Surgical treatment of high incomplete jejunum fistulas by the method of disconnection from posterolateral access
Aim of the research. To create a method for disabling high unformed jejunal fistula, not associated with difficulties in detecting the coming gut and with dangers of viscerolysis. Material and methods. The experience of treatment of 35 patients with high delimited unformed, exhausting fistulae of the jejunum is presented. To 22 patients of them, included in the comparison group, fistulas were closed or diactivated by known methods. On the basis of other 172 patients operated on acute adhesive intestinal obstruction, the topography of visceroparietal planar adhesions of the peritoneum was studied. The study of visceroparietal adhesions and their location made it possible to develop a method for proximal exclusion from posterolateral access, which was performed in 13 patients of the main group of observations. Results. Clinical application of proximal disconnection of high unformed jejunal fistula from posterolateral access, reduced the duration and traumatism of the intervention, and also eliminated the risk of prolonged intestinal deserosis. The result was a significant reduction in postoperative mortality from 59.1 ± 9.2% to 23.1 ± 11.2% (t = 2.5; p). Conclusion. Posterolateral access prevented long viscerolysis and allowed reliably and atraumatically perform intercusive anastomosis, disabling fistula. The proximal disconnection of the jejunal fistula relieved the inter-intestinal anastomosis in the postoperative period, similar to the definitive Maydl jejunostoma. The positive qualities of the proposed operative intervention led to a significant reduction in postoperative complications and lethality, compared with the results of known surgical operations of the same purpose.