Intestinal Adhesiolysis

1. Adhesive intestinal obstruction is not effective after non-surgical treatment. 2. Adhesive intestinal obstruction was relieved by non-surgical treatment and repeated. Treatment of diseases: intestinal adhesions Indication 1. Adhesive intestinal obstruction is not effective after non-surgical treatment. 2. Adhesive intestinal obstruction was relieved by non-surgical treatment and repeated. Preoperative preparation 1. Improve the general condition and correct dehydration and acidosis. 2. When there is hypoproteinemia, blood transfusion can be given. Patients with suspected intestinal necrosis should be prepared for blood. 3. Place the gastrointestinal decompression tube, exhaust the effusion in the gastrointestinal tract, reduce abdominal distension and reduce the absorption of toxins. 4. Give sedatives, antibiotics to prevent infection before surgery, control intestinal bacterial reproduction and toxin production. Surgical procedure 1. Position: supine position. 2. Incision: use the right transabdominal rectus incision; or according to the situation in the obstruction site for incision; can also remove the scar into the abdominal cavity in the original surgical incision, but in the incision of the peritoneum, should avoid entering from the scar, first from the top or A small incision is made at the lower end of the normal peritoneum, and the finger is examined for adhesion between the abdominal wall and the intestine. Then, under the protection of the finger, the peritoneum is gradually cut to avoid damage to the intestine. 3. Exploring and determining the obstruction site: Intestinal adhesion does not necessarily cause intestinal obstruction, so do not blindly separate the adhesion after entering the abdominal cavity. It is important to find the obstruction site first. The site of obstruction is the junction between the inflated intestine and the contractile intestine. When looking for, you can look up the obstruction from the contracture of the intestine and separate it to remove the obstruction. However, in the case of obstruction, the contracted intestine is covered by the inflated intestine, and it is often difficult to find the obstruction from the contracture of the intestine; if the obstruction is found down from the inflated intestine, it is easy to cause the serosa to rupture when the intestine is raised. Therefore, the inflated bowel is only proposed when the collapsed intestine is not found. When the intestine is raised, it is not necessary to use a finger to poke it out. Instead, use both hands to hold the intestines and hold it out as a good one. Then wrap it with a warm saline gauze pad and then gradually look for the obstruction. If the intestines are severely swelled, the effusions in the intestines can be drained in the case of prevention of contamination, and then the obstruction site is sought (see sterile intestinal decompression for intestinal incision decompression). Sometimes, there is extensive adhesion between the intestines, between the intestines and the abdominal wall, and it is necessary to separate the adhesions in order to gradually take out the intestines. 4. Loose adhesion: intestinal obstruction caused by intestinal adhesions, there are roughly four forms. (1) Adhesive band compression traction of the intestine is folded into an angle: this type of obstruction can be used to clamp the two ends of the adhesion band with a hemostatic forceps, and the adhesion band is removed and ligated. At this time, the intestine can be flattened under the obstruction, indicating that the obstruction has been relieved. If the intestine is not necrotic, the rough surface left after the adhesion of the adhesion zone can be cut off, and the peritoneum and intestinal serosa are covered by intermittent varus suture. (2) Adhesive tape compresses the intestine to form internal hemorrhoids: the position of the adhesive band is deeper, sometimes the intestinal tube and mesentery can be closed at the same time, and partial bowel torsion may be accompanied. Finger exploration is often used, and it may be difficult to distinguish whether it is intestinal torsion or adhesion. band. Therefore, the removal of the adhesive tape must be carried out under direct vision. It should not be blindly cut under the finger exploration, so as not to mistake the mesentery for the adhesive tape and cause undue damage. After the adhesion band is removed, the contents of the intestine can be seen to descend, and the intestine can be refilled below the obstruction, indicating that the obstruction has been relieved. At this time, it should be observed whether the compression of the intestinal wall can survive. If there is a blood circulation disorder, but the range is narrower, it is feasible to suture the sarcolemma intermittently and suture it into the intestinal lumen. If the area of necrosis is large, intestinal resection and anastomosis should be performed. The rough surface left after the adhesive tape is removed can be used for intermittent varus suture, so that it is covered by the serosa. (3) Adhesion between the intestines: If the inter-intestinal adhesions do not cause obstruction, they may not be separated, so as not to damage the intestinal wall and cause a wider adhesion. If the obstruction has been caused, the adhesion between the intestinal fistula should be separated. Adhesive loosening can be bluntly separated by fingers, but care should be taken to avoid tearing the intestinal serosa; for tight adhesion, scissors can be used for sharp separation [Fig. 3]. The rough surface after adhesion separation may be covered with sutures between the intestines, or the mesentery may be covered by the intestinal wall. When the intestines are sutured to each other, the rough surface should be more than 3 cm away from the curved part of the intestine to avoid an acute angle after suturing, causing obstruction. The rough surface can also rotate the intestine along the longitudinal axis, and cover the rough surface with its own mesangial membrane; it can also be covered with a large omentum. If extensive adhesions, bowel folding should be considered after separation. If the local intestinal tube adheres to a mass, and the serosal layer is not damaged after separation or separation, intestinal resection and end-to-end anastomosis may be considered. (4) adhesion into a group: feasible resection for the end of the anastomosis, but should try to retain a vital intestinal tube to prevent postoperative nutritional malabsorption. For obstructed intestines that are difficult to resectable, the upper and lower intestines of the obstruction can be used for lateral anastomosis shortcut surgery, but every postoperative abdominal pain, bloating, diarrhea, anorexia, anemia, weight loss and other symptoms should be avoided. 5. Suture incision: Adhesive release, after the obstruction is relieved, the intestine can be sequentially returned from the duodenal suspensory ligament from top to bottom or from the ileocecal region to the abdominal cavity from bottom to top. The abdominal wall is sutured layer by layer, and the flow strip is generally not placed. If the intestines are obviously inflated, the intestines are not decompressed before separation and adhesion. If it is difficult to return to the abdominal cavity after separation, it can be used for intestinal decompression, and then the intestines are empty and then sent back to the abdominal cavity to suture the abdominal wall; if necessary, tension can be sutured. In patients with intestinal decompression and intestinal resection and suture, it is advisable to use a plastic flap for drainage.