Boley surgery

Boley surgery is used for the surgical treatment of the whole colon-type ganglion-free megacolon. Congenital megacolon is a common digestive tract malformation (Fig. 12.13.1.5.3-0-1). It is due to the lack of ganglion cells in the distal segment of the colon, resulting in intestinal fistula and normal peristalsis of the intestine. , the formation of functional intestinal obstruction, obstruction of the proximal intestinal dilatation, hypertrophy. The length of the intestines varies from a few centimeters, sometimes to the entire colon, and even to the small intestine. The latter has serious clinical symptoms and is complicated to treat. The most common type is the sigmoid colon below the sacral segment, and the proximal intestine near the sacral segment gradually expands until the dilated segment is called the transition segment. There is also a lack of ganglion cells in this segment of the intestine. In the dilated segment of the intestine muscle layer hypertrophy, chronic inflammation of the mucosa, and even ulceration, degeneration and spasm of the intermuscular plexus and submucosal ganglion cells. The length of the dilatation segment is also inconsistent with the age of the visit, and then gradually transitions to the normal intestine. The main point of congenital megacolon surgery is to remove the sacral segment, the transitional segment and some of the dilated bowel segments that cannot restore normal function according to the characteristics of the above pathological changes. Treatment of diseases: congenital megacolon Indication Boley surgery is suitable for the colon-type ganglion-free megacolon. Contraindications Severe malnutrition or combined with enterocolitis cannot tolerate surgery. The above-mentioned sick children should undergo colostomy first, and then the radical surgery should be performed after the general condition is improved. Congenital megacolon combined with other systemic severe malformations such as severe congenital heart disease, esophageal atresia, etc. should be performed first in the intestinal stoma, to be corrected for severely life-threatening deformities, and then megacolon radical surgery. Preoperative preparation In children with congenital megacolon, there is clinical colonic obstruction, abdominal distension, large amount of feces in the colon, absorption of toxins, malnutrition, impaired heart, liver and kidney function, and poor resistance. Therefore, system preparation should be performed before surgery. Surgery creates good conditions. 1. Preoperative barium enema, rectal manometry, rectal mucosal biopsy, cholinesterase determination, clear diagnosis and understanding of the extent of the lesion. 2. Preoperative blood and urine routine examination, liver and kidney function and electrocardiogram examination. 3. Prepare the bowel before surgery for colonic lavage with normal saline 3 weeks before surgery to remove the feces in the colon, relieve abdominal distension, restore intestinal tract, reduce symptoms of poisoning, improve nutritional status, and treat enteritis. The condition of the sick child is gradually improved, and the enema effectively relieves the functional colonic obstruction, so that the partially dilated bowel gradually returns to normal, which facilitates the scope of the resection in the operation. In colonic lavage should pay attention to: 1 must use isotonic saline, because low permeability liquid is easy to cause water poisoning, high permeability liquid is easy to cause salt poisoning. The most important thing is to accurately measure the amount of enema in and out, to prevent the instilled saline from staying in the intestine. The total amount of enema per time must not exceed 100ml/kg body weight. 2 enema should choose soft, but slightly thicker anal canal, easy to excrete feces from the anal canal. The enema should understand the extent and direction of the diseased bowel, and the tube should be gentle. Each time the enema is administered, the anal canal is passed through the sacral section to reach the dilatation section. Do not inject too much liquid each time, pour a certain amount of salt water, gently massage the abdomen, and squeeze the expansion section downwards, so that the gas, feces and liquid in the intestinal tract are discharged from the anal canal. After the daily enema, the purpose of cleaning the expansion section should be achieved. 3 In the winter enema, you should keep warm to prevent cold and respiratory infections. 4 For children with short sputum, you can pour "123 liquid" (ie 33% magnesium sulfate 30ml, glycerol 60ml, normal saline 90ml) before washing with normal saline. Infants can be half-infused, stimulate bowel movements, and then cleanse the intestines with saline. 4. If there is water and electrolyte disturbance, it should be corrected in time. Anemia can be transfused in small amounts. 5. Give low slag, easy to digest, high protein, high vitamin food during enema, give high nutrition in the intestine if necessary, actively improve malnutrition, and improve the body resistance of sick children. 6. Give intestinal sterilizing agent 3 days before surgery to reduce bacteria in the intestine and reduce the infection rate after surgery. 7. Preoperative blood. 8. Place the stomach tube before surgery, and place the catheter after disinfection in the operation area. Surgical procedure The lateral peritoneum of the ascending colon was incised, the gastric colonic omentum was cut, and then the transverse colon and descending colon were excised. The rectal mucosa was removed by Soave method, the rectal muscle sheath was retained, and the free ileal end was pulled out from the rectal muscle sheath. The remaining ascending colon 15-20 cm is then anastomosed laterally with the ileum. complication Intrathecal infection or abscess formation: seen in the surgery to separate the rectal mucosal rupture caused by contamination. Sometimes a small piece of rectal mucosa is left in the process of separating the mucosa, and the secretion of intestinal fluid after surgery can cause intrathecal fluid and infection. Therefore, the operation should be carefully performed, the rectal mucosa should be completely removed, and the blood should be completely stopped, and the drainage strip should be placed. In case of infection, the drainage should be cut from the anus. If peritonitis occurs after surgery, it should be drained through the abdominal cavity in time.