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Surgical tactics in reconstruction of colon at patients with colostomas in the ratio with morphofunctional peculiarities of excluded loop


Author: Valentin Bendelic
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2006
Scientific adviser: Vladimir Hotineanu
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 15 November, 2006
Approved by NCAA on the 21 December, 2006

Abstract

Adobe PDF document1.12 Mb / in romanian

Thesis

CZU 616.345-089.844

Adobe PDF document 3.50 Mb / in romanian
114 pages


Keywords

colostoma, excluded atonic loop, short rectal stump, hidromasage, balloonography

Summary

Reconstructive intervention of digestive tract at patients with colostomas is continuing to be the only chance of socio-professional rehabilitation of these patients, taking into consideration at the same time that this type of surgery is characterized with high rate of postoperative complications including anastomotic insufficiency. The unfavorable type of complications like anastomotic insufficiency is coursed by morpho-functional changes on the level of excluded from passage intestinal loop.

The dissertation was performed in surgical clinic 1 professorship of surgery 2 of state Medical University “N. Testemiteanu”. 144 patients with stomas during the period 1993-2005 were admissed and treated in surgical clinic. Patients were divided into 2 groups: group I retrospective (admissed in surgical clinic from 1993 to 1996) and group II (basic) – all the patients treated from 1997 up to present, to whom were applicated special program of investigations and preoperative preparing.

Diagnostical algorithm of patients with colostomas included rectoromanoscopy, sphyncteromanometry, irigoscopy, ultrasound exams, balloonography of excluded from the passage intestinal loop, morphology. On the base of imaging methods in 23 (26,1%) of cases was established the atony of excluded from the passage intestinal loop. This group of patients were considered as a risk group and were underlied to special preoperative program with the aim to achieve the functional restoring of excluded from the passage intestinal loop through the application of hydro or pneumomassage of affected segment. Reconstructive intervetion was performed only after functional restoring of affected part, recorded by control balloonography.

To all patients, independed of the type of stoma, was applied the intraperitoneal method of colostomas closing. In terminal colostomas as a rule were performed end-to-end anastomosyses, in cases of bicolostomas we preferred lateral enteroraphy (type ¾ Melnicov).

In situations with short excluded distal part less than 10 cm to the patients from group II was practiced subpelvic translocation of anastomosis with installation of special system of the retroperitoneal draining, which assured the additional protection of applicated derivation.

Thus, considered that application of diagnostico-curative algorithm with identification of motility disturbances on the level of excluded part and functional restoration of this segment in cases of atony, applicated to patients from basic group of study, permitted us to decrease the frequency of anastomotic insufficiency from 7,2% to 3,4%.