Annals of surgical oncology · 2015
Avoiding Diverting Ileostomy in Patients Requiring Complete Pelvic Peritonectomy.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Sugarbaker Paul H
Аннотация
BACKGROUND: In performing cytoreductive surgery with hyperthermic perioperative chemotherapy, a rectosigmoid colon resection is frequently required. To reduce the incidence of anastomotic leakage at the colorectal anastomoses, a diverting ileostomy has been recommended in these patients.
METHODS: Stripping of mesorectal fat from the rectum up to the peritoneal reflection allows transection of the rectum at the junction of the upper and middle rectum. A suture pulls in the lateral aspects of the rectal staple line so that this staple line is included within the barrel of the stapler. After the circular-stapled anastomoses is complete, a second layer of silk sutures is used to invert the staple line.
RESULTS: In 31 stapled colorectal anastomoses, three rectal transections were so low that a layer of sutures was not possible. In the 29 two-layer colorectal anastomoses, no anastomotic leakages were observed. The incidence of diverting ileostomy was reduced from 50 to 7 %.
CONCLUSIONS: These results suggest that preservation of a 10-15 cm length of rectum allows a second layer of sutures to be placed over the stapled colorectal anastomoses. This is a safe alternative to a diverting ileostomy in selected patients.
METHODS: Stripping of mesorectal fat from the rectum up to the peritoneal reflection allows transection of the rectum at the junction of the upper and middle rectum. A suture pulls in the lateral aspects of the rectal staple line so that this staple line is included within the barrel of the stapler. After the circular-stapled anastomoses is complete, a second layer of silk sutures is used to invert the staple line.
RESULTS: In 31 stapled colorectal anastomoses, three rectal transections were so low that a layer of sutures was not possible. In the 29 two-layer colorectal anastomoses, no anastomotic leakages were observed. The incidence of diverting ileostomy was reduced from 50 to 7 %.
CONCLUSIONS: These results suggest that preservation of a 10-15 cm length of rectum allows a second layer of sutures to be placed over the stapled colorectal anastomoses. This is a safe alternative to a diverting ileostomy in selected patients.