Abstract
The implementation of conventional and laparoscopic intestinal joining is a problem, remotely solved. Along with many routine methods described, different modifications with automatic staplers are presented, each of certain value and benefits. Achieving an appropriate balance between price, reliability and health benefits is the operator-surgeon responsibility, sometimes in a condition of emergency. We aimed at assessing the safety and effectiveness of the fulfillment of end-to-end continuous anastomoses in the intraabdominal intestinal relations. Author`s own experience of 88 consecutive intra-abdominal anastomoses was presented. They were performed in the period from 01.01.2010 to 30.06.2013, since the technique has been applied. Patients were evaluated in the following groups: Group 1 - after colonic resections: right, intermediate, left hemicolectomies, resection of sigma or rectosigmoid, subtotal colectomy (N1=56, 63,6%). Group 2 - after restoring passages operation, regarding low rectal resection with double-loop protective ileostomy or transversostomy (N2=24, 27,3%). Restoring the transversostomy was performed with partial anastomosis preserving the mesenteric side of the intestine. Group 3 - patients after internal derivation (N3=8, 9,1%). Modified and applied two-layer end-to-end technique suitable for double differences in lumens, with adequate correction approach and saving blood supply of the mesentery. Digital hedging during the implementation of the second floor of the anastomosis allows additional control over the achievement of the other important for success factors: adequate lumen and tight attachment of the bowel ends serous surfaces. A total of 4 (4,54%) of the patients monitored had complications in the form of late postoperative paresis (in three patients until postoperative day 7) and partial insufficiency in one (sigmoid resection). All they were overcome conservatively. There was one exitus (1,14%) after cardiac death on the 6th postoperative day. Three of the patients were operated under a condition of urgency and in all the others a standardized preoperative preparation of the bowel tract was used. Anastomotic time was significantly shorter (25-35 min) due to the following factors: not performing close intestinal loop, small layers widths of the opposite bowel parts, better control of intestinal blood supply. Possible surgical site contamination is minimized. Anastomosis is very simple, fast, and extremely reliable. Early feeding is practiced (after 24 hours), which is the basis for a rapid (fast track) recovery of these patients. Not to ignore the low price of the joining accomplished (1÷3 nontraumatic sutures 3/0). The variability in the performance of intestinal anastomoses allows an opportunity for individualized approach. End-to-end continuous bowel connections have some tactical, technical and economic advantages, and combined with their reliability present a very good option.
Email this article (Login required) 
