HEMICOLECTOMY IN OBSTRUCTIVE CANCER OF THE RIGHT HALF OF THE COLON

The aim of the study is to improve the results of treatment in patients with obstructive cancer of the right colon and to develop and implement into clinical practice an invaginational ileotransverse anastomosis. Materials and methods. In the Surgical De-partment №2 of Regional Clinical Hospital named after Andrii Novak in the period 2015-2019 years 94 patients with obstructive colon cancer of the right colon under-went surgical treatment. 39 patients underwent right hemicolectomy with two-row "side by side" type ile-otransverse anastomosis, for 55 patients a non-contact isolational technique with one-row invaginational ile-otransverse anastomosis in our modification was per-formed. The concept of this technique is from the begin-ning of intervention to ensure the maximally blocking the main ways of tumor metastases – on the intestinal wall, hematogenous, lymphogenic and contact ways. After revision the tumor must be left "alone" – do not palpate it until colon resection. Ileotransverse anastomosis is per-formed due to Ukrainian patent #98084582. After resec-tion, a purse-string suture is made on the end of ileum with a long ligature, which is hold under tension, so con-tamination of abdominal cavity by microflora is exclud-ed. The distal 2-3 cm of ileum should be cleared from mesentery. The free end of ileum is sewn to transverse colon “end to side” under the tenia libera with one-row of serous-muscular sutures. The colon is cut along tenia to the width of the ileum diameter. Through this hole a puncture is made in tenia libera with the purse-string suture, which helps to invaginate the ileum into the colon lumen. After, serous-muscular sutures are sewn on the anterior part of anastomosis. The untied purse-string suture is deleted, which leads to opening of the ileum lumen. Results and discussion. After right hemicolec-tomy with a two-row "side by side" anastomosis anasto-motic leakage was noticed in 2 patients (5,1%). After the formation of one-row "end to side" invaginational ile-otransverse anastomosis no compilcations were noticed. On the control colonoscopy the stump of the ileum peri-stalted through intestinal wall into the transverse colon lumen. On barium enema reflux-enteritis was not ob-served. It can be argued, that invaginational ileotrans-verse anastomoses take over the function of the ileocecal valve. In our opinion, opening the lumen of the bowel is a possibility of contamination of abdomen by intestinal microflora and decreasement in reliability of an intestinal anastomosis. In determining the optimal borders of colon re-section, it is important to consider its sphincters localiza-tion. In the formation of anastomoses any obstacle for moving of intestinal contents may lead to increasement of intracolonic pressure, which can play a negative role in anastomotic leakage. The anastomosis should be formed on a colon section where are probably no sphincters. At the same time, one-row invaginational ileotransverse anastomosis can be performed in any part of the colon. Conclusions. The offered one-row invagination-al ileotransverse anastomosis reliably restores the intesti-nal patency, prevents the development of reflux-enteritis, is technically easy to perform and can be recommended for practical use in patients with obstructive colon cancer.