Anatomical justification of a modified way of enteric anastomosis formation under diffuse peritonitis
The paper presents a study of vascular micromorphology along the enteric anastomosis suture and determination of the degree of the anastomosis deformation at different intersection angles with intestinal wall under diffuse purulent peritonitis. Anatomical analysis was carried out using autopsied specimens. Submucosal and muscular layers of intestinal wall intersected at an angle of 60° demonstrate significantly larger number of arterial and venous vessels, as opposed to intersection at an angle of 90° to the colon axis. This is because at intersection angle of 60° blood is supplied to the section line from at least two adjacent straight arteries. In contrast, when the section is made at an angle of 90°, blood is only supplied to the section line through branches of a single straight artery. It is found that, when intestinal wall is intersected at an angle of 60°, there is no critical anastomosis deformation, while blood supply along the suture line improves significantly. When end-to-end enteric anastomosis is formed, afferent and efferent intestinal loops intersecting at an angle of 60° facilitate better blood supply to suture lines without forcing excessive deformation, which enhances reparative processes in the anastomosis area and reduces probability of a leak.