Pathogenesis of anastomotic integrity disorder and prevention program for surgical treatment of colon diseases

Abstract

Introduction. The leading role in impaired healing of intestinal suture belongs to intestinal hypertension (IH), which occurs as a result of disorders of the motor-evacuation function of the gastrointestinal tract in the postoperative period. It has been proved that intestinal pressure (IP) (P) leads to local disturbance of capillary blood flow, changes in the interaction of sympathetic and parasympathetic innervation, hypoxia of the mucous membrane of the intestinal wall. The aim of the study. To establish the relationship of IP with the integrity of intestinal anastomosis and to suggest ways of their prevention in the surgical treatment of diseases of the colon. Materials and methods. In a group of 30 patients, IP was measured in the postoperative period. Pressure meas-urements were performed by the Waldman method for 72 h. from the time of surgery, every 4 hours. At the same time were performed 2 measurements – before and after lavage of transanal drainage. The primary operation in all patients was resection of the sigmoid colon with the formation of an end-colostomy. The re-intervention was performed 3 months after the initial operation. When performing reoperation, colon anastomosis (CA) according to the developed method was performed in 17, manual two-row CA – 3, machine CA – 10 patients. Results of the study and their discussion. It was established that in the postoperative period in the colon there was an increase of IP during the first 24-36 h. to an average of 5.3 ± 0.1 mm Hg., with a further decrease in this level over the next 12-20 h. to 2.1 ± 0.3 mm Hg. After 20 minutes after transanal drainage lavage, the IP level decreased by an average of 3.0 ± 1.3 mm Hg. This decrease was maintained for 3-5 h., after which a gradual increase in the level of IP was noted. When using a traditional two-row anastomosis, 2 patients noted a complicated course of the postoperative period – one patient noted the failure of CA, the other – anastomositis. CA by developed method was made in 17 patients. Machine CA was applied in 10 patients, anastomositis developed in 1 patient. It was found that in all patients with advanced disorders of the healing of the intestinal suture (with anastomositis, fai lure of CA) increased IP was after 16-60 h. to 11.4 ± 0.2 mm Hg. with the peak of it’s level 16,3-17,1 mm Hg. Similar dynamics of pressure were observed up to the development of intestinal suture failure, after which there was a sharp decrease in IP. With anastomositis such a sharp decrease in IP wasn’t noticed. It was not only important the increase of the IPT with a cri tical level up to 16.3-17.1 mm Hg. but also the duration of exposure for 12-18 hours. Considering that a significant factor is the IP, measures aimed at reducing or eliminating this factor in the postoperative period will be justified. Pr eventive measures for impaired healing consist of measures aimed at intraluminal hypertension and measures aimed at elimina ting or reducing the effects of contributing local and general factors. Conclusions. Uncorrected intestinal hypertension within 16.3-17.1 mm Hg. within 12-18 hours leads to a complicated course of the postoperative period in patients with surgical treatment of diseases of the colon. The program of preventive measures for surgical treatment of diseases of the colon are direct and indirect methods of decompression of intestinal anastomosis.