THE USE OF CONTACT STOMA IN SURGICAL INTERVENTIONS ON THE RIGHT SIDE OF THE COLON IN THE CONTEXT OF ACUTE I NTESTINAL OBSTRUCTION

Abstract. Aim. To analyze the effectiveness of two different surgical methods for resolving acute intestinal obstruction (AIO), such as the formation of a terminal ileostomy and the simultaneous formation of a terminal ileostomy with a contact ascending or transverse colostomy, following resection of the ileocecal segment of the colon or right hemicolectomy. The study also aimed to investigate their impact on the quality of life and metabolic status of patients. Materials and Methods. A case series of 38 patients treated at the V. T. Zaytsev Institute of General and Emergency Surgery in Kharkiv from 2017 to 2023 is presented. Of the full cohort, fifteen patients underwent treatment after surgery for AIO without the formation of a contact transverse stoma, and the remaining eight had the formation of a terminal ileostomy and a contact transverse stoma. Fluid and electrolyte balance support in the stoma group was achieved by cleansing and filtering the contents obtained from the previously formed ileostomy and introducing the obtained fluid into the contact transverse stoma to compensate for potential fluid and electrolyte losses through the exclusion of the large intestine as the main site for fluid absorption in the body. To monitor electrolyte balance and compare, the levels of potassium, sodium, calcium, and magnesium in serum were studied in the first and second groups of patients. Statistical analysis of the results was performed using methods of variation statistics and probability estimation by Student’s t-test. Results. The results in the non-stoma group of patients indicated increased fluid, salt, and protein loss along with ileosecretum, reflecting changes in the acid-base balance towards alkalosis and hypovolemia, and dehydration. This is evidenced by a significant decrease in potassium levels by 64 %, sodium by 22 %, and a change in blood pH to (7.45±0.02) in venous blood compared to the group of patients with a formed contact stoma (p ≤ 0.05). In the group of patients who underwent hydration using a contact stoma, stable positive dynamics and no significant changes in acid-base balance indicators were observed. Significant differences in other electrolyte balance indicators were not found. Conclusions. Based on the results of the study and observation, we can conclude that the chosen surgical tactic, in addition to forming a traditional ileostomy, also involves creating a contact transverse stoma for further hydration of patients with oncological diseases of the right half of the colon complicated by acute intestinal obstruction, has achieved certain success in correcting the water balance and reducing the preoperative preparation time before the next stage of surgical intervention in patients compared to those who underwent surgery and ileostomy application in traditional tactics. The proposed method of cleaning and reusing ileosecretum for restoring electrolyte balance has great potential for development in colorectal surgery as an optimal method of supporting patients with excluded chyme and fluid from the large intestine passage.