One-stage resection and anastomosis of congenital intestinal atresia and intestinal stricture

For newborns diagnosed with congenital intestinal atresia or intestinal stenosis, the only method of treatment is surgery, so surgical treatment should be used in time to restore intestinal patency. Surgery can be divided into three categories, namely, intestinal resection and anastomosis, intestinal fistula and anastomosis and gastrointestinal (or duodenal jejunum) anastomosis. The surgical method should be selected according to the condition of the sick child and the height of the obstruction. Treatment of diseases: congenital intestinal stenosis, congenital colonic stenosis and atresia, rectal, colonic stenosis Indication Neonatal congenital intestinal atresia or intestinal stenosis, generally good, can tolerate larger surgery. Preoperative preparation If accompanied by acute intestinal obstruction in neonates, it should be actively prepared for a short period of time to ensure the safety of the operation. Preoperative preparation includes transfusion, infusion, gastrointestinal decompression, warmth and antibiotics. For sick children within 3 to 4 days, generally do not need to replenish before surgery, obviously dehydrated and diluted three times isotonic saline 20 ~ 50ml / kg body weight supply. Surgical procedure 1. Position: supine position. 2. Incision: right mid-abdominal rectus incision. 3. Exposing the closed intestinal fistula: After entering the abdominal cavity, attention should be paid to the duodenum and all small intestines. The atresia and the proximal intestine of the stenosis are all inflated, and the distal intestine is thin and contracted. After finding the intestine of the incision, the incision is made. Sometimes, the proximal hernia of the atresia may be necrotic and perforated due to excessive expansion, causing meconium or suppurative peritonitis, causing extensive adhesions. The pus in the abdominal cavity should be absorbed, and the adhesion should be carefully separated to find the atresia. 4. Resection of the intestinal fistula blind end: In order to ensure the smoothness of the distal intestine, firstly in the small distal intestine blind end of the purse suture, in the suture center into the intestine into the saline or glucose solution, which can be added to the blue or Phenol red staining, gauze was blocked in the anus until the intestines were filled, and there was staining on the anal gauze, which proved that there was no other atresia at the distal end. The blind end of the distal intestine is beveled, and the contralateral mesenteric wall should be cut more, so that the lumen of the lumen is properly enlarged to facilitate anastomosis with the proximal intestine. Then remove a segment of the intestine with a blind end proximally enlarged (the segment of the intestine is significantly dilated, the wall is thin, blood supply is blocked, no bowel movements, called non-functioning intestinal fistula), usually need to be removed 15 ~ 20cm, cut to normal intestinal fistula until. 5. End-to-end anastomosis of the intestine: the proximal and distal intestines are closed, and the suture is performed by using a discontinuous single-layer mucosal intramuscular layer. To ensure that the anastomosis is healed reliably and avoid excessive varus causing stenosis. After checking the lumen of the lumen, close the mesenteric fissure. 6. Acupuncture: The abdominal wall incision is sutured layer by layer, and the rubber sheet is drained under the skin.

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