Клинико-экспериментальное обоснование применения прецизионного кишечного шва у больных с высокой степенью вероятности возникновения послеоперационных осложнений

There were developed methods of the intestine suture on different levels of the gastrointestinal tract, which in based on the principles of meticulous technology, allowing ideal to adapt the layer of sutured tissues of stomach and intestine. Methods. The experiments were carried out for 85 rabbits. We studied mechanical strength of meticulous sutures when shaping gastrointestinal anastomosis (20 experiments), small-small intestine anastomosis (25 experiments) and large-large intestine anastomosis (25 experiments). In control series (15 rabbits) of small-small intestine anastomosis were formed by Albert — Schmieden sutures. The clinical studies were carried out in 53 patients with different surgical diseases and high risk of postoperative complications. We have developed a technique applied in extraperitoneal liquidation of colostomy (7 patients) and cecostomas (4 patients). Intraabdominal surgery (resection of the stomach, small intestine and colon, suturing wounds of the stomach and small intestine) were made in 42 patients. The work used morphometric, histological, bacteriological and physical methods of study.Results. Analysis of data on the mechanical strength of the anastomosis revealed the following. Upon application of gastroentero- and large-large intestine anastomosis formed by meticulous suture during the 1st day of the experiment, the mechanical strength varies between 144.0 ± 4.1 mmHg and 152.0 ± 4.2 mmHg. In the control group of anastomoses made using Albert-Schmieden sutures the strength was 168.0 ± 4.3 mmHg However, in all experiments, the strength of the anastomosis, regardless of intestinal suture technique, remains sufficiently high and significantly exceeds the possible pressure in the lumen of the alimentary canal. In macroscopy of anastomoses formed by meticulous suture, regardless of whether they are imposed on the stomach, small or large intestine, the common is their good permeability, almost complete absence of infiltrates and perianastomositis early after surgery. Histologically we detected minimal inflammatory reaction on suture material (vicryl, polypropylene). Nonabsorbable polypropylene sutures in 1–3 months after surgery were surrounded by a thin connective capsule.Conclusion. It was found that the proposed methods for intestinal suture enable to achieve an optimal healing of anastomoses while providing sufficient mechanical strength and biological hermeticity of anastomoses. Postoperative period in all patients was uneventful. Deaths weren’t observed.