Immediate results of treatment of necrosis of colon transplantat after sphincter-sparing surgery in patients with rectal cancer
DOI:
https://doi.org/10.11603/2414-4533.2018.1.8862Keywords:
necrosis of the colon transplantat, colostomy, sphincter-saving operations, postoperative mortality.Abstract
The aim of the work: to increase the effectiveness of treatment of patients with rectal cancer.
Materials and Methods. The material for the work was data on 271 patients with necrosis of the colon transplantat. All patients with this complication were divided into two groups: control (176 patients) and study (95 patients).
Results and Discussion. For the treatment of patients in the control group, colostomy was used; for the treatment of patients in the study group it was optimized the treatment approach depending on the time of its onset and the level of necrosis: in patients with early high necrosis of the colon transplantat, amputation of the colon transplantat should be performed, in patients with early low necrosis of the colon transplantat should be performed re-pull through operation from the side of the perineum; in patients with late necrosis of the colon transplantat, disconnection of the left half of the colon shold be performed by forming a loop transversome on the right side of the colon with simultaneous tamping of the pelvic cavity and am putation of the canal to prevent its stenosis.
Intraoperative complications were indicated in (10.3±1.8) %, in the control group – in (13.1±2.5) %. The use of the new approach let to reduce (p <0.05) the risk of postoperative complications in this category of patients, RR = 0.54 (95 % CI 0.29–0.99) compared to the previously used technique. The incidence of postoperative complications was (21.6±3.1) % in the control group and (11.6±3.3) % in the study group. Thanks to the use of the developed treatment tactics, the decrease in postoperative mortality was reduced in 2 times – from (12.5±2.5) % (22 patients) to (6.2±2.5) % (6 patients).
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