Simultaneus Primary Submersible Tolstokishechnj Anastomosis

INFO abstract Colon cancer, which occurs without acute obturative intestinal obstruction, the author proposes to impose primary tolstokishechnyj anastomosis. It reduces the risk of postoperative peritonitis. This is achieved by dipping the anastomosis for -3.5 3.0cm clearance in the distal colon. The technique was applied at 3 patients. Colon cancer was discovered accidentally during an operation carried out at the acute cholecystitis. All patients carried out simultaneous operations. Com-plications were observed.


Introduction
Colon cancer refers to the leading oncological problems. He is 4-6% of all malignant tumors in humans (8)(9). Most often it occurs in the age of 40-60 years and mostly in men (3:2). In the year 2015 at 100 000 of the population accounted for observing this cancer 132.9 localization, and in 2017 year 142.9, i.e. notable growth of the disease (3.4). Of the number of patients with newly diagnosed stage I-II process has been installed at 47.2%, which allows you to perform a primary resection of the colon or the public, or (private) laparoscopic ally [1][2][3][4]. However, as a rule, patients arrive with the phenomena of acute obturative intestinal obstruction, which have made it difficult to provide them with medical assistance [5].
This happens because of the sharp increase in the volume of colon fragment lying above the tumor and its overflow gases, liquid and dense kalovymi masses. Manipulating the gut becomes dangerous because of the threat of getting this content in the free abdominal cavity that leads to the development of putrid peritonitis. Makes it difficult to overlay the primary anastomosis and intestine width difference above and below the for all these reasons and more, running or left-hand or right-sided gemikoljektomija. If the right half colon cancer manages to preserve the natural passage of fecal masses (ileotransverzoanastomoza blend), cancer of the left half of the already have a colostomy impose and further carry out reconstructive surgery tumor [6].
Post-operative life expectancy in these patients depends on the local distribution of cancer process and the availability of regional

Material and Methods
The The length of the gut wall tumor lesions was from 4 to 6cm and it is not prorastala her wall, leaving free to half its diameter. During an operation found that the tumor is movable, IE not grows into surrounding tissues. All these data necessary for simultaneous production just did an operation because it could immediately correct both pathological process-and in the area of the gall bladder and the colon.

Discussion
In the presence of acute colonic obstruction, combine holecistjektomiju or other operation, with primary colon resection is not recommended, as this may lead to the development of putrid peritonitis. This is due to the fact that shovnuju thread will inevitably have to navigate through fecal masses. These observations after removal of tumors impose or single-colostomy (on both ends of the colon), or produce gemikoljektomii and via 3-4 month carry out reconstructive surgery. In those same three observations were favorable conditions for primary colon resection. Without going into the details of group operations, you must specify that they should be held more frequently, and for this it is necessary to detect colon tumors prior to development in patients this complication.
So, for example, of the 315 patients admitted to the hospital with symptoms of acute colonic obstruction, 14 (4.4%) earlier during the period from 3 up to 6 months in various hospitals were subjected to laparoscopic cholecystectomy. There can be no doubt that the tumor they have during the operation already had, but a proper audit of abdominal cavity then did not, and she has not been diagnosed. Simultaneous operations that were performed in these 3 patients got rid of severe discomfort associated with a colostomy, the repeated reconstructive surgery and hospitalization time is halved, i.e. have an explicit social and economic effect.

Conclusion
The primary submersible tolstokishechnyj anastomosis helps reduce the risk of postoperative peritonitis, as he plunges into a wall off the Division, even if insolvency comes seams, this will not lead to infection abdominal cavity. Clinical observations fully confirm this conclusion. When implementing the laparoscopic operations necessary to produce a thorough audit of the abdomen to detect colon tumors and other tissue in the early stages of their development.sss