RU146199U1 - DEVICE FOR FORMING A DELAYED INTESTINAL COMPRESSION ANASTOMOSIS - Google Patents

Abstract

A device for the formation of a delayed interintestinal compression anastomosis, including a Fedorov clamp, characterized in that on two branches of the clamp there are two needles parallel to each other from needles made of 50 mm long metal with a diameter of 2.5 mm for medical use, on which are inserted medical nozzles steel with a diameter of 2.6 mm, a length equal to the length of the needle minus the length of the "sharpening" of the needle, and consisting of two parts, the greater part being equal to the length of the anastomosis, and the smaller part being put on the needle first.

Description

Among the urgent tasks of modern surgery of the abdominal organs, an important place is occupied by the problem of the failure of intestinal sutures. This complication is observed in 1.5-3% of cases with operations on the stomach and duodenum, in 2.8-8.7% - with operations on the small and in 4-32% of cases with operations on the colon (G.I. Vorobiev 1990). The most dangerous is the formation of intestinal anastomoses in conditions of peritonitis, intestinal obstruction, in patients with a hormone-dependent form of bronchial asthma, with severe diabetes, with hypoproteinemia.

The main advantages of compression inter-intestinal anastomoses compared with ligature ones are their healing by the type of primary tension, their delayed opening, which prevents the failure of the suture line.

But for various reasons, the introduction of delayed inter-intestinal compression anastomoses (OMCA) in clinical practice is extremely slow. This is due to the fact that the formation of "seamless" anastomoses "end to end" requires a complete opening of the lumen of the intestine, accompanied by infection of the abdominal cavity. It is not always possible to select devices corresponding to the diameter of the intestine, which causes marginal necrosis and anastomotic failure. There are problems associated with the evacuation of large-sized devices from the intestinal lumen using tools.

The indicated drawbacks are deprived of a titanium nickelide device in the form of a paper clip. But at the same time, due to the presence of titanium, the alloy easily combines nitrogen and oxygen. To prevent reactions with these elements, it is necessary to use vacuum equipment in the production. Processing is difficult in the manufacture of parts, especially cutting, which is the flip side of high strength. The price of metal is quite high. At the end of the 20th century, it cost slightly less than silver (Kecherukov A.I. et al., 2005), and the organization of the implementation of these devices in Russia is still imperfect.

For the prototype, “Method for the formation of a delayed inter-intestinal compression anastomosis (OMKA)” was selected (RF patent No. 2290099. / V.L. Martynov, A.G. Semenov, V.N. Rulev // No. 2004116720; claimed 01.06.2004; publ. 12/27/2006).

The prototype method is as follows: perform a laparotomy, impose sero-muscular sutures between the intestines, where the application of a delayed anastomosis is planned. Ligature No. 4-5 is carried out through the lumen of metal tubes with a diameter of 1.5-2 mm and a length equal to the length of the future anastomosis, the ends (each end separately) of the threads are fixed in the ears of the needles. Through an injection and an injection, the distance between which is equal to the length of the future anastomosis, a thread is passed through the lumen of the stitched intestines 1 cm from the line of serous-muscular sutures. The ends of the threads are pulled on one side and the portion of the thread between the metal tubes on the other, thereby creating a conductor for the tubes, the metal tubes are inserted into the lumen of the stitched intestinal sections and tied on the basis of metal tubes. The intestinal walls are compressed and the compression site is peritonized with serous-muscle sutures 1 cm from the line of the future anastomosis. Thus, a site is created from two fused intestinal walls, after 7-10 days the delayed anastomosis opens and begins to function. Connected tubes depart naturally.

This method has disadvantages:

- the ends of the tubes remain in the wounds from punctures in the seam line between the serous membranes, which interferes with wound healing;

- infection of the anastomotic line reaches 10 ⁶ ;

- in some cases (especially with significant thickness of the intestinal wall) there is no sufficient compression of the intestinal wall tissue, which leads to prolonged failure to open the anastomosis for up to 1.5 months, and in some cases the complete absence of anastomotic opening.

The purpose of the utility model is to optimize the method for the formation of a delayed inter-intestinal compression anastomosis (OMCA).

The goal is achieved by using the created device. The device is a Fedorov clamp, on the branches of which are parallel to each other two needles of metal that is allowed for medical use and with dimensions of 50 mm in length, 2.5 mm in diameter. On the needles there are tube-nozzles made of medical steel, the length equal to the length of the needle minus the length of the "sharpening" of the needle, and a diameter of 2.6 mm. Nozzles consist of two parts, the length of the majority determines the length of the anastomosis. For example, 10 mm and 40 mm, 20 mm and 30 mm, 25 mm and 25 mm. The smaller part is put on the needle first.

In FIG. 1 shows a general view of the device, where 1 is the jaw of Fedorov’s clamp, 2 is the needle, 3 is the nozzle tube. In FIG. 2 shows sets of nozzle tubes of various lengths.

The device operates as follows. Tubes-nozzles are selected depending on the length of the future anastomosis and its distance from the puncture site. They put nozzles on the needles, first a smaller part, then a large part. Resection of the affected area of the intestine is performed, the distal end of the intestine is sutured tightly. The distal and proximal sections of the intestine are isoperistaltically stitched with gray-serous sutures for about 10 cm, leaving below the joint not stitched 15 cm of the proximal section in order to further excrete it on the stoma (Fig. 3). Departing from the seam line by 1 cm, on the mesenteric collapse of two sections of the intestine through two punctures, the device’s needles with nozzle tubes are inserted into the lumen of two sections of the intestine (Fig. 4). The device branches are brought together and fixed as much as possible (Fig. 5). A needle with ligatures No. 5 through the walls of the intestine is carried out under the large parts of the nozzle tubes in three places (in the center and along the edges) and tightly tied, which causes a constant further compression of the tissues of the walls of the two sections of the stitched intestines between the nozzle tubes (Fig. 6). The needles with the small parts of the nozzle tubes remaining on them are removed from the intestinal lumen, leaving a large part in the intestinal lumen (Fig. 7). Places of intestinal punctures are sutured with z-shaped sutures, localizing them outside the anastomosis line. A second row of gray-serous sutures is applied. The proximal site is displayed on the stoma. After 8-11 days, along the line of compression, necrosis of the intestinal wall tissue occurs and the large parts of the nozzle tubes connected to each other exit into the lumen of the distal intestine, and later on with the stool out.

The study group consisted of 25 patients aged 39 to 78 years. All 25 patients were operated on an emergency basis for intestinal obstruction, peritonitis of various etiologies. All anastomoses opened.

The developed device facilitates the formation of OMCA, minimizes infection of the anastomotic line, and causes sufficient compression of the intestinal wall tissues, which causes the anastomosis to open.

Claims (1)

A device for the formation of a delayed interintestinal compression anastomosis, including a Fedorov clamp, characterized in that two needles of 50 mm long, 2.5 mm diameter metal permitted for medical use are located on two branches of the clamp parallel to each other, and medical nozzles steel with a diameter of 2.6 mm, a length equal to the length of the needle minus the length of the "sharpening" of the needle, and consisting of two parts, the greater part being equal to the length of the anastomosis, and the smaller part being put on the needle first.

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