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CLOSED TECHNIQUE OF INTESTINAL ANASTOMOSIS


By • Дек 19th, 2010 • Category: Colon

Procedure for establishing closed anastomosis Because of the danger of infecting the peritoneum while opening the intestinal lumen, a number of Soviet and foreign surgeons employ the so-called closed techni­que of intestinal anastomosis.

Two corrugating clamps are applied on either side of the sigmoid segment to be resected (preliminarily freed from mesosigmoid), with two ordinary stiff clamps (Payr’s and Ochsner’s) being placed next to the corru­gating ones in the direction of the tumour. Having ap­plied the corrugating clamp, the surgeon passes a long steel needle between its teeth, which pierces the bowel wall folds held in the clamp.

The bowel is dissected between two clamps — the corrugating and the ordinary one — by the diathermy knife (Fig. 172.1).

An identical maneuver is carried out on the other side. The corrugating clamps are then removed, and both sigmoid stumps (now having closed corrugated ends) remain attached to the steel needles (Fig. 172.2). The stumps are next brought together, and the surgeon inserts the posterior row of silk sutures to include the seromuscular layers of the stumps. The sutures are tied as soon as the entire row has been inserted.

The anterior row of seromuscular sutures is then applied in a similar manner (Fig. 172.3), and the steel needles are removed. The surgeon now checks the ana­stomosis for patency by two fingers and smoothes out the compressed edges of the stumps (Fig. 172.4).

To strengthen the anastomosis, a second row of se­romuscular catgut sutures should be inserted along its entire circumference.

If the anastomosis is located above the sacral pro­montory level, the closed technique is not applicable, because it will be impossible to accomodate the corru­gating clamp in the pelvis. Than the must be made ceeostomy.

Closed method of intestinal anastomosis (according to S. A. Kholdin)

Fig. 172. Closed method of intestinal anastomosis (according to S. A. Kholdin):

1. The bowel is dissected with diathermy knife bet­ween two clamps.

2. Both sigmoid stumps sutured with steel wires (needles) are approximated, and the posterior row of anastomotic sutures is laid.

3. Application of the anterior row of anastomotic su­tures.

4. Following extraction of the steel wires, the surgeon check the patency of the anastomosis with two fingers.



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