Modified Antimesenteric Tapering Enteroplasty: An Alternative Technique for the Treatment of Dysfunctional Anastomosis in Patients With Short Bowel
| Autor: | Ruy J. Cruz |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Short Bowel Syndrome medicine.medical_specialty Serial transverse enteroplasty Tapering Anastomosis Suture (anatomy) Blunt dissection Intestine Small Humans Medicine Mesentery In patient Retrospective Studies business.industry Anastomosis Surgical Gastroenterology General Medicine Middle Aged Plastic Surgery Procedures Short bowel Surgery medicine.anatomical_structure Female business Dilatation Pathologic |
| Zdroj: | Diseases of the Colon & Rectum. 64:e520-e525 |
| ISSN: | 0012-3706 |
| DOI: | 10.1097/dcr.0000000000001973 |
| Popis: | INTRODUCTION Several techniques have been described to taper the dilated small bowel to improve intestinal motility and decrease complications related to overdilated small bowel, including longitudinal intestinal lengthening and tapering, serial transverse enteroplasty, and spiral intestinal lengthening and tailoring. We propose an alternative technique designed to optimize bowel function and minimize the effects of recurrent small-bowel bacterial overgrowth in patients with short or ultra-short gut syndrome and dysfunctional anastomosis with maintenance of the actual absorptive surface. TECHNIQUE The dilated side-to-side anastomosis is identified, and the mesentery leaves from both the proximal and distal small-bowel loops are separated by using blunt dissection. The previous anastomosis is divided longitudinally with a GI stapler. Once the small-bowel transection is completed, 2 separate blind loops of intestine are created, each one with half the circumference of the dilated side-to-side anastomosis. The antimesenteric stapled line is then reinforced with an outer layer of running suture. The blind loops of the tapered small bowel are then trimmed and anastomosed in an end-to-end isoperistaltic fashion in 2 layers. RESULTS There were no postoperative complications. The length of the tapering ranged from 10 to 23 cm, corresponding to approximately 16% (range, 13%-20%) of the remaining small-bowel length. Three of 4 patients presented significant improvement of their symptoms and were able to have their parenteral support discontinued. CONCLUSIONS Modified antimesenteric tapering enteroplasty is an alternative technique to improve intestinal motility and treat patients with short-bowel syndrome and dysfunctional side-to-side anastomosis without the need for further small-bowel resection. This bowel-sparing technique represents a valuable option in the armamentarium of the surgeon who manages patients with intestinal failure. |
| Databáze: | OpenAIRE |
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