Zaman Ranja, Humera Zafar, Haroonur Rasheed.
Outcome of primary reconstruction after intestinal resection in mesenteric vascular occlusion.
Pak J Med Health Sci Jan ;4(3):203-5.

Background: primary reconstruction after resection of ischemic bowel in mesenteric vascular occlusion involving distal ileum usually warrants major resections. Jejuno transverse anastomosis after right hemicollectomy is the commonly performed procedure in our unit under such setting. In this prospective study the option of jejuno ileal anastomosis was evaluated against jejuno transverse anastomosis. Study design: Qusi experimental Method: this study was conducted in surgical unit II of CMH Rawalpindi from Nov, 2005 to Dec, 2008. Patients presenting with acute abdomen were hospitalized from emergency and out patient department. They were operated upon with in 24 hours after fluid resuscitation and antibiotic therapy. Patients with per-operative diagnosis of mesenteric vascular occlusion were included in the study. The ischemic/gangrenous gut was removed and primary anastomosis carried out. In 38 patients right hemicollectomy with jejuno transverse anastomosis was contemplated where as in 13 patient it was possible to establish continuity through jejuno terminal ileal anastomosis. Post-operatively patients were put on anti-coagulant therapy. Descriptive analysis was used for interpretation of results. Results: A total number of n=51 patients were included in the study, 13 in experimental group and 38 in control group. In experimental group “A” one patient 7.69 % had infarct extension, became toxic and tender & was re-operated on third post-operative day. The patients expired after three days of second surgery due to cardiac event while 10 patients 26.31% died in group “B”. Anastomotic leakage was observed in 5 patients 13.16% and wound infection in 7 patients 18.42% in Group “B” as compare to 0 in Group “A”. The experimental group had advantage over the control group with respect to Post-operative ileus (1.5 days and 2.5 days), time of surgery (100 min and 150 min), length of hospital stay (mean 6 and 10 days) respectively. Institution of oral feeding was also earlier in Group “A” 4th Post-Op day as compare to 5.5 Post-Op day in Group “B”. Conclusion: Jejuno ileal anastomosis provides a workable option after resection of ischemic bowel in mesenteric vascular thrombosis where applicable. It is better tolerated by the patient in terms of morbidity and mortality as compare to jejuno transverse anastomosis after extensive resection.

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