[A method for the temporary closure of a small intestine fistula].
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The problem of prophylactics of postoperative infectious complications in the surgery of digestive tract is discussed. A comparative analysis of efficiency of two methods of antibacterial prophylactics during operations of closing the formed intestinal fistulas in children is given. High efficiency of the method of preoperative subtotal decontamination of the intestine according to individually selected schemes is shown.
A review is given on frequency, etiology, anatomopathology and physiopathology of vesico-intestinal fistulas. Symptomatology and diagnosis with stress on adjuvant technical investigations are studied. In conclusion the principles for a surgical treatment are discussed.
The experience with the treatment of 132 children with the external intestinal fistulas is summarized. In 28, the fistulas closed under the influence of conservative therapy. Operated on were 44 children. The postoperative lethality was 9%, total lethality-- 44.7%.
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A method for containing troublesome intestinal stomas or fistulas in open wounds is described. Custom-fitted faceplates are made using alginate materials and vulcanizing silicone rubber at room temperature. Three patients have been presented illustrating the rehabilitation and palliation that can be achieved by collaborative interaction between surgeons, enterostomal therapists, and prosthetic technicians.
Experience in using complex treatment in 42 children with unformed small-intestinal fistulas, generalized defects of the anterior abdominal wall and severe disorders of alimentary status is presented. Their preoperative preparation included parenteral alimentation, enteral probe feeding with special elementary milk formulas, correction of metabolic disorders. Intestinoplication during surgery was carried out with the medicinal glue MK-7 to prevent intestinal obstruction and formation of interloop abscesses. The use of portions of the tendinous part of the musculus tensor fasciale late was one the simple and effective methods for plasty of anterior abdominal wall defects.
The authors present a report of four personal cases of intestinal fistulas, treated by parenteral hyperalimentation. They describe the technique of parenteral hyperalimentation used. There was one complication due to yeast septicemia from a sub-clavian catheter used for parenteral nutrition. Treatment of the yeast septicemia by amphotericine B was successful. (Acta anaesth. belg., 1976, 27, 35-44).
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During the past 20 years 17 patients with abdominal-aortic-intestinal fistulas have been operated in our department. Hospital-letality accounted till 1986 with 75%. Since then we preferred direct reconstruction by implantation of a vascular graft, covered by omentum in primary fistulas. Hospital letality could be reduced by this management to 0% in primary fistulas by a total survival rate of 67%.
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The results of 28 patients with formed small intestine fistulas after resection of portions of the small intestine of different length were analyzed. In 15 patients the terminal part of the iliac was not more than 10 cm, in 13 patients it was completely ablated. The reconstructive operation for closure of the fistulas was performed in 3.5 months at an average since the moment of putting the fistulas. The enteroenteral anastomosis next to the blind gut was formed to 12 patients, enterocecal--to 8 patients. Long-term results were good in 15 patients, satisfactory--in 5.
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