SURGICAL CORRECTION OF THE DISTURBANCES OF FUNCTIONS OF ILEOCECAL APPARATUS

H.B. ISAYEV, H.Z. JAFAROV

Scientific Surgical Center named after M.A.Topchubashov, Baku, AZERBAIJAN

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Such abnormalities as free mesentery of the cecal and ascending colon are aften endountered and consist 7-11 % of diseases of organs of abdominal cavity. After surgical operations applied during abnormalities of the right side of the colon, recurrence of insufficiencies of ileocecal apparatus have high figures. To restore normal activity of the ilececal apparatus, there are a number of methods in the literature. Each of the existing methods that serious insufficient features and authors offering such methods obtained rather good results, than unsatisfactory. Methods so far applied for the plasty of Baugine cover are aimed at the creation of additional invaginate of the mucosal coat of the ileum within the cecum by the insertion of sero-muscular or sero-serous sutures to the parts of the ileac wall connecting to the cecum. Invaginate obtained in such manner will later restore its condition and cause the restoration of the preoperative function of ileocecal apparatus. Normal function of the ileocecal apparatus is restored by anterior and posterior frenulums of Baugin cover. The frenulums are closely connected to the internal fold of the cecum, are closed during its enlargement, and open during its release to allow discharge of iliac content into the cecum. We determined that when the height of the cecum is more than its width, frenulums of Baugin cover can close more effectively, and vice-versa whent the width is more than height, frenulums are weak, and disorders are more likely to occur in their closure. Based on such anatomic-physiologic postulates, we apply a method, which so far has not been offered for the restoration of the functions of Baugin cover – the essence of the method is that to restore the function of the ileocecal apparatus disfunctions, it is necessary to increase sizes of the cecum. Therefore, we try to shorten the diameter by insertion of 2 lines of sero-muscular sutures to the anterior and posterior walls of the cecum in transverse direction. In this case, height of the colon is by 2.5-3 cm longer than the width. Thus, the pressure on the ring-shaped muscles around the diameter of the orifice of the ileum opening into the cecum is decreased, and on the other hand good conditions for the closing of frenulums of Baugin cover are created. Irrigography conducted long after such surgical operations (6-12 months later) confirmed adequate function of ileocecal apparatus. Given the above, we may make a conclusion, that the method offered for the restoration of iliac dysfunction – increase of the height of cecum – can be considered a simple method, based on anatomic and physiologic principles.

RESULTS OF TOTAL COLECTOMY IN PATIENTS WITH DOLICHOCOLON

E.A. JAVADOV ², F.S. KURBANOV ¹

Peoples’ Friendship University, Moscow, RUSSIA¹; Scientific Surgical Center named after acad. M.A. Topchubashev, Baku, AZERBAIJAN²

Total colectomy for chronic constipation against the background pf dolichocolon was performed in 29 patients, including 5 men and 24 women at the age of 15-69 years (average age 34,3 ± 2,7 years). All patients reported rare bowel evacuation (two or less times a week) and the separation of a small amount of stool during defecation. Duration of disease ranged between 2 - 47 years (comp. - 12,5 ± 2,3 years). Preoperative examination was based on the data of irrigoscopy, colonoscopy and time of intestinal transit (transit time more than 96 hours was observed in 52.4% of patients, the average time was 88,0 ± 8,8 hours). The study of long-term results was carried out by of full-time inspection and examination, as well as a written quiz within the period of 1-3 years or more. The number of defecations and the nature of stool, as well as the need for repeated and additional treatment were assessed. During the assessment of the dynamics of the frequency of defections at different times after surgery, significant and reliable reduction in the average frequency of defecations with the increase of time, passed after colectomy was observed(p <0.05). Similarly, with the increase in the rehabilitation term there was observed changing nature of the stool. A month after the intervention, third of patients complained of the appearance of watery stool, in the rest the stool was half-shaped, six months later, watery stool was only in 4% of patients. A year after total colectomy more than 40% of patients had shaped stool, and 3 years later watery stool was almost in 70% of patients. UTILIZATION OF LINEAR STAPLER IN SURGICAL TREATMENT

Date: 2014-12-28; view: 828