Matters needing attention in release operation

1. It is difficult to enter the abdominal cavity. Due to the adhesive intestinal obstruction caused by operation, there are many adhesions between the intestine and the abdominal wall at the scar of the surgical incision. Therefore, when the scar of the original incision is removed and enters the abdominal cavity, there is often a danger of damaging the intestine. Sometimes, because patients have had multiple operations, it is more difficult to enter. Therefore, during the operation, we should be vigilant, carefully separate, find out the gap, reach into our fingers, find out the situation, avoid entering the intestinal cavity and make it safely enter the abdominal cavity.

2. When the intestinal wall is widely adhered to the abdominal incision, a knife or scissors can be used for sharp separation. It is best to remove part of the peritoneal wall to ensure that the intestinal wall is not damaged and ruptured, and to avoid peritonitis or intestinal fistula.

3. The separation of adhesion should be done patiently and carefully. After extensive intestinal adhesion and separation, the surface of intestinal canal will be rough, and even the serosa muscle layer will be damaged. We should combine blunt separation with sharp separation, be patient and meticulous, and don't use violence; Otherwise, it will not only cause more serious adhesion, but also cause serious complications such as peritonitis, abdominal abscess and intestinal fistula. Serious damage to the intestinal wall can be repaired, and serious intestinal resection is needed.

4. When suturing peritoneum, it is required to be satisfied with anesthesia for a long time. When anesthesia fails, extra anesthesia should be given. If the patient holds his breath and the abdominal wall is extremely tense, he will reluctantly reset the intestinal tube, which may cause volvulus and intestinal obstruction again. The way to prevent re-obstruction is to arrange the intestinal tubes in a row from the left upper abdomen to the right lower abdomen according to the anatomical position after anesthesia recovery and abdominal wall relaxation, and put them in order.

5. When sewing peritoneum, don't sew the intestinal wall together by mistake. When the peritoneum is sutured, the intestine should be separated from the abdominal wall with a pressure plate or gauze pad, so as to avoid hanging the intestinal wall by mistake during suture and forming an acute angle, resulting in postoperative re-obstruction.