Double mouth intestinal fistula closure

Intestinal fistula refers to the intestinal fistula that penetrates the abdominal wall and communicates with the outside world. In the past, it was caused by abdominal trauma. In recent years, due to the expansion of the scope of abdominal surgery, the complexity of the disease, the increase of the difficulty of surgery, and the application of radiotherapy and chemotherapy in the perioperative period, 70% to 90% of intestinal fistulas are iatrogenic, that is, caused by surgery. In the 1960s, the mortality rate was 50% to 60%. Afterwards, the cure rate was gradually improved. So far, the cure rate of each treatment center has reached 80% to 90%. This is due to the application of effective nutrition support and the overall situation of patients. And strengthen monitoring, maintain the balance of homeostasis and the results of effective application of antibiotics. However, the mortality rate of 10% to 20% is still high, and it is still necessary to emphasize prevention and further improve the efficacy of this problem. Treatment of diseases: intestinal 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 is made around the fistula to remove the skin around the fistula. 2. Block the mouth: use gauze to fill the mouth, suture the skin edges on both sides, and seal the mouth. 3. Cut the fistula and make the anastomosis: first cut the peritoneum from the side of the fusiform incision, separate the adhesion, use the finger to find the proximal and distal intestinal fistula, and use the duodenal forceps on the normal intestine. Clamp and cut. The intestinal stump on the side of the mouth was closed with dry gauze. Then the proximal and distal segments of the intestine are anastomosed. 4. Resection of the fistula: The peritoneum on the other side of the intestine is cut from the abdominal cavity. The sharp and blunt separation method is gradually separated from the subcutaneous layer to the deep muscle layer, and the stump of the ostomy tube can be removed together with the surrounding tissue. 5. Acupuncture: The abdominal wall incision is sutured layer by layer, and the rubber sheet is drained under the skin.