METHODS OF ILEO-TRANSVERSE AND COLON INVAGINATIONAL ANASTOMOSES CREATING

Summary. The aim of the study. To improve the results of patients with tumors and non-neoplastic diseases of the colon treatment, to introduce into clinical practice the original surgical technique and methods of creating of colon anastomoses, which were tested in experiment. Materials and methods. Original methods of invaginational ileo-transverse and colon anastomoses creating were developed in the experiment on rabbits. Taking into account the obtained positive results, the methods of anastomoses formation were transferred to the surgical clinic and patents of Ukraine were obtained. In 2020, ileo-transverse and colonic anastomoses were formed in 134 patients on the basis of Transcarpathian Antitumor Center: one-row invaginational anastomosis according to the developed method in 22 patients (16.4 %), two-row manual — in 58 (43.3 %), circular stapler — in 36 (26.9 %), linear stapler anastomosis — in 4 (3 %), laparoscopic (linear stapler) — in 14 (10.4 %). Results and discussion. The most of complications occurred in the group with manual two-row anastomosis (16), in two cases the anastomotic leakage was recorded. When using a circular stapler suture, anastomotic leakage was observed in 1 patient, and anastomositis — in 4. When using linear stapler anastomoses, postoperative wound suppuration was observed in 1 patient. Conclusions. The most of early postoperative complications was observed after using a two-row manual colonic anastomosis (27.5 %). When using a circular stapler suture, the number of early postoperative complications was less than with a two-row manual anastomosis (22.2 % vs. 27.5 %, respectively). The least number of complications was recorded after the creation of a one-row invaginational anastomosis in the proposed original technique.

Choosing a method to perform an esophageal-intestinal anastomosis after complete removal of the stomach

The paper reviews various methods of performing esophageal-intestinal anastomoses with complete removal of the stomach (gastrectomy). The main methods of manual and stapler stitching of the esophagus with the jejunum are described. Special attention is paid to detailing of techniques for the most commonly performed esophageal-intestinal anastomoses, with a comparative assessment of the reliability of manual and stapler anastomoses. Given the large number of proposed methods to perform esophageal-intestinal anastomoses, it can be stated that no universal anastomosis yet exists. In laparotomy, a stapler suture is most commonly used to perform an esophageal-intestinal anastomosis with circular crosslinking devices, while the manual version implies one of the invagination techniques, or muff-like anastomosis (the Tsatsanidi K.N., Bondar G.V., Davydov M.I. procedure). With laparoscopic access, the anastomosis is performed with linear endoscopic crosslinking devices. The choice of a technique to perform an esophageal-intestinal joint remains with the operating surgeon and depends on his/hers experience, skills, individual intraoperative situation, and equipment of the operating unit.

Hand-sewn and stapled esophageal anastomosis: experimental study in dogs

PURPOSE: To compare experimentally, the healing of cervical oesophageal anastomoses performed either with stapler or 2-layer hand-sewn sutures. METHODS: Thirty six dogs were randomised to two groups: stapled anastomoses (n = 18); hand-sewn anastomoses (n = 18). Each group was divided into three subgroups, corresponding to the day of sacrifice (3rd, 7th and 14th postoperative day). Healing was assessed by: a) anatopathology b) anastomotic resistance to bursting pressure test; c) quantification of hidroxyproline RESULTS: Group 1 heal by second intention, group 2 showed a healing by first intention. Bursting pressure was similar between groups at day 3, though group 1 animals showed it significantly higher at day 7and day 14 compared with group 2. Statiscally, there were no interaction between the day of sacrifice and groups, as well as there was no difference among the dates of observation regarding the results of hidroxyproline CONCLUSIONS: a) mechanical suture is more resistant than hand-sewn; b) In stapler anastomoses, healing was as secondary union, whereas in hand-sewn anastomoses, healing was by first intention; c) no correlation was found in the results of bursting pressure and hidroxyproline quantification.