RU2845574C1 - Method for applying single-layer intestinal suture - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: invention refers to medicine, namely to abdominal surgery. On one side of the wound, a needle is inserted through a submucous membrane, in an arched upward direction through the muscular membrane and a subserous puncture. On the other side of the wound, the needle is pricked in in a subserous direction from top to bottom through a muscular coat and pricked out into a submucous membrane. Apposition wound edges are fixed with surgical knot, thus contour of intestinal suture setting has form of Reuleaux triangle, suturing is repeated until wound is closed.

EFFECT: method provides the precise adhesion of the intestinal wall layers without involving the serous and mucous membranes and optimizes all the stages of the intestinal wall wound healing, enables reducing a rate of inconsistency and providing the early functional recovery.

1 cl, 1 dwg, 1 ex

Description

The invention relates to medicine, namely to abdominal surgery, and can be used in suturing wounds of hollow organs of the gastrointestinal tract and in the application of interintestinal anastomoses.

Surgery knows a large number of methods for applying intestinal sutures. There are single-row and multi-row, interrupted and continuous, manual and mechanical intestinal sutures. Sutures also differ in the location of the nodes and the degree of apposition of the edges of the intestinal wound. Each method has its advantages and disadvantages.

A method for applying an adaptive intestinal suture is known, which includes case-by-case suturing of the wall of a hollow organ from the outside inward with crossing of the ligature at the border of the muscular and submucosal layers (RU 2132651 C1), 1996. A61B 17/00.

The disadvantage of this adaptive intestinal suture is manifested in uncontrolled trauma to the tissues of the intestinal wall due to the formation of excess tension in the area of the ligature crossing, which leads to pathological healing.

The closest and chosen as a prototype is the method of applying a single-row interrupted intestinal suture (RU 1787433 C), 1990 - A61B 17/00: the first puncture of the needle is made through the submucosa, muscular and serous membranes, and the puncture of the first suture is made through the corner of the edge of the serous membrane on the right side of the incision. The second puncture of the first suture is made in the corner of the edge of the serous membrane on the left side of the incision. The needle is passed through the serous, muscular and submucosa membranes on the left side of the incision and the second puncture of the first suture is made at the border of the submucosa and mucous membranes on the left side of the incision. The third puncture of the first suture is made through the base of the mucous membrane on the right side of the incision and the third puncture of the first suture is made on the mucous membrane on the right side of the incision at the site of the first puncture and a knot is tied. The distance between the sutures is 3-4 mm.

However, the known method is not without some disadvantages, which are: inaccurate matching of the edges of the wound due to multidirectional ligature tension in the intestinal wall, this leads to loose conjugation of the intestinal membranes and, ultimately, slows down the process of epithelialization of the wound from the lumen side, forms a postoperative scar with excess fibrous tissue.

Technical result of the proposed method consists in optimizing all stages of intestinal wall wound healing, which reduces the incidence of failure and ensures early restoration of function.

What is new in achieving the set technical result is that on one side of the wound, the needle is inserted through the submucosa, in an arc from the bottom up through the muscular membrane and a subserous puncture, and on the other side of the wound, the needle is inserted subserously, in an arc from the top down through the muscular membrane and a puncture into the submucosa.

What is also new is that the apposed edges of the wound are fixed with a surgical knot, while the outline of the tied intestinal suture has the shape of a Reuleaux triangle, and the application of sutures is repeated until the wound is closed.

The method ensures precise matching of intestinal wall layers without capturing serous and mucous membranes. The advantageous ligature profile when joining wound edges has the shape of a Reuleaux triangle. The intestinal wall membranes are accurately matched, ensuring contact equal strength along the entire length of the wound, since the ligature contour holds the optimal tissue volume and has axial symmetry, moreover, excessive pressure on the contact surfaces of the wound is prevented, since the said tissue volume has the smallest cross-sectional area of all possible ones. Intestinal trauma is minimized, since there is no puncture of the serous and mucous membranes. All this together improves the conditions for optimal healing in the postoperative period and reduces the thickness of the surgical scar. When using the proposed intestinal suture, thread cutting is not observed due to the equal strength load on the stitches, which do not deform the intestinal wall and contain a minimum volume of suture material. The proposed method of applying a single-row intestinal suture can also be used when applying interintestinal anastomoses after resection of a small-diameter intestine, for example, in newborns.

The claimed method can be recommended for medical practice.

The invention is illustrated by a drawing, which does not cover and, moreover, does not limit the entire scope of claims of this technical solution, but is only illustrative material of a particular case of implementation.

The drawing shows a general view of the suture, where: 1 - mucous membrane, 2 - submucosa, 3 - muscular membrane, 4 - subserosa, 5 - serous membrane, 6 - ligature contour in the form of a Reuleaux triangle.

The method is carried out as follows. The operation is carried out under combined endotracheal anesthesia. Laparotomy and revision of the gastrointestinal tract are performed using known techniques. The presence of a defect on the wall of a hollow organ is established and a single-row intestinal suture is applied. At one end of the wound, a needle is inserted through the submucosa (2), arcuate from bottom to top through the muscular membrane (3) and a subserous puncture is made (4). At the other side of the wound, the needle is inserted subserously (4), arcuate from top to bottom through the muscular membrane (3) and a puncture is made into the submucosa (2). The ends of the thread are pulled until the edges of the wound are apposed, while the thread has the shape of a Reuleaux triangle (6). A surgical knot is tied. In this case, the serous (5) and mucous (1) membranes remain intact. The surgical technique is repeated until the wound is closed. The distance between the sutures is 3-4 mm. The laparotomy wound is sutured layer by layer and the operation is completed.

We give a specific example of the claimed method.

Patient S., 3 years old, was admitted to the emergency surgical department of the Irkutsk State Regional Children's City Hospital on February 12, 2023 with the diagnosis: blunt abdominal trauma (car accident), hemoperitoneum, peritonitis. The patient underwent enterography of the jejunum, sanitation and drainage of the abdominal cavity. During revision of the abdominal cavity, food masses and inflammation of the peritoneum of the mesogastric region were found. On the lateral wall of the jejunum, there is a rupture 23 mm long and 11 mm wide with leakage of intestinal contents. The intestinal wound was sutured using the proposed method. The postoperative period was uneventful, without complications. The patient was discharged on February 20, 2023 in a satisfactory condition.

The proposed method of applying a single-row intestinal suture can also be used when applying interintestinal anastomoses after resection of a small-diameter intestine, for example, in newborns.

The claimed method can be recommended for medical practice.

Claims (1)

A method for applying a single-row nodal intestinal suture, including marginal suturing of an intestinal wound, tying an intraluminal knot, characterized in that on one side of the wound, a needle is inserted through the submucosa, arcuate from the bottom up through the muscular membrane and a subserous puncture, and on the other side of the wound, the puncture is started subserously, arcuate from the top down through the muscular membrane and a puncture into the submucosa, the appositioned edges of the wound are fixed with a surgical knot, while the outline of the tying of the intestinal suture has the shape of a Reuleaux triangle, the application of sutures is repeated until the wound is closed.