Anastomosis of jejunum and duodenal fistula

Jejunum and duodenal anastomosis for the surgical treatment of extraintestinal fistula. Parenteral fistula is different from medical enterostomy. It is due to intestinal anastomosis, suture rupture, surgical injury, intestinal trauma, intestinal inflammatory disease (Crohn's disease, ulcerative colitis, etc.), radiation damage, etc. caused by intestinal damage, intestinal fluid spilled into the abdominal cavity, abdominal wall To. Due to the serious disorder of homeostasis, malnutrition and abdominal infection, the pathophysiological changes caused by it are extremely complicated and heavy. The current treatment principle is to correct the imbalance of homeostasis, control infection, manage sputum, strengthen nutrition support, and maintain organ function to fight for self-healing. Deterministic surgery is performed only when it is not possible to heal itself. This has changed significantly from the treatment strategies of the 1970s. In the past, definitive surgery for intestinal fistula was performed at an early stage. After non-surgical treatment, sputum may heal itself. The causes of intestinal hemorrhoids are: lip-shaped hernia (intestinal mucosa valgus and abdominal wall wounds), specific infection, distal intestinal fistula obstruction, foreign body retention in the intestine fistula, radioactive injury, scarring of the fistula. Generally, after appropriate non-surgical treatment, if there is no cause of healing, the extraintestinal fistula will heal within 3 to 8 weeks. If you can't heal yourself, you need to find the cause and prepare for surgery. Curing disease: Indication The duodenal stump or lateral iliac crest is larger, the surrounding scar is more, the suture repair is difficult to heal, and when the bowel resection is difficult, the jejunal end that can be cut off is aligned with the fistula or the end-to-side anastomosis. Close the mouth. There are fewer indications for jejunum and duodenal anastomosis. Preoperative preparation Patients with extraintestinal fistula, especially those with large sputum sputum discharge, large number of fistulas, and severe intra-abdominal infections, have malnutrition and impaired organ function, and the operation is often complicated and traumatic, compared with other intestinal surgery. Higher surgical failure rate. Whether the surgical preparation is perfect or not directly affects the success of the operation. Surgical preparation includes understanding the condition of sputum and abdominal infection, the status of important organ functions, nutritional status and preparation of the intestine. In daily life, 80% of extraintestinal fistula is a complication of abdominal surgery. Some patients have also undergone surgery to repair hernia. The normal anatomical position of the abdominal organs and intestines has been changed. A more comprehensive understanding of the condition of the ankle before surgery will contribute to the design of the surgical plan. Abdominal infection is a factor that causes complex pathophysiological changes in patients with extraintestinal fistula, and is also a key to the success of definitive surgery for intestinal fistula. Infection causes severe adhesions in the abdominal cavity, edema of the intestines, fragility and anastomosis, partial repair of the repair, and even postoperative sepsis and organ dysfunction. Heart, liver, lung, kidney and other organs in the case of severe malnutrition and infection, their functions have been damaged, it is very important to understand and judge them before surgery. The organs most susceptible to dysfunction in patients with extraintestinal fistula are the lungs and liver. The former has acute respiratory distress syndrome (ARDS), and the latter has jaundice and the like. Of course, multiple organ dysfunction will be more likely to occur in patients with severe abdominal infection after surgery. Nutrition has always been a problem that should be taken seriously in the treatment of patients with intestinal fistula. The nutritional status of the patient before surgery will affect the post-operative wound healing, infection control and organ function. Strengthening nutritional support before surgery does not mean giving excessive nutrition, but based on the results of nutrition measurement, the insufficient part is given. Adjustment. Nutritional status can also be improved in a few days before surgery. Generally, it takes at least 10 days to prepare. Nutrition support is an important part of treatment in patients who receive reasonable treatment from the onset of sputum, and the nutritional status can be maintained at an appropriate level until surgery. However, in preoperative treatment, patients whose nutrition is not valued, the improvement of nutritional status is a key point in preoperative preparation. Gastrointestinal nutrition includes tube feeding factor diet is the preferred nutritional method, but when gastrointestinal nutrition is not available, parenteral nutrition can effectively improve the nutritional status of patients. An important indicator of whether the nutritional status is improved should be whether the visceral protein can return to normal levels rather than simply gaining weight. In addition to nutritional status, water, electrolytes and acid-base disorders should be corrected before surgery. Intestinal preparation is not required before the small intestine surgery. The bacteria in the small intestine are affected by the pH of the gastrointestinal fluid, and its reproduction is limited. However, in the case of small intestinal fistula, the intestinal environment is destroyed, the intestinal lumen is directly connected to the outside of the body, and bacteria in vitro can also enter the intestinal parasite and multiply. Preoperative fasting, oral antibiotics (aminoglycosides) and anti-anaerobic drugs ( metronidazole) often meet the requirements of intestinal preparation. In summary, the preoperative preparation of patients with intestinal fistula has its particularity. The timing of surgery for a selective bowel fistula surgery depends on whether the intra-abdominal infection has been controlled, the nutritional status is improved, and the vital organ function is observed. It is not the time after the occurrence of cockroaches. Surgical procedure 1. After separating the intestinal fistula, remove the adhesions and scars around the mouth, trim the edges of the mouth to the normal intestinal tissue, and stop the bleeding with saline gauze for use. 2. Under the duodenal suspensory ligament 15-20 cm cut off the jejunum, the distal end is lifted and the prepared intestinal fistula is made of two layers of discontinuity 3-0 non-absorption line suture to complete the jejunal end and the intestinal fistula to do the end - End or end-to-side anastomosis. At the end of the anastomosis, 20 to 30 cm, the proximal end of the jejunal cut end is anastomosed to the end of the distal jejunum. Although this is also a Y-shaped anastomosis, it is not required to prevent the intestinal contents of the proximal jejunum from flowing back to the intestinal tract. On the contrary, the intestinal contents of the intestinal sac will still enter the upper intestine segment. Therefore, there is no need to have a long distance between the two anastomosis. Just because the contents of the intestine can enter the lower jejunum through the intestinal fistula and the proximal jejunum, it is possible that some intestinal contents will enter the lower intestinal tract too quickly.

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