Zaporožskij Medicinskij Žurnal (Oct 2024)
Pelvic small intestine reservoirs of a new type
Abstract
Aim. To improve the results of surgical treatment for patients with severe non-cancerous diseases of the colon by developing and implementing the new type of pelvic small intestine reservoirs. Materials and methods. A new type of pelvic small intestine reservoirs has been developed and introduced into clinical practice to improve processes of intestinal digestion, absorption, anal retention after radical surgery for ulcerative colitis, Crohn’s disease with total colon involvement, familial adenomatous polyposis. Each of the reservoirs has been adapted to anatomical relationships between the small intestine and the debuccalized surgical anal canal depending on a radical surgery extent and a functional state of the small intestine. Pelvic small intestine reservoirs of a new type were used in 39 patients of the main study group, 21 (53.8 %) men and 18 (46.2 %) women. The patients’ age ranged from 21 to 43 years. The comparison group consisted of 42 patients. The patient groups were identical in terms of sex, age, diagnosis and complications of the underlying disease. Patients in the comparison group differed in that they underwent the well-known “J”-shaped pelvic small intestine reservoir procedures. Results. The number of postoperative complications was statistically significantly higher in patients of the comparison group due to acute and chronic complications, 33.2 % and 10.4 %, respectively. Indicators of intestinal digestion, absorption and anal retention were statistically significantly better in the majority of patients of the study group. The number of patients with I (mild) degree of pathological post-colectomy syndrome was significantly higher in the study group, and the number of patients with diarrheal syndrome and secondary anal incontinence syndrome was significantly lower. Positive results after the introduction of a new type of pelvic small intestine reservoirs were obtained by applying the following basic principles of their formation: the use of only known factors of physiological delay in the passage of contents through the small intestine, preservation of the small intestine wall anatomical integrity, location of the small intestine reservoir at a certain distance from the upper border of the rectal sphincters, as well as the reasonable expediency of choosing a method of forming the pelvic small intestine reservoir depending on the patient’s anatomy. Conclusions. The use of physiological factors of delayed passage of the contents in the small intestine, small intestine wall anatomical integrity preservation in the formation of pelvic small intestine reservoirs of the new type, the reservoir location at a certain distance from the upper border of the rectal sphincters has resulted in significant improvements in the functions of intestinal digestion, absorption, and anal retention. Practical application of the new type of pelvic small intestine reservoirs has helped to significantly decrease the incidence of postoperative complications from 33.2 % to 10.4 %, increase the number of patients with post-colectomy syndrome of the I (mild) degree from 47.4 % to 86.4 %, reduce the number of patients with diarrheal syndrome from 55.3 % to 8.1 %, and secondary anal incontinence syndrome from 36.8 % to 5.4 %.
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