SU1694119A1 - Method for forming the terminal intestinal anastomosis - Google Patents

Abstract

The invention relates to medicine, namely to surgery and coloproctology, and can be used in the surgical treatment of diseases of the colon. The purpose of the invention is the prevention of inconsistency of anastomotic sutures by increasing the strength of the suture and accurate matching of the layers of the large intestine. When an internal suture is formed, a thin synthetic filament is passed through the muscular and submucous layers with pickup of the mucosa without flashing it through, then re-passing through the submucosal layer into the intestinal lumen and tying it in a knot. 2 Il.

Description

The invention relates to medicine, namely to surgery and coloproctology, and can be used in the surgical treatment of diseases of the colon associated with the necessity of resection of the intestine and the imposition of anastomoses.

The purpose of the invention is the prevention of inconsistency of the sutures due to a more accurate mapping of the mucous membrane and an increase in the strength of the zone of the junction, which is achieved by imposing a 2-ply seam, with knots inside without capturing the mucous and double flashing of the submucosal layer.

Figure 1 shows the imposition of the internal musculo-submucosal suture and non-penetrating suture of the mucous membrane of the colonic anastomosis; 2 shows a comparison of the layers of the walls of the anastomosing intestines.

The method is carried out as follows.

Before resection of the colon within the intended limits, preparation of the ends of the intestine is carried out to create a fistula: the areas to be anastomized are pre-flashed with UO-40 or UO-60 devices. In the area of anastomosis, the marginal vessels should be preserved and the walls of the intestine should be stretched so that the antivascular side forms the front lip of the anastomosis and the mesenteric - posterior. The edges of the intestinal walls involved in the anastomosis are freed from the omental processes. When the ends approach each other, three muscle bands of the connected ends of the intestine are carefully adapted without the use of intestinal zhomov. All stitches are applied with thin synthetic threads on atraumatic needles. On the mesenteric (weak) portion of the posterior lip of the anastomosis, a U-shaped gray-serous suture should be applied. The outer row of the posterior lip is formed by nodal

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gray-serous seams. The distance between the sutures should be 0.3 cm. At a distance of 0.5 cm from the line of sutures, the sero-muscular layer is opened circularly, and then along the edge of the contracted muscular layer, the submucosa and mucous membrane. At the same time, sections of the ends of the intestine stitched with tantalum brackets are cut off. The lumens of the anastomosed intestinal crisps are wiped with gauze balls soaked in a 0.02% chlorhexidine aqueous solution. Bleeding from the vessels of the submucosal layer is stopped using hemostatic clamps of the mosquito type and their subsequent delicate ligation.

Imposition of the internal row of seams of the posterior lip of the anastomosis is possible from any of its corners. When the surgeon is located to the right of the patient, the injection of the posterior lip is made to the edge of the submucosal layer of the distal stump of the created fistula. The needle is passed through the mucous membrane, without piercing it through, then again with the capture of the submucosal and muscular layers to a depth of 0.5 cm along the longitudinal gut, the needle is punctured on the border of the muscular and serous layers, sub-serous. The transition to the posterior intestine wall of the proximal anastomotic stump is carried out in the reverse order through the Muscle and submucosal layers with the capture of the mucous membrane and the puncture of the submucosa of the mucosa. The distance between the internal stitches of 3 mm makes it possible to match the mucous membrane, submucosal and muscular layers of the anastomized guts well enough when stitching the stitches. In this case, an internal non-penetrating seam of the mucous membrane is formed, the nodules are located inside the lumen of the junction, reliably covered by the edges of the mucosa. Double seizure of the submucosal layer increases the strength of the suture; The serous shell during the formation of the inner row and the fusion does not fit into the seam.

The internal row of sutures of the anterior lip of the anastomosis is formed in a similar way. To accurately and reliably match the layers of the walls of the stitched intestines, the last 2-3 seams are tied after they are applied. The outer row of the anterior lip is the same as the outer row of the back lip.

Example. Sick D., 47 years old (case history NS 2279/447), was admitted to the surgical department on April 15, 1988, complaining of persistent pain in the left half of the abdomen, bleeding from the anus, delayed stools and gas, and weight loss.

After two weeks of training aimed at correcting anemia, metabolic disorders, intestinal obstruction, was operated on. Sigmoid colon resection with

end anastomosis of the proposed method. Decompression of the anastomosis was carried out for 7 days through a silicone tube transanally held above the anastomosis. Complications from the anastomosis was not. Discharged for outpatient treatment in a satisfactory condition. With the control corrigoscopy and colonoscopy after 5 months. After the operation, the fistula was not diagnosed.

Thus, the proposed method can be recommended in surgery, oncology and coloproctology in the surgical treatment of diseases of the colon associated with the need for resection

intestines and the imposition of anastomoses, especially in the presence of clinical factors that adversely affect the healing of colonic fistula in elderly and debilitated patients. The proposed technique improves the quality of layer by layer matching of the edges of the anastomosis, promotes healing of the intestinal wound by primary tension. The strength of the anastomosis created in this case makes it possible to abandon the traditional preventive transverse or cervical after left-side resections of the colon. Perhaps the application of the proposed method for resection of the small intestine.

Claims (1)

Invention Formula The method of forming the terminal colonic anastomosis by double-stitched sutures using microsurgical techniques without piercing through the mucous layer, characterized in that, in order to prevent the inconsistency of the sutures due to a more accurate comparison of the mucous membranes and the strength of the zone of the fistula, when the inner row is put with knots inside, the thread is conducted with a stick in the edge of the submucosal layer through the thickness of the mucous, then again through the submucosal and muscle layers and out subserous, and on the opposite side in reverse order. H serozna muscular - submucic-tsg mucous FIG. one FIG. i