Restoring Intestinal Continuity in a Hostile Abdomen: The Deloyers Procedure

1. To study further the influence of luminal nutrition on small bowel structure and function, segments of rat jejunum and ileum were completely excluded from intestinal continuity by Thiry-Vella by-pass operations. The effect of partial deprivation of luminal nutrition was also studied in jejunal segments that had been surgically transposed to a distal position in the intestinal tract. 2. Macroscopically, by-passed jejunum and ileum both became narrowed and atrophic, whereas the intestine in continuity showed hypertrophic changes similar to those seen after intestinal resection. 3. In by-passed intestine the pattern of villi changed from mucosal ridges to ‘fingers’ and ‘leaves’. Although villous height and total mucosal thickness were both reduced, light microscopy showed that even 6 months after exclusion from intestinal continuity villous morphology was still retained. 4. Epithelial-cell migration rate and turnover time were diminished in both jejunum and ileum after by-pass. In intestine in continuity the migration rate was increased, but the turnover time remained the same as in controls. 5. In by-passed jejunum, in vivo glucose absorption diminished progressively with time, but did not change in excluded ileal segments. 6. After ileo-jejunal transposition, the jejunum showed no major morphological changes, but glucose absorption became significantly depressed. 7. These results further support the concept that intraluminal nutrition exerts a major influence on cell turnover, villous morphology and absorptive function in the small intestine.

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Restorative minimally invasive interventions in patients with colostomy

Kazan medical journal ◽

10.17816/kmj2018-1004 ◽

2018 ◽

Vol 99 (6) ◽

pp. 1004-1008

Author(s):

F Sh Akhmetzyanov ◽

N A Valiev ◽

A N Daminov ◽

B Sh Bikbov

Keyword(s):

Surgical Intervention ◽

Surgical Trauma ◽

Distal Stump ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Intestinal Continuity ◽

Intestinal Stoma ◽

The Right ◽

Medical Indications ◽

Oncology Center

Aim. To show the benefits of performing mini-access restorative phase on the colon in patients with colostomy. Methods. A retrospective analysis of the results of closure stomy operations in 2011-2017 in two emergency cancer departments of Republican Clinical Oncology Center MH RT was conducted. The inclusion criteria of the study were: 1) surgical intervention for acute intestinal obstruction in colorectal cancer performed in RCOC; 2) mandatory removal of the primary tumor during the first surgery; 3) the presence of a functioning intestinal stoma formed during the first surgery; 4) fixation of both stumps in one stoma. The exclusion criteria were refusal to restore the continuity of the colon for medical indications and the patient's refusal to undergo the surgery. Results. The study included 11 males (44 %) and 14 females (56 %). The age interval was 49 to 81 years, of which 12 patients were over 70 years old (48 %), the average age was 67.7 ± 5.4 years. The tumor removed at the first stage was localized in the right parts of the colon in 5 patients (20 %), and in the left in 20 patients (80 %). By the stages of the malignant process, the patients were distributed as follows: stage B - 14 cases (56 %), stage C - 10 (40 %), stage D - 1 (4 %). The average duration of the surgery was 53 ± 14.38 minutes (40 to 123). The postoperative period was 10.8 ± 1.92 days on average (5 to 18). Conclusion. Restoration of intestinal continuity through mini-paracolostomy access is technically rational, as due to the mini-access the patient undergoes minor surgical trauma; the anatomical proximity of the anastomosed bowel stumps excludes the difficulties associated with the search for the distal stump in the traditional method of recovery; the duration of the postoperative hospital stay decreases significantly.

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Short bowel syndrome in infancy: recent advances and practical management

Frontline Gastroenterology ◽

10.1136/flgastro-2020-101457 ◽

2020 ◽

pp. flgastro-2020-101457

Author(s):

Elena Cernat ◽

Chloe Corlett ◽

Natalia Iglesias ◽

Nkem Onyeador ◽

Julie Steele ◽

...

Keyword(s):

Parenteral Nutrition ◽

Short Bowel Syndrome ◽

Intestinal Adaptation ◽

Intestinal Failure ◽

Rare Condition ◽

Oral Feeding ◽

Short Bowel ◽

Intestinal Continuity ◽

Gastrointestinal Reconstruction ◽

Lipid Reduction

Short bowel syndrome (SBS) is a rare condition characterised by extensive loss of intestinal mass secondary to congenital or acquired disease. The outcomes are determined by dependency on parenteral nutrition (PN), its possible complications and factors that influence intestinal adaptation. In order to achieve the best results, patients should be managed by a specialised multidisciplinary team with the aims of promoting growth and development, stimulating intestinal adaptation and preventing possible complications. This involves timely surgical management aimed at rescuing maximum bowel length and eventually re-establishing intestinal continuity where appropriate. A combination of enteral and parenteral nutrition needs to be targeted towards maintaining a balance between fulfilling the nutritional and metabolic needs of the child while preventing or at least minimising potential complications. Enteral nutrition and establishment of oral feeding play a fundamental role in stimulating bowel adaptation and promoting enteral autonomy. Other measures to promote enteral autonomy include the chyme recycling in patients where bowel is not in continuity, autologous gastrointestinal reconstruction and pharmacological treatments, including promising new therapies like teduglutide. Strategies such as lipid reduction, changing the type of lipid emulsion and cycling PN are associated with a reduction in the rates of intestinal failure–associated liver disease. Even though vast improvements have been made in the surgical and medical management of SBS, there is still lack of consensus in many aspects and collaboration is essential.

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Shape memory compression anastomosis clips in gastrointestinal surgery in dogs

Veterinární Medicína ◽

10.17221/1/2016-vetmed ◽

2016 ◽

Vol 61 (No. 9) ◽

pp. 524-527

Author(s):

P. Holak ◽

Z. Lekston

Keyword(s):

Shape Memory ◽

Surgical Procedures ◽

Bowel Resection ◽

Gastrointestinal Surgery ◽

Nickel Titanium ◽

Clinical Experiences ◽

Bowel Anastomosis ◽

Simple Method ◽

Compression Anastomosis ◽

Intestinal Continuity

This paper describes clinical experiences with the use of shape memory nickel-titanium (NiTi) clips in gastrointestinal surgery in dogs. Side-to-side small bowel anastomosis was performed in eight dogs where intestinal continuity had to be restored after bowel resection. Billroth’s operation I was performed in one case. Compression anastomosis clips with two-way shape memory were used in all surgical procedures. Intestinal and gastrointestinal anastomoses involving shape memory clips were effective in all patients. Anastomotic leaks were not observed, and all clips were expelled 5–7 days after surgery. The outcomes of surgical procedures performed on canine patients with the use of shape memory NiTi clips indicate that sutureless compression anastomosis is a safe, effective and simple method of restoring gastrointestinal continuity, which can be widely applied in veterinary practice.

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