RU2171635C2 - Method for carrying out abdominoanal resection of the rectum - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves mobilizing the rectum in accessing it through the abdomen. The rectum resection is carried out is and anal canal mucosa is excised. Seromuscular layer is separated on the descended intestine segment in distal direction. Intestine segments are descended into the anal canal from the mucous membrane with submucous layer. The muscular layer of the intestine is sutured to the internal sphincter. The mucous membrane is attached to skin all over its perimeter. EFFECT: improved blood supply of intestine segment in the sphincter.

Description

 The aim of the invention is the creation of a technique for lowering the colon after abdominal-anal resection of the rectum for cancer of the ampullar region, in which the sphincter function is least disturbed, its earlier recovery occurs, while the radicalization of the operation is not reduced.

 The prototype is the operation proposed by Villard (1905), in which, after mobilization of the rectum, a circular incision is made through the abdominal cavity at the border of the skin and mucous membrane of the anus. Sphincter stretch and exfoliate the mucous membrane from the sphincter up. The levators are dissected and the mobilized intestine is reduced.

 The disadvantage of this method is the passage of the reduced intestine through the sphincter along with the adjacent fiber and blood vessels, as a result of which there may be a strangulation of blood vessels and a disturbance in the blood supply to the portion of the reduced colon located in the anal canal, which often manifests itself as necrosis. In addition, due to the passage of a large volume of tissue through the anus, a violation of the function (tiredness) of the sphincter occurs.

 Our proposed technique is as follows.

 After the mobilization of the rectum from the abdominal cavity during the perineal stage, the anal mucosa is excised and intersected at the border with the skin. At the level of the proposed upper resection line, in the place of good blood supply, at the edge of the vessel, a circular dissection of the serous-muscle layer of the colon is performed, the serous and muscle membranes are separated from the submucosal layer in the distal direction for 3-4 cm. At this level, the intestine is ligated and intersects, the resected intestine is removed. In cases where the drug with the tumor can be passed through the sphincter without stretching it, after ligation at the distal edge of the intestine prepared for the reduction, the entire removed drug is dragged through the anus and only then the intestine is crossed, and the drug is removed. The proximal end of the large intestine is brought down through the anal canal, while only the prepared, as indicated above, submucous layer of the intestine comes into contact with the sphincter. The serous-muscular membrane of the intestine is sutured with several interrupted sutures to the internal sphincter, and the mucous membrane is sutured along the perimeter to the skin.

 The proposed method allows to reduce the frequency of necrosis after the reduction operation due to better blood supply to the area of the intestine located in the sphincter, as the volume of tissues encircled by the sphincter decreases and compression of the intramural vessels does not occur. Due to the fact that the adjacent fiber and the serous-muscular membrane are not passed through the anus, the "tiredness" of the sphincter is eliminated, and its function is restored more quickly.

 Example 1. Patient P., 57 years old, was admitted to the surgical department of GSMO "Oncology" for colorectal cancer. Examination revealed an exophytic tumor of 5x4 cm at a distance of 6 cm from the transitional fold. Surgery undertaken. The rectum was mobilized to the levators, the sigmoid colon and the left half of the colon were mobilized. The patient was transferred to the gynecological position. The skin around the anus is dissected, the mucosa of the anal canal is bluntly and sharply separated from the sphincter. The prepared intestine is relegated through the anus. At the resection level, the serous-muscular membrane of the sigmoid colon is dissected to the submucosal layer and separated from the latter by 4 cm distally from the latter. An anastomosis with the mobilized mucosa was superimposed according to the method described above. The postoperative period was uneventful. An independent chair was on the fifth day. In the early days, stool was observed with a frequency of 3-5 times a day, after 2 weeks - 1-2 times a day. The sphincter tone is normal, controlled by the patient.

 Example 2. Patient S., 59 years old, was under treatment for colorectal cancer. When laparotomy revealed: a large rectal tumor grows into the uterus, distant metastases were not detected. Produced abdominal-anal resection of the rectum with excision of the mucosa of the anal canal, extirpation of the uterus with appendages. The drug due to its large size is removed through the abdominal cavity. Colon reduction was performed according to the described procedure. The postoperative period without features, the wound healed by primary intention. At discharge, the function of the sphincter is satisfactory, the patient is controlled.

Sources of information
1. A.A. Shalimov, V.F. Sayenko. Digestive tract surgery. - Kiev, 1987.

 2. S. Fractions. Bowel surgery. - Budapest, 1983.

Claims (1)

 A method of lowering the large intestine after abdominal-anal resection, including mobilizing the rectum through the abdominal cavity and removing it with excision of the mucosa of the anal canal from the perineum, characterized in that the serous-muscular layer of the colon is distally separated from the submucous layer in the reduced portion of the intestine and a section consisting of a mucous membrane with a submucosal layer is lowered into the anal canal, devoid of the mucous membrane, while the muscle layer of the intestine is sutured to the internal sphincter and the mucous membrane - along the perimeter to the skin.