EP1018947A1 - Anastomosis of the small intestine and the rectum - Google Patents
Anastomosis of the small intestine and the rectumInfo
- Publication number
- EP1018947A1 EP1018947A1 EP98944346A EP98944346A EP1018947A1 EP 1018947 A1 EP1018947 A1 EP 1018947A1 EP 98944346 A EP98944346 A EP 98944346A EP 98944346 A EP98944346 A EP 98944346A EP 1018947 A1 EP1018947 A1 EP 1018947A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- tube
- rectum
- small intestine
- intestine
- mucosa
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/1114—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
Definitions
- the present invention relates to a method for surgical joining together the small intestine and the rectum according to the preamble of claim 1.
- a method of this kind is known from the prior art and is referred to as ileorectal anastomosis.
- certain diseases such as ul- cerative colitis or adenomatous polyposis coli, it is necessary at least to remove the large intestine.
- the standard solution which is used is the abovementioned ileo-pouch-anal anastomosis.
- both the large intestine and the rectum are removed, and the free end of the small intestine is firstly used to form a reservoir and secondly to provide a join to the anus.
- the removal of the rectum and the ileo-anal anastomosis in particular represent critical phases of the ileo-pouch-anal procedure.
- the object of the present invention is to provide a procedure which does not have the drawbacks described above, but with which the entire diseased mucosa is nevertheless removed. Moreover, the aim is to restore the intestinal continuity, with defecation per vias naturales. Moreover, it is intended to avoid septic complications and sexual dysfunctions, while retaining the reservoir function of the (new) rectum. This object is achieved using a method as described above having the characterising features of claim 1.
- the invention is based on the insight that only the mucosa of the rectum is affected, while in particular the surrounding muscular wall is healthy. Therefore, in the method according to the invention, this muscular wall is left intact, and the mucosa of the rectum is replaced by the freed mucosa of the small intestine. Surprisingly, it has been found that after a certain time this mucosa adapts itself to the conditions prevailing inside the muscular tunic, which takes over the slightly modified function there.
- the method according to the invention combines the advantages of the above- described ileorectal anastomosis and ileo-pouch-anal anastomosis, while avoiding their drawbacks, i.e.
- the distance over which the mucosa of the small intestine is prepared in such a manner that it is made free, i.e. at least the muscle tissue is removed is approximately 20 cm. This distance corresponds to the length of the remaining part of the rectum.
- the connective tissue is also removed from the rectum.
- a temporary stoma is made in the small intestine.
- a supportive plug is temporarily introduced into this mucosa in the rectum from outside.
- the invention also relates to a device for making free the free end of the small intestine and joining it to the rectum.
- a tube for locating (human) organs is generally known in the art.
- WO 89/0741 describes a probe for locating an endo-tracheal or endo-oesophageal tube in the trachea or oesophagus .
- Such tube is not suitable for realising the method as described above.
- This tube is closed at one end and has a diameter of 10 mm maximum. Otherwise such a tube can not introduced in the trachea or oesophagusa.
- EP-0 771 5 ⁇ 5 Al describes a disposable rectoscope.
- This rectoscope comprises a rigid tube to be introduced in a human being.
- the method according to the invention cannot be realized with such a rectoscope because of the presence of gripping means making removing of the rectoscope after the procedure of the invention impossible.
- EP 0 478 358 Al describes a suture guide for urethral surgery.
- This guide comprises a rigid tube having a curvature of around 45° and the diameter of 6-7 mm. The ends of the tubes are closed.
- US-A-4,530,354 describes a tracheal tube in which an inflatable cuff member is provided. No communication between the free ends of the tube in view of the presence of the cuff. The diameter for its intended use will be around 10 mm.
- the subject invention provides a device for joining two intestine parts comprising a rigid tube, which is to be introduced into the separated intestine and has an outer diameter between 1 and 25 mm and a length of 18- 30 cm, the opposed ends of said tube being open and in communication with each other, said tube having a curvature of about 20°, the outer shape of the tube being substantially continuous.
- the outer diameter of the tube should correspond with the inner diameter of the parts to be connected and on the other hand the inner diameter of the tube should be as large as pos- sible to provide for introduction of several items such as a betadine immersed tampon to be positioned near the place of connection.
- the device according to the invention is also possible to realise the device according to the invention as a flexible tube which is to be introduced into the separated intestine and has an outer diameter between 15 and 25 mm and a length of 18-30 cm, the opposed ends of said tube being open and in communication with each other, the outer shape of the tube being substantially continuous.
- Such flexible tube can be bent into the desired curvature but it is also possible that it has been (partially) curved in advance.
- disconnectable gripping means are provided.
- the tube can be provided with a treated hole to receive a rod being provided with a cooperating thread.
- a gripping means such as a groove
- pliers having jaws, wherein the related tissue is placed in between and clamped in position. Both measures described above improve handling of the tissue material to be connected.
- This device comprises a tube with a diameter of between 15 and 25 mm and a length of approximately 18 - 30 cm.
- This tube is preferably curved in accordance with the shape of the rectum.
- the diameter of the tube is more particularly between 19 and 23 mm, while its length is approximately 20 cm.
- the curvature of the tube is preferably approximately 20° , and the tube is preferably a somewhat flexible tube, in order to be able to adapt to the particular conditions of the body.
- the material from which the tube is produced may be any material which is known from the prior art. Examples are flexible plastic material as well as rigid thin walled metal tubing. This material is preferable chosen such that during cutting no material of the tube frees from the tube material. Through the use of a thin walled large diameter tube the inner dimensions of the tube are as large as possible allowing for introduction of for example a tampon after the operation has been succeeded.
- Fig. 1 diagrammatically depicts part of the human intestinal system
- Fig. 2 diagrammatically shows a first step of the operational technique according to the invention
- Fig. 3 shows a second step of the procedure according to the present invention
- Fig. 4 shows the join according to the present invention
- FIG. 5 shows a further embodiment of the tube shown in Figs. 2-4.
- Part of the human intestinal system is shown in Fig. 1. It comprises the small intestine 1, large intestine 2, rectum and anus 4.
- 5 shows the blood vascular system for the small intestine.
- Certain diseases such as ulcerative colitis or familial adenomatous Polyposis, affect the large intestine (colon) and the rectum.
- the invention is based on the insight that not all of the colon and rectum tissue is affected, but rather only the colo-rectal mucosa, which in Fig. 3 is denoted by 14. Surprisingly, it has been found that the connective tissue 13 and the muscle tissue 12 are not affected.
- the large intestine is separated from the small intestine (ileum) and the rec- turn, respectively.
- the large intestine part is removed.
- the device according to the invention which is denoted overall by 20, is inserted into the remaining part of small intestine 1.
- the muscle tissue 6 is removed over the distance b, so that only intestine mucosa 8 and the connective tissue 7 remain.
- this distance b is approximately 20 cm.
- This end of the small intestine is then introduced into the prepared remainder of the rectum.
- the remainder of the rectum is illustrated in Fig. 3 and comprises muscle tissue 12, connective tissue 13 and mucosa 14.
- the preparation involves removing the original layer of mucosa 14 and the layer of connective tissue 13 from the rectum. This is because it has been found that only this tissue 14 bears the disease.
- device 20 with the surrounding mucosa tissue of the small intestine is introduced into the rectum. Owing to the particular shape of the device 20, it fits the shape of the remainder of the rectum. After the introduction has been carried out, the distal end of muscle tissue 6 is joined to the proximal end of muscle tissue 12.
- device 20 is removed and the mucosa tissue of the small intestine is attached transanally to the connective tissue of the remainder of the rectum. Then, after the device 20 has been removed anally, the new rectum is filled with a gynaecological tampon or plug (not shown) which has been soaked in 0.1% Betadine.
- An auxiliary stoma is made in the small intestine, in a manner not shown in more detail, which stoma can be removed after the mucosa tissue has been grown into the rectum wall, after which the patient can evacuate normally.
- the above-described device 20 is preferably a tube made of plastic, which more particularly is slightly flexible.
- the angle of curvature " is preferably approximately 20°, and this tube has a length of at least 20 cm.
- the diameter of the tube lies between 20 and 22 mm.
- This tube preferably consists of a material which can be sterilized, and more particularly of a (flexible) plastic, such as polyvinyl chloride a thin walled rigid metal tube.
- Fig. 5 Shows an alternative embodiment of a device according to the invention and the tube according to the invention is generally referred to by 30.
- the opposed ends 31.32 are open and in communication with other.
- Tube 0 is provided with a threaded bore 33 to receive a rod 34 being provided with a corresponding male thread.
- This connection is only necessary during connection of the related organs.
- rod 3 is removed and tube 30 is removed through the rectum of the related patient. In this way the position of the tube can be accurately fixed during operation. Further fixing of the tissue material can be realised by gripping it at extremity 32.
- a set of pliers 37 is shown having jaws 38. These jaws have a stepped design and the protruding portion thereof is able to enter groove 36 of tube 30. By positioning the jaws around the tissue this tissue is forced inside the groove and its position is fixed.
- results The method according to the invention was found to be highly feasible on a technical level without the need for major changes to the procedure. Macroscopic ingrowth of the mucosa of the ileum was observed in all eight pigs after one week. The median percentage of mucosa coverage of the neo- rectum surface, assessed during the proctoscopy, was 75% after 1 week (spread 50 - 90%), 90% after three weeks (75 - 100%) and 100% after six weeks (60 - 100%) .
- the histological changes in the transplanted mucosa and submucosa can be divided into three phases:
- the mucosa In most of the pigs, the mucosa has normal villi, with a virtually completely intact brush border. There is a considerable increase in the number of inflammation cells in the mucosa.
- the mucosa has completely restored itself, and the length of the villi is normal again.
- the brush border is absent only at the tips of the villi.
- the infiltration of inflammation has decreased and disappears over the course of time.
Abstract
Description
Claims
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
NL1007101 | 1997-09-23 | ||
NL1007101A NL1007101C2 (en) | 1997-09-23 | 1997-09-23 | Method and device for surgically establishing a connection between the small intestine and the rectum. |
PCT/NL1998/000550 WO1999015087A1 (en) | 1997-09-23 | 1998-09-23 | Anastomosis of the small intestine and the rectum |
Publications (1)
Publication Number | Publication Date |
---|---|
EP1018947A1 true EP1018947A1 (en) | 2000-07-19 |
Family
ID=19765724
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
EP98944346A Withdrawn EP1018947A1 (en) | 1997-09-23 | 1998-09-23 | Anastomosis of the small intestine and the rectum |
Country Status (5)
Country | Link |
---|---|
EP (1) | EP1018947A1 (en) |
AU (1) | AU9190498A (en) |
CA (1) | CA2304149A1 (en) |
NL (1) | NL1007101C2 (en) |
WO (1) | WO1999015087A1 (en) |
Families Citing this family (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
RU2748250C1 (en) * | 2020-07-02 | 2021-05-21 | Андрей Анатольевич Крячко | Method for forming end-loop ileorectal anastomosis during reconstructive stage of operation after colectomy |
Family Cites Families (9)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
FR979425A (en) * | 1949-01-25 | 1951-04-26 | Improvements to endoscopes and more particularly to rectosygmoidoscopes | |
US3417746A (en) * | 1968-02-27 | 1968-12-24 | Welch Allyn Inc | Illuminating endoscope with disposable elements |
FR2245324A1 (en) * | 1973-09-12 | 1975-04-25 | Prioton Bernard | Process and device for portal disconnection of the oesophagus - clip is inserted with remote-controlled applicator |
US4530354A (en) * | 1983-02-07 | 1985-07-23 | Froilan Faustino C | Endotrachael tube and holder |
WO1989007415A1 (en) * | 1988-02-19 | 1989-08-24 | Antec Systems Limited | Method and apparatus for locating an endo-tracheal or endo-oesophageal tube |
US4950275A (en) * | 1989-07-19 | 1990-08-21 | Cyanamid Italia S.P.A. | Bowel-anastomosis-ring holder pincers |
US5053043A (en) * | 1990-09-28 | 1991-10-01 | Vance Products Incorporated | Suture guide and method of placing sutures through a severed duct |
DE4205488C1 (en) * | 1992-02-22 | 1993-08-05 | Kernforschungszentrum Karlsruhe Gmbh, 7500 Karlsruhe, De | |
IT1276074B1 (en) * | 1995-11-02 | 1997-10-24 | Sapi Med Srl | DISPOSABLE RECTOSCOPE |
-
1997
- 1997-09-23 NL NL1007101A patent/NL1007101C2/en not_active IP Right Cessation
-
1998
- 1998-09-23 AU AU91904/98A patent/AU9190498A/en not_active Abandoned
- 1998-09-23 EP EP98944346A patent/EP1018947A1/en not_active Withdrawn
- 1998-09-23 WO PCT/NL1998/000550 patent/WO1999015087A1/en not_active Application Discontinuation
- 1998-09-23 CA CA002304149A patent/CA2304149A1/en not_active Abandoned
Non-Patent Citations (1)
Title |
---|
See references of WO9915087A1 * |
Also Published As
Publication number | Publication date |
---|---|
WO1999015087A1 (en) | 1999-04-01 |
CA2304149A1 (en) | 1999-04-01 |
NL1007101C2 (en) | 1999-03-29 |
AU9190498A (en) | 1999-04-12 |
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