Kümmerle F, Seitz W
Zentralbl Chir. 1977;102(17):1045-52.
A certain amount of relaparotomies after small bowel surgery is caused by technical failures, such as the technique of suturing the anastomosis and the kind of re-establishing the continuity of the bowel. An end-to-end-anastomosis with sufficient vascularisation at the cut ends, tension free, and without an overdone inversion will guarantee a more successful suturing of the bowel than a side-to-side-anastomosis. At first the whole small bowel should be explored to recognize multiple lesions. Postoperative malabsorption due to the exclusion of more less extended segments of the bowel--by bypass anastomoses or construction of blind loops--can be repaired successfully by corrective laparotomies. Special problems in operative tactics and technique of Crohn's disease are discussed.
小肠手术后一定数量的再次剖腹手术是由技术失误导致的，比如吻合口缝合技术以及肠道连续性重建的方式。与侧侧吻合相比，端端吻合在吻合口两端有足够的血管化、无张力且没有过度内翻的情况下，能保证肠道缝合更成功。首先应探查整个小肠以识别多处病变。因通过旁路吻合术或构建盲袢排除或多或少的肠段而导致的术后吸收不良，可通过再次剖腹手术成功修复。文中还讨论了克罗恩病手术策略和技术中的特殊问题。
