Surgical Procedure for Release

1. Position: lying down. Postoperative treatment 1.In order to make the intestinal peristalsis recover early, it is necessary to move as early as possible after the operation and turn over often. In the case of abdominal distension, electroacupuncture can be given to strongly stimulate the foot Sanli and the branch groove according to the situation; or use neostigmine 0.25-0.5mg, double foot Sanli closed; also can be used as a compound Da Cheng Qi Tang enema.

2. If the patient's general condition is poor, there is low protein, etc., then the postoperative period should be given to transfusion of fresh blood or plasma, the fasting period should be intravenous drip of glucose in sufficient quantities, give vitamin C, etc.. At the same time, attention should be paid to electrolyte and acid-base balance.

3. The rest is the same as intussusception repositioning.

2. Incision The right side of the rectus abdominis muscle incision is used; or according to the situation, an incision is made in the obstruction area; or the scar can be removed from the original surgical incision to enter the abdominal cavity; however, when incising the peritoneum, the entry of the scar should be avoided, and a small incision should be made first from the normal peritoneum of the upper or lower end of the peritoneum, and a finger should be used to probe the abdominal wall for adherence with the intestinal tube, and then the peritoneum is gradually incised with the finger under the protection of the peritoneum, so as not to damage the intestinal tube.

3. Probing to determine the site of obstruction Intestinal adhesions do not always cause intestinal obstruction, so after entering the abdominal cavity, do not blindly separate the adhesions, it is important to find the site of obstruction first. It is important to find the site of obstruction first. The site of obstruction is the junction of distended and deflated bowel. When searching for the site of obstruction, it is possible to search for the site of obstruction from the deflated bowel upward, to be separated, and to release the obstruction. However, in the case of obstruction, the deflated intestinal canal is covered by the distended intestinal canal, so it is very difficult to search for the obstruction upward from the deflated intestinal canal; if the distended intestinal canal is searched downward for the site of obstruction, it is easy to cause the rupture of the plasma membrane layer when the intestinal canal is raised. Therefore, only when no deflated bowel can be found, the distended bowel should be raised. When the intestinal tube is raised, it is not necessary to carry it out with fingers, but to hold the intestinal tabs with both hands to hold it out, and then wrap it with a large gauze pad with warm saline to protect it, and then gradually look for the obstruction site downward. If the intestinal tube is severely distended, the intestinal gas and fluid can be discharged with good protection against contamination, and then the site of obstruction can be sought (for enterotomy and decompression, see Sterile Intestinal Decompression). Sometimes, there are extensive adhesions between the intestines and between the intestines and the abdominal wall, and it is necessary to separate the adhesions while gradually cupping the intestines out.

4. Loosening adhesions There are four general patterns of intestinal obstruction caused by intestinal adhesions.

(1) adhesion band compression traction intestinal folding into the angle: this type of obstruction can be used to clamp the ends of the adhesion band with hemostatic forceps, excision of the adhesion band, to be ligated, at this time the obstruction of the atrophic intestinal tube can be immediately flatulence, indicating that the obstruction has been lifted. If there is no necrosis of the intestinal tube, the rough surface left after cutting off the attached part of the adhesion band, and the peritoneum and the plasma membrane of the intestinal tube can be covered with interrupted inversion suture.

(2) The adhesion band compresses the intestinal tube to form an internal hernia: the position of this adhesion band is deeper, sometimes it can press the intestinal tube and mesentery at the same time, and it can be accompanied by partial intestinal torsion, which is often probed by the finger, and it is difficult to recognize whether it is intestinal torsion or adhesion band. Therefore, the resection of adhesion band must be carried out under direct visualization, and cannot be cut off blindly under finger probing, so as not to mistake the mesentery for adhesion band and cause undue damage. After resection of the adhesive band, the intestinal contents can be seen traveling downward, and the deflated intestinal tube below the obstruction fills up again, indicating that the obstruction has been lifted. At this time, it should be observed whether the place where the intestinal wall is compressed can survive. If there is hemotransmission obstruction in the area, but the range is narrow, it is feasible to intermittently turn the plasma muscular layer inward and turn it into the intestinal lumen. If the area of necrosis is large, enterotomy anastomosis should be performed. Rough surfaces remaining after resection of the adhesion zone can be closed with interrupted inversion sutures so as to be re-covered by the plasma membrane.

(3) Adhesions between the intestinal collaterals: if the adhesions between the intestinal collaterals do not cause obstruction, they can not be separated, so as not to damage the intestinal wall and cause more extensive adhesions. If it has caused obstruction, it should be separated from the intestinal collaterals. If the adhesion is loose, it can be separated bluntly with fingers, but attention should be paid to avoid tearing the intestinal plasma membrane layer; for tight adhesions, scissors can be used for sharp separation. The rough surface after adhesion separation can be covered by mutual suture between the intestinal tubes or by sewing the mesentery to the intestinal wall. When sewing the intestinal tubes to each other, the rough surface should be more than 3cm away from the curved part of the intestinal tubes, so as to avoid the formation of sharp angles after sewing, causing obstruction. The rough surface can also be rotated along the longitudinal axis of the intestinal tube, and the rough surface can be covered with its own mesenteric suture; the greater omentum can also be used to cover it. If adhesions are extensive, bowel folding should be considered after separation. If the localized adhesion of the intestinal tube becomes a mass and cannot be separated or the plasma membrane layer is severely damaged after separation, intestinal resection and end-to-end anastomosis can be considered.

(4) Adhesion into a mass: feasible resection for end-to-end anastomosis, but should try to retain the viable intestinal tube, in order to prevent the occurrence of postoperative nutrient absorption disorders. It is not easy to resect the obstructed intestinal segment, can be used to obstruct the upper and lower intestinal collaterals for side-to-side anastomosis shortcut surgery, but every postoperative abdominal pain, abdominal distension, diarrhea, anorexia, anemia, emaciation, etc., so it should be avoided as much as possible.

5. Suture closure of the incision After the adhesions are loosened and the obstruction is lifted, the intestines can be returned to the abdominal cavity from the duodenal suspensory ligament from top to bottom or from the ileocecal region from bottom to top in a sequential manner. The abdominal wall is sutured layer by layer, and drainage strips are usually not placed. If the intestinal tube is obviously swollen, and no intestinal decompression is done before separating the adhesions, and it is difficult to return to the abdominal cavity after separation, intestinal decompression can be done, so that the intestines can be emptied and then returned to the abdominal cavity, and the abdominal wall can be sutured; tension sutures can be added if necessary. Patients with intestinal decompression and intestinal resection suture, the incision to place a piece of rubber drainage is appropriate.