Time frames and volume of surgical intervention of reconstructive restorative stage after Hartmann’s procedure

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Abstract

Aim. To improve immediate and remote results of reconstructive restorative procedures in patients with complicated colorectal cancer.

Methods. The study is based on clinical experience of treatment of 107 patients who had reconstructive restorative procedures performed in specialized oncology institution after previous Hartmann’s procedure performed in urgent surgical department for complicated colorectal cancer. Reconstructive restorative procedures were performed at different time after the primary operation. To assess functional state of anal sphincter all patients were adminestered sphincteromentry during the preoperative period. Morphological analysis of all tissues removed during the surgery was performed. To evaluate morphological changes of distal end of the stump at different time a histological analysis was performed.

Results. According to the results of sphincterometry dynamic reduction of tonic contraction and maximum pressure of anal sphincter is observed. The more the period between Hartmann’s operation and reconstructive restorative surgery, the less pronounced muscle tone of anal sphincter. Histological studies of intestinal wall during the first 3 months after Hartmann’s surgery revealed intact quantity and size of intestinal crypts, non-significant inflammatory infiltration of mucous and submucous layers, during the period of 4 to 6 months - initial signs of diversion colitis, during the period of 7 to 12 months - atrophic changes in mucous membrane (reduction of crypts quantity, their shortening, decreased thickness of mucus), after 1 year - signs of atrophy of its submucous layer.

Conclusion. Reconstructive surgery in patients with previous Hartmann’s surgery for complicated colorectal cancer should be performed in specialized departments with all modern methods of surgical, radiation and medical treatment of colon cancer available; based on functional and morphological studies the optimal time frame for reconstructive surgery is 1 to 3 months after the initial surgery.

About the authors

I G Gataullin

Kazan state medical academy

Author for correspondence.
Email: marat-khalikov@inbox.ru

M M Khalikov

Republican clinical oncology dispensary

Email: marat-khalikov@inbox.ru

E V Kozlova

Republican clinical oncology dispensary

Email: marat-khalikov@inbox.ru

Z A Afanas’eva

Kazan state medical academy

Email: marat-khalikov@inbox.ru

V P Potanin

Republican clinical oncology dispensary

Email: marat-khalikov@inbox.ru

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© 2017 Gataullin I.G., Khalikov M.M., Kozlova E.V., Afanas’eva Z.A., Potanin V.P.

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