Lateral intestinal fistula closure

This method is used for the fistula formed by trauma, infection or anastomosis of the intestinal wall, or when the condition of the intestine fistula is no longer needed for ostomy. Treatment of diseases: intestinal fistula, small intestine, colonic fistula Indication 1. Intestinal fistula formed after various intestinal operations. 2. Those who cannot heal themselves after various enterostomy. 3. Temporary artificial anus. 4. Intestinal fistula formed by abdominal infection. Preoperative preparation 1. Intravenous infusion, if necessary, transfusion or plasma to correct dehydration and anemia. 2. Control the infection, so that the infection, inflammation and edema in the abdominal and abdominal wall ostomy are resolved. 3. Preoperative fistula with X-ray examination of 12.5% sodium iodide or dilute sputum, to find out the location, extent and adhesion of intestinal fistula. 4. The lesions in the lower bowel of the ostomy should have been completely healed or have been thoroughly treated without recurrence of the disease after recovery of the fecal flow. 5. Oral sulfa drugs or antibiotics 3 to 5 days before surgery. 6. The fistula was lavaged once daily with warm saline on the 3rd day before surgery, and the lavage was cleaned in the morning of the operation. 7. Switch to low-slag diet 2 days before surgery. 8. Place the gastrointestinal decompression tube on the morning of the operation. Surgical procedure 1. Position, incision: supine position. A fusiform incision around the fistula. 2. Block the fistula: Plug the pupil with a gauze mass and suture it with the excised skin to prevent leakage of the contents of the intestine. 3. Separate the fistula: start the acute and blunt separation of the fistula from the subcutaneous layer, gradually separate into the peritoneum, lift the fistula with tissue forceps, first cut the peritoneum into a small mouth, carefully probe and separate the adhesion near the incision with your fingers; then, enlarge the peritoneum Incision, the fistula and the connected intestine are presented to the surgical field. 4. Resection of the fistula: If the area of the fistula connected to the intestinal wall is small, the intestine wall connected to the fistula can be fusiformly removed; if the area of the fistula connected to the intestine is large, the intestine should be removed. 5. Anastomosed intestine: If a small part of the intestinal wall is removed, the incision can be sutured transversely. Firstly, the 2-needle fixed traction suture is used, and the inner layer is made of 2-0 thin gut line or 1-0 silk thread for full-layer intermittent or continuous suture, and the outer layer is sutured with fine silk thread as the sarcoplasmic layer, and the intestine wall is cut. . If the intestine is partially removed, the intestine can be anastomosed. 6. Suture the abdominal wall: suture the abdominal wall incision with a silk thread layer by layer, and drain the rubber sheet under the skin.