal pulp, believing that the crown supply to the edges of the intestine should not be disturbed. There is no need to devascularize the edges of the intestine by clearing fat from its mesenteric edge or removing fatty pendants. A line of continuous seam starts from the back wall and gradually moves to the front until the ends of the thread meet, here they are tied. The key is to make the seam large enough; stitches, capturing the submucosa, muscular and serous membranes, but without the mucous membrane (“large stitches on the outside, small stitches on the inside”). The needle insertion should be located at least 5-7 mm from the edge of the intestine, and the gap between the stitches should not miss the ends of the De Bakey clamp (3-4 mm). The assistant holding the suture thread should ensure its moderate tension, without excessive compression of the tissue. This technique is suitable for end-to-side, end-to-end, and even routine vascular anastomoses. We use this technique throughout the gastrointestinal tract, from the esophagus to the rectum. In this case, it is possible to create a wide inverted and safe anastomosis in no more than 15 minutes, using only one or two threads.

IN " difficult cases“When the anastomosis area is relatively inaccessible, we prefer a single-row interrupted suture, which allows for a more accurate comparison of the intestine. You will learn how to do this and how to use staplers correctly from your teachers.

Anastomosis control

If the intestinal anastomosis is correctly applied, there is no need to check it for leaks; the common practice of pressing (“pushing”) the anastomosis is ridiculous, remember you are using a single row stitch. “Problematic” ones include low rectal anastomoses; they need to be checked for leaks: place the intestinal sponge above the anastomosis, fill the pelvic cavity saline solution and introduce air into the rectum. Instead of air, you can use blue. If air bubbles or bluing appear in the pelvis, try to close the defect with a suture. If the attempt is unsuccessful, a proximal double-barreled colostomy is indicated.

When Shouldn't an anastomosis be performed?

If I wish we knew the exact answer! In general, if the likelihood of future anastomotic failure is high, it is better not to resort to it (this complication entails severe consequences). But how can you predict anastomotic leakage? The traditional avoidance of sutures in the colon for trauma, obstruction, or perforation was based on many years of practice. But times are changing; If during the Second World War a colostomy was performed for any damage to the colon, then subsequently c It became possible to successfully close the majority of such wounds. Moreover, three- or two-stage interventions for colonic obstruction were replaced by one-stage resection with anastomosis

It is difficult to give precise recommendations on when an intestinal anastomosis should not be performed. You must weigh carefully general state the patient, the condition of his intestines and abdominal cavity. In general, we would avoid colonic anastomoses in the presence of diffuse intra-abdominal infection (as opposed to contamination; For the small bowel, anastomosis is indicated in most cases, but in the presence of more than one of the following factors, we are more inclined to conservative management of the patient, exteriorization or stoma. which depends on the specific circumstances:

· postoperative peritonitis;

· anastomotic leak

· disruption of mesenteric blood flow;

· severe swelling or distension of the intestine;

· Severe exhaustion of the patient;

· chronic asteroid deficiency;

· unstable condition of the patient with the necessary monitoring of violations

There are no ready-made recipes or algorithms here. Rely on your own judgment, but get rid of the obsession of always performing an anastomosis. YES, we know that you want to protect the patient from an unpleasant stoma, but. please don't try to kill him this way. You should not be afraid of the imposition of a high enteric fistula: previously they were considered as unpromising, but today, with the proven technique of parenteral and distal nutrition, treatment with somatostatin and modern care these temporary proximal intestinal fistulas can be life-saving.

Conclusion

Intestinal The anastomosis is the "elective" part of the emergency surgery you are about to perform.

Remember! your goal is to save life and reduce the suffering of the patient; anastomosis, when the chances of success are high, at least expediently, there are many ways and means to achieve the goal, including with intestinal anastomoses. Master several methods and use e them selectively.
Many books have been written, read them, each offers something different, but you and only you will decide how to perform the anastomosis.

Surgeries on the intestines are considered one of the most difficult. The surgeon must not only eliminate the pathology, but also maintain maximum functionality of the organ. To connect hollow organs during surgical interventions use a special technique - anastomosis.

Types of intestinal surgeries

Most often, operations performed on the intestine include enterotomy and resection. The first type is chosen if a foreign body is detected in the organ. Its essence lies in the surgical opening of the intestine with a scalpel or electric knife. The suture is selected depending on the section of the intestine, the presence or absence of an inflammatory process in the area of intervention. The wound is sutured with the so-called interrupted Gumby suture, making a puncture through the muscular, submucosal layer without capturing the mucous membrane, as well as with a Lambert suture, connecting the serous (covers the small intestine from the outside) and muscular membranes.

Resection means surgical removal organ or part thereof. Before performing it, the doctor assesses the viability of the intestinal wall (color, ability to contract, presence of an inflammatory process). After the doctor marks the boundaries of the resected area, he selects the type of anastomosis.

Methods of anastomosis

There are several ways to perform an anastomosis. Let's look at them in detail.

This type is considered the most effective and is most often used if the difference in the diameter of the compared ends of the intestine is not very large. On the one that has a smaller diameter, the surgeon makes a linear incision to increase the lumen of the organ. Upon completion (this is the final area of the colon before moving into the rectum), this particular technique is used.

After intestinal surgery, the patient must undergo a rehabilitation course: breathing exercises, therapeutic exercises, physiotherapy, diet therapy. Taken together, these components will greatly increase the chances of effective recovery body.

It is used if resection is necessary large plot or when there is a risk of severe tension at the anastomotic site. Both ends are closed with a double-row suture, and then the stumps are sutured with a continuous Lambert suture. Moreover, its length is 2 times the diameter of the lumen. The surgeon makes an incision and opens both stumps along the longitudinal axis, squeezes out the contents of the intestine, and then closes the edges of the wound with a continuous suture.

This type of anastomosis consists in the fact that the stump of the efferent intestine is closed using the “side to side” technique, the contents of the organ are squeezed out and compressed with intestinal sphincter. The open end is then applied to the side of the intestine, sewn using a continuous Lambert suture.

The next stage is when the surgeon makes a longitudinal incision and opens the efferent part of the intestine. Its length should correspond to the width of the open end of the organ. The anterior part of the anastomosis is also sutured with a continuous suture. This type of anamostosis is optimal for many interventions, even such complex ones as (means it complete removal, including the nearest lymph nodes, fatty tissue).

Intestinal anastomoses with any type of connection are used on the small and large intestines. But in the first case, a one-story suture is necessarily chosen (that is, all layers of tissue are captured), in the second - only two-story interrupted sutures (the first row consists of simple sutures through the thickness of the walls being stitched, and the second without puncture of the mucous membrane).

The main purpose of the anastomosis is to restore the continuity of the intestine after resection and to form a passage in case of intestinal obstruction. This technique allows you to save life and at least partially compensate for the role of removed organs. Even with (removal of half the colon with the formation of a bone fracture - unnatural anus, brought to the front abdominal wall) it allows you to save most intestinal functionality.

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult your doctor!

Intestinal anastomosis is a complex operation that is performed only in cases of extreme necessity and in 4-20% of cases leads to various complications.

What is intestinal anastomosis, and in what cases is it prescribed?

Fistulas are a cause of colon cancer.

Anastomosis is the joining of two hollow organs and their suturing. In this case we're talking about about stitching together two parts of the intestine.

There are two types of intestinal operations that require subsequent anastomosis - enteroctomy and resection.

In the first case, the intestine is cut to remove the foreign body from it.

During resection, you cannot do without an anastomosis; in this case, the intestine is not just cut, but part of it is also removed, after which only two parts of the intestine are stitched together in one way or another (varieties of anastomosis).

Bowel anastomosis is serious surgical procedure. It is carried out under general anesthesia, and after it the patient requires long-term rehabilitation, and complications cannot be ruled out. Bowel resection with anastomosis may be prescribed in the following cases:

Colon cancer. Colon cancer is the leading cancer among oncological diseases found in developed countries. The cause of its occurrence may be fistulas, polyps, ulcerative colitis, and heredity. Resection of the affected area followed by anastomosis is prescribed in the initial stages of the disease, but can also be carried out in the presence of metastases, since leaving the tumor in the intestine is dangerous due to possible bleeding and intestinal obstruction due to tumor growth.
Intestinal obstruction. Obstruction may occur due to a foreign body, tumor, or severe constipation. In the latter case, you can rinse the intestines, but for the rest, you will most likely have to undergo surgery. If the intestinal tissue has already begun to die due to compressed vessels, part of the intestine is removed and an anastomosis is performed.
Intestinal infarction. With this disease, the flow of blood to the intestines is disrupted or completely stops. This dangerous condition, leading to tissue necrosis. It is more common in older people with heart disease.
Crohn's disease. It's a whole complex various conditions and symptoms that lead to intestinal dysfunction. This disease has no cure surgically, but patients have to undergo surgery, since life-threatening complications may arise during the course of the disease.

This video will tell you about colon cancer:

Preparation and procedure

Espumisan eliminates gases.

Such serious procedure, like intestinal anastomosis, requires careful preparation. Previously, preparation was carried out using enemas and diet.

Now the need to follow a slag-free diet remains (for at least 3 days before the operation), but the day before the operation the patient is prescribed the drug Fortrans, which quickly and efficiently cleanses the entire intestine.

Before surgery, you should completely avoid fried foods, sweets, hot sauces, some cereals, beans, seeds and nuts.

You can eat boiled rice, boiled beef or chicken, and simple crackers. You should not break your diet, as this can lead to problems during surgery. Sometimes before surgery it is recommended to drink Espumisan to eliminate gases.

The day before the procedure, the patient only has breakfast and starts taking Fortrans from lunch. It is available in powder form. You need to drink at least 3-4 liters of the diluted drug (1 sachet per liter, 1 liter per hour). After taking the drug, painless watery stools begin within a couple of hours.

Fortrans is considered the most effective drug for preparing for various manipulations on the intestines. It allows you to completely clean it short time. The procedure itself is performed under general anesthesia. Anastomosis has 3 types:

"End to end." The most effective and frequently used method. It is possible only if the parts of the intestine being connected do not have big difference in diameter. If it consists of slightly smaller parts, the surgeon slightly incises it and increases the lumen, and then sews the parts together edge to edge.
"Side to side." This type of anastomosis is performed when a significant part of the intestine has been removed. After the resection, the doctor sutures both parts of the intestine, makes incisions and stitches them side to side. This surgical technique is considered the simplest.
"End to side." This type of anastomosis is suitable for more complex operations. One of the parts of the intestine is stitched tightly, making a stump and first squeezing out all the contents. The second part of the intestine is sewn to the side of the stump. Then a neat incision is made on the side of the deaf intestine so that its diameter coincides with the second part of the intestine and the edges are sutured.

Postoperative period and complications

Eating cereals will reduce the load on the intestines.

After intestinal surgery, the patient must undergo a mandatory rehabilitation course. Unfortunately, complications after intestinal resection are very common even with highly professional surgeons.

In the first days after surgery, the patient is observed in the hospital. Minor bleeding is possible, but it is not always dangerous. Seams are regularly inspected and processed.

For the first time after surgery, you can only drink still water; after a few days, liquid food is acceptable. This is due to the fact that after such a serious operation you need to reduce the load on the intestines and avoid bowel movements for at least the first 3-4 days.

Proper nutrition is especially important during the postoperative period. It should provide loose stools and replenish the body's strength after abdominal surgery. Only those products that do not cause increased gas formation, constipation and do not irritate the intestines.

Liquid cereals, dairy products, after a while fiber (fruits and vegetables), boiled meat, and puree soups are allowed.

Complications after surgery may appear due to the fault of the patient himself (non-compliance with the regime, poor nutrition, increased physical activity), and due to circumstances. Complications after anastomosis:

Infection. Doctors in the operating room follow all safety rules. All surfaces are disinfected, but even in this case it is not always possible to avoid infection of the wound. With infection, redness and suppuration of the suture, fever, and weakness are observed.
Obstruction. The intestines may stick together after surgery due to scarring. In some cases, the intestine becomes bent, which also leads to obstruction. This complication may not appear immediately, but some time after the operation. It requires repeated surgery.
Bleeding. Abdominal surgery is most often accompanied by blood loss. Internal bleeding is considered the most dangerous after surgery, since the patient may not notice it immediately.

It is impossible to completely protect yourself from complications after surgery, but you can significantly reduce the likelihood of their occurrence if you follow all the doctor’s recommendations and undergo regular preventive examination After surgery, follow nutritional rules.

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What is intestinal anastomosis and why is it done?

Types of intestinal surgeries

Resection means surgical removal of an organ or part of it. Before performing it, the doctor assesses the viability of the intestinal wall (color, ability to contract, presence of an inflammatory process). After the doctor marks the boundaries of the resected area, he selects the type of anastomosis.

Methods of anastomosis

There are several ways to perform an anastomosis. Let's look at them in detail.

Overlay methods

This type is considered the most effective and is most often used if the difference in the diameter of the compared ends of the intestine is not very large. On the one that has a smaller diameter, the surgeon makes a linear incision to increase the lumen of the organ. Upon completion of resection sigmoid colon(this is the final area of the colon before moving into the rectum) they use this particular technique.

After intestinal surgery, the patient must undergo a course of rehabilitation: breathing exercises, therapeutic exercises, physical and dietary therapy. Together, these components will greatly increase the chances of effective recovery of the body.

Side to side

It is used when resection of a large area is necessary or when there is a risk of severe tension at the anastomotic site. Both ends are closed with a double-row suture, and then the stumps are sutured with a continuous Lambert suture. Moreover, its length is 2 times the diameter of the lumen. The surgeon makes an incision and opens both stumps along the longitudinal axis, squeezes out the contents of the intestine, and then closes the edges of the wound with a continuous suture.

This method is used in case of large-scale intestinal resection or when there is a threat of strong tension in the anastomotic area. In this case, both ends of the intestine are sutured with a double suture, but incisions are made on their lateral parts, which are then sutured side to side with a continuous suture. The lateral fistula between the intestines should be twice as long as the diameter of the lumen of the ends.

The next stage is when the surgeon makes a longitudinal incision and opens the efferent part of the intestine. Its length should correspond to the width of the open end of the organ. The anterior part of the anastomosis is also sutured with a continuous suture. This type of anamostosis is optimal for many interventions, even such complex ones as extirpation of the esophagus (meaning its complete removal, including the nearest lymph nodes and fatty tissue).

The main purpose of the anastomosis is to restore the continuity of the intestine after resection and to form a passage in case of intestinal obstruction. This technique allows you to save life and at least partially compensate for the role of removed organs. Even with hemicolectomy (removal of half of the colon with the formation of a bone fracture - an unnatural anus brought to the anterior abdominal wall), it allows you to preserve most of the functionality of the intestine.

Surgery on the rectum for oncology almost always involves its removal, especially if the tumor is “low”, that is, located close to the anus (less than 6 cm). The formation of an anastomosis is the only way to restore its patency, most often if an anterior resection of the organ is performed.

In 4-20% of cases (depending on the condition of the tissues and the professionalism of the doctor), complications arise: obstruction, insufficient sutures, peritonitis. To minimize the risk, the surgeon must carry out thorough sanitation of the suture and nearby areas on the lumen side.

Advice: to reduce the likelihood of complications, the patient should follow all the doctor’s recommendations and remember to independently monitor the connection. For example, in order to minimize the threat of developing narrowing and obstruction after removal of the stomach, it is worth regularly undergoing X-ray examinations.

Intestinal anastomosis is a unique surgical technique that allows you to connect hollow organs and at least partially restore the functionality of the intestine. Different ways overlays are used depending on the type of operation. To maximize the effectiveness of the anastomosis, the doctor needs to follow the technology and carefully treat the seam with antiseptics.

Intestinal anastomoses

Intestinal anastomosis is a necessary surgical measure performed after certain types of surgery.

Types of intestinal surgeries

The anastomosis technique is used for intestinal resection, removal of the affected area of the intestine in order to restore the viability and functionality of the organ. The need for intestinal resection may be prompted by:

What is anastomosis?

This is a procedure for fusion (natural way) or stitching (artificial process) of two hollow organs, creating a fistula between them. Natural processes occur mainly between capillaries and vessels, and have a beneficial effect on blood circulation throughout the body and internal organs of a person. Artificial anastomoses are applied between hollow organs, if necessary, using surgical thread, special instruments and the skillful hands of an experienced surgeon. An intestinal anastomosis can be laid between the intestines to connect them in the event of removal of part of the intestine, or to create a bypass channel in the event of intestinal obstruction. If the operation is performed at the junction of the stomach and small intestine, in this situation a gastroenteroanastomosis is performed.

Depending on the location, the interintestinal anastomosis is divided into small-intestinal, small-colic, and large-colic. Single-layer sutures are made on the small intestine - all balls of tissue are stitched. The large intestine is sewn with two-story interrupted sutures. The first row is sutures through all layers of tissue, the second row of sutures is done without touching the mucous membrane.

sewn with two-layer interrupted seams. The first row is sutures through all layers of tissue, the second row of sutures is done without touching the mucous membrane.

Overlay methods

This method of anastomosis is used when the diameter of the connected parts of the intestine is almost the same. In this case, the smaller end is slightly cut and thus enlarged to the size of the second end, then these parts are sewn together. This type of anastomosis is considered the most effective and is ideal for similar operations on the sigmoid colon.

the smaller end is cut slightly and thus enlarged to the size of the second end, then these parts are sewn together. This type of anastomosis is considered the most effective and is ideal for similar operations on the sigmoid colon.

Side to side method

This method is used in case of large-scale intestinal resection or when there is a threat of strong tension in the anastomotic area. In this case, both ends of the intestine are sutured with a double suture, but incisions are made on their lateral parts, which are then sutured side to side with a continuous suture. The lateral fistula between the intestines should be twice as long as the diameter of the lumen of the ends.

This type of anastomosis is used for more complex operations when significant intestinal resection is required. It looks like this. One end of the intestine is tightly sutured, creating a stump. The two ends of the intestine are then sutured side by side. An incision is made in the side of the stump, equal to the diameter of the hole in the second sewn end of the intestine. The end hole is sutured to the side incision on the stump.

when significant bowel resection is required. It looks like this. One end of the intestine is tightly sutured, creating a stump. The two ends of the intestine are then sutured side by side. An incision is made in the side of the stump, equal to the diameter of the hole in the second sewn end of the intestine. The end hole is sutured to the side incision on the stump.

Despite all the positive aspects of this procedure, there are cases when the imposed intestinal anastomosis shows its failure. This manifests itself in different ways and at the beginning the consequences can be completely invisible, without revealing any symptoms. However, bloating, increased heart rate, and fever may then appear. Then the patient develops peritonitis or the release of feces through the resulting fistula. These consequences of anastomotic failure may be accompanied by septicemic shock (the patient's blood pressure drops, the skin turns pale, urine does not enter the bladder, acute heart failure occurs, and fainting occurs).

The diversity of causes that are the causative agents of the symptoms that appear indicates that anastomotic failure can occur in all operated patients. Therefore, after surgery, every patient needs active health monitoring. If the patient does not show positive dynamics, and his condition worsens, you should sound the alarm and figure out what’s wrong. In such a situation, an x-ray of the chest and peritoneum, an extensive analysis of the cellular composition of the blood, computed tomography, irrigoscopy with a contrast agent are immediately prescribed. If the anastomosis fails, the level of leukocytes in the blood often rises, and x-rays show dilation of the intestinal loops.

Treatment of anastomotic leak

Elimination of insolvency depends on the cause of its occurrence. Patients with extensive peritonitis are prescribed laparotomy. In this case, the anastomosis is removed, the stitched ends of the intestines are renewed, and the anastomosis is reconstructed. After this, the intestines are thoroughly washed with saline with the addition of antibiotics. Next, the patient receives antibacterial therapy intravenously for 5 days.

In patients with local peritonitis the situation is simpler. It is enough for them to undergo a course of antibacterial therapy administered intravenously. However, if no improvement is observed, then laparotomy should not be delayed. If a fecal fistula has formed in the wound, then you can also do without a scalpel. If the fistula does not go away for a long time, the patient may need artificial nutrition. Special attention in this case, you need to apply it to the surrounding areas of the skin so that the feces do not cause irritation.

Complications

Complications after intestinal anastomosis may include:

Infection in a wound can occur both in the operating room and through the fault of a patient who does not follow the prescribed hygiene rules. The infection is accompanied by weakness of the patient, high temperature, redness and suppuration of the wound. Obstruction occurs due to kinking or sticking together of the intestines due to scarring. This outcome requires secondary surgery. An anastomosis to the intestine involves abdominal surgery, which is often accompanied by blood loss. In this case, you should be wary of the opened internal bleeding, which is not immediately detectable.

Anastomosis

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First health care. - M.: Bolshaya Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M.: Soviet Encyclopedia. - 1982-1984

See what “Anastomosis” is in other dictionaries:

ANASTOMOSIS - (from the Greek anastomosis opening) (ostium), 1) in animals and humans, a side branch (channel) connecting vessels, nerves, excretory ducts, hollow organs. An artificial anastomosis is performed surgically.2) In higher plants, the connection... ... Big Encyclopedic Dictionary

ANASTOMOSIS - (Greek) coincidence; in anatomy the connection of two blood vessels or lymphatic vessels or nerves for the purpose of their fusion. Dictionary of foreign words included in the Russian language. Pavlenkov F., 1907. anastomosis (gr. anastomosis hole, exit) ... ... Dictionary of foreign words of the Russian language

anastomosis - anastomosis, connection, anastomosis Dictionary of Russian synonyms. anastomosis noun, number of synonyms: 5 connection (277) ... Dictionary of synonyms

ANASTOMOSIS - (from the Greek anastomosis, opening, exit), in animals, a connection between two blood or lymphatic vessels. vessels or two nerves. In higher plants, connections between tubular structures, e.g. veins in leaves, branches of laticifers, etc. ... Biological encyclopedic dictionary

anastomosis - A connection between two vessels (blood or lymphatic), two nerve fibers or two hollow organs, in plants A. a connection between two tubular anatomical elements, in fungi A. a connection between two hyphae. [Arefyev V.A.,... ...Handbook of technical translator

ANASTOMOSIS - English anastomosis German Anastomose French anastomose see > ... Phytopathological dictionary-reference book

anastomosis - (from the Greek anastómōsis opening, outlet) (ostium), 1) in animals and humans, a side branch (channel) connecting vessels, nerves, excretory ducts, hollow organs. An artificial anastomosis is performed surgically. 2) In higher plants, the compound ... Encyclopedic Dictionary

anastomosis - the connection of two hollow organs; for example, arteriovenous anastomosis. anastomosis connecting arteries and veins. Source: Medical Popular Encyclopedia ... Medical Terms

Anastomosis - This article needs to be completely rewritten. There may be explanations on the talk page. Anastomosis (from the Greek ... Wikipedia

anastomosis - anastomosis anastomosis. A connection between two vessels (blood or lymphatic), two nerve fibers or two hollow organs, in plants A. a connection between two tubular anatomical elements, in fungi A. a connection between two ... ... Molecular biology and genetics. Dictionary.

Intestinal anastomoses

In anatomy, natural anastomoses are called anastomoses of large and small vessels in order to enhance the blood supply to an organ or support it in case of thrombosis of one of the directions of blood flow. Intestinal anastomosis is an artificial connection created by a surgeon between the two ends of the intestinal tube or intestine and a hollow organ (stomach).

The purpose of creating such a structure is:

ensuring the passage of the food bolus in more lower sections for continuity of the digestive process;
formation of a workaround in case of a mechanical obstacle and the impossibility of its removal.

Operations can save many patients, provide them with fairly good health, or provide assistance to prolong life in the case of an inoperable tumor.

What types of anastomoses are used in surgery?

Anastomosis is distinguished based on the connected parts:

esophageal - between the end of the esophagus and duodenum bypassing the stomach;
gastrointestinal (gastroenteroanastomosis) - between the stomach and intestines;
interintestinal.

The third option is a mandatory component of most intestinal surgeries. Among this type are anastomoses:

small-colic,
small intestine,
colonic.

In addition, in abdominal surgery (a section related to operations on the abdominal organs), it is customary, depending on the technique of performing the connection of the adductor and abducent areas, to distinguish certain types anastomoses:

What should the anastomosis be like?

The created anastomosis must correspond to the expected functional goals, otherwise there is no point in operating on the patient. The main requirements are:

ensuring sufficient lumen width so that the narrowing does not impede the passage of contents;
absence or minimal interference in the mechanism of peristalsis (contraction of intestinal muscles);
complete tightness of the seams providing the connection.

If one specialist cannot decide what to do with the patient, a consultation is held

It is important for the surgeon not only to determine what type of anastomosis will be performed, but also with what suture to fasten the ends. This takes into account:

intestinal section and its anatomical features;
Availability inflammatory signs at the site of surgery;
intestinal anastomoses require a preliminary assessment of the viability of the wall; the doctor carefully examines it by color and ability to contract.

The most commonly used classic seams are:

Gambi or nodal - needle punctures are made through the submucosal and muscular layers, without capturing the mucous membrane;
Lambert – stitched serosa(external to intestinal wall) and muscle layer.

Description and characteristics of the essence of anastomoses

The formation of an intestinal anastomosis is usually preceded by the removal of part of the intestine (resection). Next, it becomes necessary to connect the adducting and efferent ends.

End to end type

Used to sew together two identical sections of the large intestine or small intestine. Performed with a two- or three-row seam. Considered to be the most beneficial in terms of compliance anatomical features and functions. But technically difficult to implement.

The condition for connection is that there is no big difference in the diameter of the compared sections. The end that is smaller in clearance is cut to ensure full compliance. The method is used after resection of the sigmoid colon, in the treatment of intestinal obstruction.

First, the posterior wall of the anastomosis is formed, then the anterior one

End-to-side anastomosis

The method is used to connect sections of the small intestine, or the small intestine on one side and the large intestine on the other. Usually the small intestine is sutured to the side of the wall of the large intestine. Provides 2 stages:

At the first stage, a dense stump is formed from the end of the efferent intestine. The other (open) end is applied to the intended anastomosis site from the side and sutured along back wall Lambert seam.
Then an incision is made along the abductor colon along a length equal to the diameter of the adductor section and the anterior wall is sutured with a continuous suture.

Side to side type

It differs from previous options in the preliminary “blind” closure with a double-row suture and the formation of stumps from connected intestinal loops. The end above the stump is connected with the lateral surface to the underlying area by a Lambert suture, which is 2 times longer than the diameter of the lumen. It is believed that technically performing such an anastomosis is the easiest.

It can be used both between homogeneous sections of the intestine and to connect dissimilar areas. Main indications:

the need for resection of a large area;
danger of overstretching in the anastomosis area;
small diameter of connected sections;
formation of an anastomosis between small intestine and stomach.

The advantages of the method include:

no need to suture the mesenteries of different areas;
tight connection;
guaranteed prevention of intestinal fistula formation.

With side-to-side anastomosis, the preliminary creation of stumps is one of the disadvantages of the technique

Side to end type

If this type of anastomosis is chosen, this means that the surgeon intends to sew the end of the organ or intestine after resection into the created hole on the lateral surface of the afferent intestinal loop. More often used after resection of the right half of the large intestine to connect the small and large intestines.

The connection can have a longitudinal or transverse (more preferable) direction with respect to the main axis. In the case of a transverse anastomosis, less is crossed muscle fibers. This does not disrupt the peristalsis wave.

Preventing complications

Complications of anastomoses may include:

seam divergence;
inflammation in the anastomosis area (anastomositis);
bleeding from damaged vessels;
formation of fistula tracts;
formation of narrowing with intestinal obstruction.

To avoid adhesions and intestinal contents entering the abdominal cavity:

the surgical site is covered with napkins;
the incision for suturing the ends is carried out after clamping the intestinal loop with special intestinal sponges and squeezing out the contents;
the incision of the mesenteric edge (“window”) is sutured;
the patency of the created anastomosis is determined by palpation before completion of the operation;
V postoperative period broad-spectrum antibiotics are prescribed;
The rehabilitation course necessarily includes a diet, physiotherapy and breathing exercises.

Modern methods of protecting anastomoses

In the immediate postoperative period, anastomositis may develop. Its cause is considered to be:

inflammatory reaction to suture material;
conditional activation pathogenic flora intestines.

To treat subsequent cicatricial narrowing of the esophageal anastomosis, polyester stents (expandable tubes that support the walls in an expanded state) are installed using an endoscope.

To strengthen the sutures in abdominal surgery, autografts are used (suturing one’s own tissue):

from the peritoneum;
oil seal;
fat deposits;
mesenteric flap;
seromuscular flap of the stomach wall.

However, many surgeons limit the use of the omentum and peritoneum on a pedicle with a blood supply to only the last stage of colon resection, since they consider these methods to be the cause of postoperative purulent and adhesive processes.

The process of anastomosis is painstaking work

Various drug-filled protectors for suppressing local inflammation are highly favored. These include glue with biocompatible antimicrobial content. into it for protective function included:

As well as antibiotics and antiseptics:

Surgical glue becomes stiff as it hardens, so the anastomosis may become narrowed. Gels and solutions are considered more promising hyaluronic acid. This substance is a natural polysaccharide, secreted by organic tissues and some bacteria. It is part of the intestinal cell wall, so it is ideal for accelerating the regeneration of anastomotic tissue and does not cause inflammation.

Hyaluronic acid is included in biocompatible self-absorbable films. A modification of its compound with 5-aminosalicylic acid (the substance belongs to the class of non-steroidal anti-inflammatory drugs) is proposed.

The intestinal sphincter is applied along the longitudinal axis, allowing you to safely isolate the area required for resection

Postoperative atonic constipation

Coprostasis (stagnation of feces) appears especially often in elderly patients. Even short term bed rest and their diet disrupts intestinal function. Constipation can be spastic or atonic. Loss of tone is relieved as the diet expands and physical activity increases.

To stimulate the intestines, on days 3–4 a cleansing enema is prescribed in a small volume with hypertonic saline solution. If the patient needs to avoid food intake for a long time, Vaseline oil or Mucofalk is used internally.

For spastic constipation it is necessary:

relieve pain with medications with an analgesic effect in the form of rectal suppositories;
reduce the tone of the rectal sphincters using antispasmodic drugs (No-shpy, Papaverine);
To soften stool, make microenemas from warm Vaseline oil on a solution of furatsilin.

They have an osmotic effect:

Glauber's and Carlsbad salts;
magnesium sulfate;
lactose and lactulose;
Mannitol;
Glycerol.

Laxatives that increase the amount of fiber in the colon - Mucofalk.

Early treatment of anastomositis

To relieve inflammation and swelling in the suture area, the following is prescribed:

antibiotics (Levomycetin, aminoglycosides);
when localized in the rectum - microenemas from warm furatsilin or by installing a thin probe;
soft laxatives based on petroleum jelly;
Patients are recommended to take up to 2 liters of liquid, including kefir, fruit drink, jelly, compote to stimulate the passage of intestinal contents.

If intestinal obstruction develops

The occurrence of obstruction can cause swelling of the anastomosis area and cicatricial narrowing. When acute symptoms A repeat laparotomy is performed (an incision in the abdomen and opening of the abdominal cavity) to eliminate the pathology.

In case of chronic obstruction in the long-term postoperative period, intensive antibacterial therapy, removal of intoxication. The patient is examined to decide whether surgical intervention is necessary.

Any complications require treatment

Technical reasons

Sometimes complications are associated with inept or insufficiently qualified surgery. This is caused by excessive tension of the suture material and unnecessary application of multi-row sutures. Fibrin falls out at the junction and mechanical obstruction forms.

Intestinal anastomoses require compliance with the surgical technique, careful consideration of the condition of the tissues, and the skill of the surgeon. They are applied as a result of surgery only in the absence of conservative methods treatment of the underlying disease.

Marble anastomosis. Anastomosis to the alimentary canal

End to end artery anastomosis

End to side artery anastomosis

Side to side anastomosis

Additional techniques for arterial anastomoses

Types of intestinal surgeries

What is anastomosis?

sewn with two-layer interrupted seams. The first row is sutures through all layers of tissue, the second row of sutures is done without touching the mucous membrane.

Overlay methods

the smaller end is cut slightly and thus enlarged to the size of the second end, then these parts are sewn together. This type of anastomosis is considered the most effective and is ideal for similar operations on the sigmoid colon.

Types of intestinal surgeries

Methods of anastomosis

What is intestinal anastomosis, and in what cases is it prescribed?

Preparation and procedure

Postoperative period and complications

What is intestinal anastomosis and why is it done?

Types of intestinal surgeries

Methods of anastomosis

Overlay methods

Side to side

Intestinal anastomoses

Types of intestinal surgeries

What is anastomosis?

sewn with two-layer interrupted seams. The first row is sutures through all layers of tissue, the second row of sutures is done without touching the mucous membrane.

Overlay methods

the smaller end is cut slightly and thus enlarged to the size of the second end, then these parts are sewn together. This type of anastomosis is considered the most effective and is ideal for similar operations on the sigmoid colon.

Treatment of anastomotic leak

Complications

Anastomosis

See what “Anastomosis” is in other dictionaries:

Intestinal anastomoses

What types of anastomoses are used in surgery?

What should the anastomosis be like?

Description and characteristics of the essence of anastomoses

End to end type

End-to-side anastomosis

Side to side type

Preventing complications

Modern methods of protecting anastomoses

Postoperative atonic constipation

Early treatment of anastomositis

If intestinal obstruction develops

Technical reasons

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