RISKS OF DEVELOPMENT OF ANASTOMOTIC SUTURE FAILURE DEPENDING ON THE METHOD OF DISSECTION OF THE TISSUES OF THE ORGANS OF THE GASTROINTESTINAL TRACT AND THE FEATURES OF THEIR FORMATION

Abstract

Summary. The purpose of the study: experimental and clinical study of the peculiarities of the course of reparative processes in the area of gastro- and colostomy wounds after carrying out various types of dissection and justification of the technique of forming anastomoses of the gastrointestinal tract. Research materials and methods. The paper presents the results of an experimental and clinical study of the processes occurring in the area of gastro-, entero-, and colostomy wounds made with electrosurgical or ultrasonic scalpels, immediately after exposure to tissues and within thirty days. Research results. Data were obtained that indicate a significant difference in destructive and reparative processes after various types of dissection. The use of ultrasonic dissection made it possible to maximally reduce ischemia of tissues and the internal ridge of anastomoses, in connection with which the reparative processes proceeded favorably and the patency through the anastomosis was not disturbed. The obtained results made it possible to scientifically substantiate the necessary distance of the needle from the edge of the dissection, depending on the type of dissection of the wall of the gastrointestinal tract. Conclusions. Ultrasonic dissection of the gastrointestinal tract is characterized by a relatively gentle effect on biological tissues, which is accompanied by the formation of much smaller areas of necrosis and necrobiosis than with electrosurgical exposure. In addition, biological welding of the edges of the wound, reliable hemostasis is achieved; there are no carbonization of fabrics, their sticking to the surface of the manipulator, smoke, sparks and other effects. It was established that after electrosurgical dissection, the phenomenon of prolonged necrosis develops, i.e., the necrosis zone spreads within three days, including due to the necrobiosis zone. This fact must be taken into account when applying seams. Adherence to the technical rules for the formation of gastrointestinal anastomoses, based on experimental data, made it possible to eliminate the risks of developing postoperative complications, first of all, their failure.