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By • Дек 18th, 2010 • Category: Colon

In those cases of transverse colonic resection when the entire left half of the bowel has to be removed, the end-to-end anastomosis in the region of splenic flexure may prove unreliable because of the tension and inade­quate blood supply of the intestine. Instead, an anasto­mosis between the end of transverse colon and the la­teral surface of sigmoid colon should be performed fol­lowing removal of the affected bowel and complete clo­sure of the distal end of the transverse colon in the re­gion of splenic flexure.

The first steps in this operation are identical with those described for standard resection of the transverse colon (Fig. 177,1,2,3,4 and 5).

Then, following excision of the bowel between clamps, its left stump is closed completely in the splenic flexure region in two layers (Fig. 178.1), while the right stump is covered with a gauze square after painting it with iodine tincture from the inside.

Now the surgeon brings the sigmoid colon to the wound, and applies a soft angled clamp on its middle (most mobile) loop. The right open stump of transverse colon is then approximated to this loop by taking hold of the soft clamp closing it, and an end-to-side anasto­mosis is effected (Fig. 178.2). First, the posterior row of seromuscular interrupted sutures is applied, then the sigmoid lumen is opened, and the surgeon unites both edges of the bowels being anastomosed with interrupted silk sutures, including all layers of the intestinal wall (Fig. 178.3). Similar sutures are next inserted on the an­terior half of anastomosis circumference (Fig. 178.4). The last to be applied is the anterior row of interrupted seromuscular sutures (Fig. 178.5). To complete the opera­tion, the assistant introduces per anutn a rubber tube in­to the sigmoid for 2 or 3 days, with the surgeon passing this tube up above the anastomotic line into the remain­der of transverse colon. The abdomen is then sutured in layers.

Variant of resection of transverse colon with anastomosis of its end to the side of sigmoid colon

Fig. 178. Variant of resection of transverse colon with anastomosis of its end to the side of sigmoid colon:

1. The left stump of transverse colon is completely closed in two layers near the splenic flexure.

2. The transverse- colon stump is approximated by means of forceps to the middle portion of sigmoid. The first row of seromuscular anastomotic sutures has been applied.

3. The sigmoid lumen has been opened. Insertion of a row of interrupted sutures on the posterior semicir-cumference of the anastomosis.

4. Insertion of interrupted sutures to the anterior se-micircumference of the anastomosis.

5. The anterior row of interrupted seromuscular su­tures has been completed, and a rubber tube is passed into the bowel above the anastomosis level.

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