RU1806630C - Method for forming enterostomy - Google Patents

Abstract

The invention relates to medicine, more specifically to abdominal surgery, oncology and coloproctology. The purpose is to prevent postoperative complications by increasing the tightness of the anastomotic suture line. A method of forming a coloenteroanastomosis involves forming a cuff of the distal end of the adductor loop, suturing the anterior and posterior walls of the anastomosis, wherein suturing of the posterior wall of the anastomosis begins with piercing the mucous membrane, displacing it by 1.9-1.5 cm in the proximal direction, followed by a puncture deeper into the muscle-serous layer of the intestine, and the opposite end of the outlet loop is stitched in the reverse order, and when suturing the front wall of the anastomosis, through sutures are applied at an angle of 45 [deg.] from each side. 6 ill.

Description

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The invention relates to medicine, more specifically to abdominal surgery, oncology and coloproctology.

The purpose of the invention is to prevent postoperative complications by increasing the tightness of the anastomotic suture line.

The mobility of the mucous layer of the small and large intestine relative to the submucous layer was studied on 47 macroscopic preparations (segment of the small or large intestine). As a result of studies, we found that the mucosa is displaced relative to the submucosal layer by 1.0-1.5 cm.

Consider the dependence of the angle of inclination of the puncture of the intestinal wall relative to its axis when creating optimal conditions for matching the ends of the intestinal wall and at the same time to achieve a screwing effect.

It can be seen from the figure that the optimality of the tightness of the anastomosis line in combination with the maximum screwing effect depends on the location of the connecting thread assembly.

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It can be seen from the figure that, in turn, the location (removal) of the node from the axis of the connecting thread depends on the angle of inclination of the pro; stake of the intestinal wall relative to its axis.

The figure shows b a ctg a, where a

b intestinal wall thickness ctg a -

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Moreover, with an optimal angle of inclination of the puncture of the intestinal wall relative to its axis, the displacement of the node relative to the connecting thread is equal to the intestinal wall, b a, sl

finally ctg a -; ctg a 1 a

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Figure 1-6 shows a diagram of the implementation of the proposed method.

The method is carried out as follows.

After relaparotomy, the right half of the colon is removed with a tumor or lesion and the formation of colonenteroanastomosis is started. Suturing of the posterior wall begins with gray-serous nodular silk sutures between the end of the ileum and the end of the transverse colon. Then, single catgut sutures are inserted through all layers of the posterior lip of the anastomosis, and the catgut suture begins with tingling of the mucous membrane (Fig. 1), which is displaced by 1.0-1.5 cm in the proximal direction, after which a puncture is performed deeper into muscle-serous layer of the intestine of figure 2, the opposite end of the outlet loop begin to flash from piercing the serous-muscle layer to the submucosal layer, in which the needle is directed along the mucosa towards the anastomosis line and the mucosa is displaced by 1.0-1.5 cm proximal puncture direction they are awakening her. Then the ligature is tied, and the mucous membrane above the seam forms a roller (Fig.3,4,

5) After suturing the posterior wall of the anastomosis, the formation of the anastomosis anterior wall proceeds. Through single catgut sutures imposed alternately on each side towards each other at an angle of 45 ° (Fig.6).

Then, the suture line is immersed with separate parietal sero-muscular sutures, the evaginate of the terminal ileum being introduced into the lumen of the initial part of the colon and fixed with separate parietal sero-muscular sutures.

The result is a valve invaginative-national extraperitoneal coloenteroanastomosis,

The proposed method operated on 29 people with a diagnosis of cancer of the right half of the colon, including the blind (men - 17, women - 12).

The advantage of the claimed method is that the tightness is increased.

seam lines of the anastomosis. This is achieved by suturing the posterior wall of the anastomosis with piercing of the mucous membrane and then displacing it by 1.0-1.5 cm in the proctosigmal direction due to

the mobility of the mucosa relative to the submucous layer, after which a puncture is performed deeper into the muscle-serous layer of the intestine, and the opposite end of the outlet loop is sutured in the reverse order.

This technique allows the roller to form from the mucous membrane in the anastomotic zone, which closes the catgut suture, and to eliminate the appearance of anatomositis as a result of impaired blood circulation in the mucous membrane.

Claims (1)

The effectiveness of the method is achieved by the fact that by attaching the front wall of the anastomosis, single catgut sutures are alternately applied at an angle of 45 ° from each side, which in turn enhances the screwing effect, and the number of sutures per unit length is reduced. Reducing the number of sutures allows to reduce circulatory disorders in the area of the formed anastomosis. From the foregoing, it follows that with a decrease in the number of sutures, the tightness effect is enhanced by passing the suture material through the intestinal wall at an angle of 45 °. SUMMARY OF THE INVENTION A method for forming an inter-intestinal anastomosis, comprising applying a through, serous-muscular series of sutures, characterized in that, in order to prevent postoperative complications by increasing the tightness of the anastomosis line, the anastomosis is punctured first the mucous membrane of the adducting intestine, the mucosa is displaced by 1.0-1.5 cm in the proximal direction, then the muscle-serous layer of the intestine is punctured, the opposite end of the abducting intestine is sutured in the reverse order, and the through seams on the front wall of the anastomosis are applied at an angle of 45 ° on each side. FIG. 1 Figure 2 FIG. 4 FIG. 5