Colostomy after obstructive resection of the sigmoid colon. When to performa restorative operation?
DOI:
https://doi.org/10.11603/2414-4533.2020.2.10765Keywords:
reconstructive restorative operations, colon, colostomyAbstract
The aim of the work: improvement of the results of reconstructive restorative operations of colon by determining the optimal timing of their implementation.
Materials and Methods. Treatment results of 152 patients, who underwent reconstructive restorative operations were analysed. Histopathologic structure, endoscopic changes of the rectal stump on the different terms after its disconnection were studied. It allowed us to establish the optimal time for reconstructive restorative operation.
Rresults and Discussion. Analysis and prognosis of regenerative processes in the area of bowel reconstruction is based on the results of morphological studies. Therefore, studies of morphological changes in the proximal and distal colon became the basis for optimizing the timing of reconstructive restorative operations after colostomy. Structural and functional restructuring of the mucous membrane begins in the proximal colon and in the colon stump 1 month after the first phase of surgical treatment and is manifested by the advantage of hyperplastic and reactive-inflammatory changes, which were restored, according to our data, 3 months after stoma application. In the later stages of the research (6 months or more) of the colon stump, a number of trends in the morphofunctional restructuring of the colon are clearly defined. These trends are characterized by a gradual and uneven increase in crypt atrophy with focal regression after 6 months and morphofunctional cell remodeling of the integumentary epithelium. Despite the fact that the number and length of crypts decreases, in the later stages after the first phase of surgical treatment, their architectonics and cellular composition is preserved with a significant predominance of goblet cells. An endoscopic examination of the rectal stump was held at different times. Analyzing the endoscopic picture of the stump of the colon, it was found that in the period of 2.5–3 months the mucous membrane of the stump corresponds to the norm. With an increase of the period of disconnection of the colon, significant changes in the colon wall occur, namely, the folds of the colon are smoothed out, the tone of the wall of colon decreases, arrise atrophic changes in the mucous membrane.
References
Kosovan, V.M. (2010). Vidnovliuvalni operatsii pislia perenesenykh obstruktyvnykh rezektsii syhmopodibnoi kyshky v ranni terminy [Reconstructive operations after suffering obstructive resection of the sigmoid colon in the early stages]. Visnyk Vinnytskoho natsionalnoho medychnoho universytetu – Bulletin of Vinnytsia National Medical University, 14 (1), 119-122 [in Ukrainian].
Poyda, A.I. (2009). Rekonstruktivno-vosstanovitelnye operatsii v khirurgii tolstoy kishki [Reconstructive restorative in colon surgery]. Zdorovye Ukrainy – Health of Ukraine, 12 (1), 44-45 [in Russian].
Poida, O.I., & Melnyk, V.M. (2011). Nespromozhnist shviv anastomoziv v khirurhii tovstoi kyshky [Failure of anastomosis sutures in colon surgery]. Ukrainskyi zhurnal khyrurhii – Ukrainian Journal of Surgery, (2), 44-47 [in Ukrainian].
Mametkuliiev, B.R. (2013). Optymizatsiia rezultativ rekonstruktyvno-vidnovliuiuchykh operatsii pry obstruktyvnykh rezektsiiakh tovstoi kyshky z urakhuvanniam profilaktyky hniino-septychnykh uskladnen [Optimization of the results of reconstructive operations for obstructive bowel diseases and profitable septic complications]. Aktualni pytannia transportnoi medytsyny – Actual Issues of Transport Medicine, (1), 97-107 [in Ukrainian].
Tamm, T.I., Datsenko, B.M., Belov, S.G., & Kirillov, A.V. (2010) Rekonstruktivno-vosstanovitelnye operatsii v koloproktologii [Reconstructive surgery in coloproctology]. Khіrurgіchna persperspektiva — Surgical Perspective, (1), 173-175 [in Russian].
Zakharash, M.P., Zakharash, М.Р., Poyda, А.І., & Melnik, V.M. (2011). Vybor metoda vosstanovitelnogo etapa operatsii pri khirurgicheskom lechenii kolorektalnogo raka [The choice of the method of the recovery phase of the operation in the surgical treatment of colorectal cancer]. Proceedings of the 3rd Сongress of сoloproctologists of Ukraine with the Participation of Countries of Central and Eastern Europe. Odessa, May 18-20. (рр. 257-259) [in Russian].
Kotsubanov, K.V., Yaroshchak, S.V., & Miminoshvili, A.O. (2011). Morfo-funktsionalnoe sostoyanie otklyuchennoy tolstoy kishki v razvitii posleoperatsionnogo pareza pri vosstanovitelnykh operatsiyakh [Morphological and functional state of the disabled colon in the development of postoperative paresis during recovery operations]. Ukrainskyi zhurnal khirurhii – Ukrainian Journal of Surgery, (1), 136-139 [in Russian].
Shaprynskyi, V.O., & Shalyhin, S.M. (2012). Vybir optymalnoho terminu vykonannia rekonstruktyvno-vidnovliuiuchykh operatsii na tovstii kyshtsi [The choice of the optimal term for reconstructive surgery on the colon]. Klinichna anatomiia ta operatyvna khirurhiia – Clinical Anatomy and Surgery, (3), 106-107 [in Ukrainian].
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish their work in Hospital Surgery. Journal by L. Ya. Kovalchuk agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
