Introduction: Common purulent peritonitis is one of the most formidable complications in abdominal surgery. Evidence of this is the continuing high mortality rate, which according to various authors, ranges from 11% to 83%. According to modern concepts, the leading role in the development and progression of widespread purulent peritonitis is assigned to enteric insufficiency syndrome (EIS), which occurs in 90-100% of cases. Aim: The aim of the study was to improve the treatment outcomes of patients with peritonitis complicated by the development of enteric insufficiency syndrome and also by developing and introducing into clinical practice a complex of therapeutic measures, including the combined use of enterosorption in combination with antioxidant and antihypoxant therapy. Materials and Methods: The evaluation of the effectiveness of the proposed complex therapeutic measures was carried out on the basis of a prospective examination of 83 patients (26 men and 57 women) aged 24 to 76 years with diffuse peritonitis with III-IV degree of operational risk for ASA. The comparison group included 37 healthy people aged from 20 to 54 years. All examined patients were divided into two clinical groups. The first clinical group 67 patients with EI of the first degree and second clinical group 16 patients with II degree EI. Before the operation, a suspension of enterosorbent was preliminarily prepared. Suspension of DS was injected through the inserted probe using a Janet syringe, creating an exposure for 10-15 minutes. Then restored the free outflow of the contents of the probe. After completion of the surgical intervention, in the conditions of the intensive care unit, enterosorption continued to be performed every 8 hours (3 times a day). The study was carried out before the operation and in the terms of the 1-3rd and 10-14th days in the postoperative period. Anti-endotoxin antibodies of classes A, M and G (respectively anti-LPS-IgA, anti-LPS-IgM, anti-LPS-IgG) were determined by ELISA. Results: When used in the postoperative period for the treatment of enteric insufficiency with detoxification and antihypoxic therapy according to the developed method, a favorable effect is noted, which is confirmed by an assessment of the state of antiendotoxin immunity associated with the development of bacterial translocation and enterogenic toxemia. Conclusion: The use of the proposed intestinal therapy in combination with antioxidant and antihypoxic therapy helps to prevent the progression of endogenous intoxication, through inactivation and effective clearance of toxic metabolites, reducing the effects of hypoxia, which leads to a significant decrease in membrane-destabilizing effects from the intestinal cell structures and leads to a significant decrease in the expressed specific antigen of the immune system and better clinical outcomes.

This article presents the results of morphologic examination of intestinal anastomoses (IAs) formed by a precision technique in an experiment. Processes of regeneration in the zone of bowel anastomoses made with the author's precision one-row continuous suture (POCS) (Ukraine patent UA 32940), the author's precision one-row interrupted suture (POIS) (Ukraine patent UA 119073) and a double-row Albert-Schmieden suture (DASS) on rabbits of butterfly breed (n=45) are reviewed. Histological examination on Days 1, 3, 5, 14 and 30 revealed differences in reparative processes depending on the type of anastomoses. The morphological pattern in the early term (Day 3) of reparation is caused by the predominance of lysis of collagen fibers; nevertheless, in the early term the quantitative evaluation of healing stages was higher in the two groups of precision anastomoses than in the DASS group (2.00±0.00 points vs. 1.33±0.33 points). Formation of granulation tissue and collagen started on Days 5-7 in the two groups of precision anastomoses versus Days 7-14 in the DASS group, and in the two groups the process reached Stage 5 of reparation (3.00±0.00 points), while in DASS group it reached only Stage 4 (1.67±0.33 points). There were differences in the quantitative evaluation of staging on Day 30. In Group 1 (POCS), it was 5.00±0.00 points in average while in Group 2 (POIS) it was insignificantly lower (4.67±0.33 points). Differences between healing stage criteria were statistically significant in the precision technique sutures versus DASS (P<0.05). We did not find a statistically significant difference in the healing process between the two types of anastomoses formed by the precision technique. In contrast to DASS, the precision technique sutures do not deform a bowel lumen. Thus, the use of microsurgical techniques is the preferred method for forming IA.