Intracolonic pressure at reconstructive-restorative surgery in ostomy patients
DOI:
https://doi.org/10.11603/2414-4533.2020.1.10741Keywords:
intracolonic pressure, large intestine anastomosis, reconstructive operation, stomaAbstract
The aim of the work: to improve treatment outcomes in patients with surgical pathology of the colon by working-out and implementing pathogeneticly grounded treatment algorithm and anastomosis creation technology, aimed at reducing the frequency of postoperative complications.
Materials and Methods. The intracolonic pressure (ICP) was measured in the postoperative period in a group of 30 patients. During the operation, except transanal drainage, which was located higher from anastomosis by 5–10 cm, was inserted a tube with diameter of 0.5 cm., which end was located at large intestine anastomosis (LIA). Pressure measurement was performed by Waldman method within 72 hours after the operation, every 4 hours. There were performed 2 measurements – before and after lavage of transanal drainage. During performing reconstructive operation worked-out LIA technique was performed 17 times, two-row suture manual LIA – 3, machine LIA -10.
Results and Discussion. It was found that in the postoperative period the ICP was increasing during the first 24–36 hours to an average of (5.3±0.1) mm Hg, with a further reduction of it’s level over the next 12–20 hours to (2.1±0.3) mm Hg. In 20 minutes after the lavage of transanal drainage the ICP reduced by an average of (3.0±1.3) mm Hg. This decreasing was detained for 3–5 hours, then was noticed a gradual increasing of ICP. In case of using traditional two-row suture anastomosis in 2 patients was noticed complicated postoperative period – the anastomotic leakage in one patient, the second had anastomositis. Worked-out LIA technique was used in 17 patients, machine LIA – in 10 patients, while anastomositis developed in 1 patient. It was found that in all patients with disorders of suture wound healing was marked the increasing of ICP after 16–60 hours to (11.4±0.2) mm Hg, with a peak of ICP (16.3–17.1) mm Hg. This dynamic of pressure was observed until the development of intestinal suture failure (anastomotic leakage), with a reduction of ICP after it. In patients with anastomositis such a reduction of ICP wasn’t noticed. It had importance not only the increasing the level of pressure 16.3–17.1 mm Hg, but it’s duration for 12–18 hours.
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