RU2008819C1 - Method for appendectomy and device for appendectomy - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: after cutting mesoappendix, appendix vermiformis is placed in hollow cylinder of device whose conical working end is invaginated together with base of appendix vermiformis into hollow of caecum. Processes are cut with loop located in case, cylinder together with process is removed, and at the same time, pursestring suture is tightened. EFFECT: simplified operation technique and prevented complications involved in contamination of operation field during operation. 2 cl, 1 dwg

Description

 The present invention relates to medicine, in particular to surgery, and can be used for surgical treatment of patients with acute appendicitis.

 A known method of appendectomy, including ligation of the mesentery of the vermiform appendix and its intersection over the ligature closer to the appendix, clamping and ligation of the base of the vermiform appendix with a catgut ligature, applying 1.5 cm from the base of the cecum, retreating from the base of the vermiform appendix, is muscular cutting off the vermiform appendix slightly higher than the ligature superimposed on its base, processing the stump of the appendix with an alcoholic solution of iodine and immersing it with purse-string and Z-shaped sutures. The disadvantage of this method is the formation of a closed infected cavity surrounding the stump of the appendix, which can contribute to the development of an abscess or infiltrate in the stump of the appendix.

 Closest to the proposed and adopted as a prototype is an appendectomy method in which the immersed stump of the appendix in the cecum is connected with the purse string suture with a ligature and an easily dissolving knot, which is removed after immersion of the stump with a purse string suture.

 Common disadvantages of the methods is the infection of body tissues that form the surgical field, an inflamed appendix and stump after cutting off. It is known that almost regardless of the form of inflammation of the appendix, after 8 hours from the onset of the disease, pathogenic microorganisms penetrate its wall and are found on the peritoneum and in the nearest lymph nodes, and the main cause of deaths in acute appendicitis are complications of purulent infection. The invagination of the stump of the appendix in the cecum is carried out by anatomical forceps or clamp without teeth. The use of any special devices for appendectomy is not described.

 The aim of the invention is the prevention of postoperative complications and simplification of the operation technique.

 This goal is achieved by the fact that after a laparotomy, removal of the appendix, ligation and intersection of its mesentery, a metal loop is applied to the base of the appendix, and the entire appendix is placed in a cylindrical case and fixed there. Then, a purse-string serous-muscular suture is applied to the dome of the cecum, the conical working end of the case is invaginated into the lumen of the cecum together with the base of the appendix, the base of the appendix is intersected with a metal loop in the cecum, the cylindrical case together with the vermiform appendix is removed and simultaneously tightened and additionally peritonize it with a Z-shaped seam.

 The drawing shows a device for implementing the method.

 The device comprises two pivotally connected jaws 1 with a rack 2 and working jaws 6 with an insulating element made in the form of detachable parts of a hollow cylinder equipped with a conical end fairing 7. A curved pin 3 is pivotally mounted on one of the jaws and a metal rod 4 is attached to one end of it connected to a loop-shaped knife 8 and placed in a longitudinal through hole 5 made underneath it in the wall of the isopying element.

 The essence of the method and device is that for appendectomy for the first time, a method and device is proposed that isolate an infected vermiform appendix in a cylindrical case, invaginate and intersect the base of the vermiform appendix with a working conical end of the case and a metal loop in the lumen of the cecum without seeding pathogenic microorganisms surrounding tissue.

 The method is as follows.

 After isolating the vermiform appendix, ligation and intersection of its mesentery, a metal loop is applied to the base of the vermiform appendix and, slightly pulling it, the appendix is pinched. Then the appendix is placed in the cylinder and there is isolated, closing the branches of the device. A purse-string serous-muscular suture is placed on the dome of the cecum, retreating 1-1.3 cm from the base of the vermiform appendix. The conical working end is immersed in the lumen of the cecum. By clicking on the free end of the curved finger 3, pivotally mounted on one of the branches of the device, they cross the loop-shaped knife 8 of the base of the appendix in the lumen of the cecum. The conical cowling 7 of the cylinder, together with the vermiform appendix, isolated from the surrounding tissues, is removed from the lumen of the cecum while tightening the purse string suture. The stump of the appendix is additionally peritonized with a Z-shaped serous-muscular suture.

 PRI me 1. Patient K., 22 years old, medical history N 261, was admitted to the clinic 07.01.91 g with complaints of pain in the right iliac region, nausea, single vomiting. Sick about 10 hours. On examination, the diagnosis was established - acute appendicitis and the patient was offered surgical treatment. Under local infiltration anesthesia, the patient made an oblique variable incision in the right iliac region. The appendix is swollen, hyperemic, and easily removed to the wound. The mesentery is stitched, bandaged and crossed. The base of the appendix is pinched by a loop-shaped knife 8, the appendix is placed in the cylinder and isolated there. A serous-muscular purse string suture was imposed on the dome of the cecum, departing 1 cm from the base of the vermiform appendix. By pressing on the free end of the curved finger 3 of the device after immersion of the conical fairing 7 of the cylinder in the lumen of the cecum, the base of the appendix is intersected. The cylinder was removed along with the vermiform appendix from the cecum and the purse string suture was simultaneously tightened. An additional sero-muscular Z-shaped suture was applied to the cecum dome. The wound of the anterior abdominal wall is sutured in layers. The patient was discharged from the clinic on the 6th day after the operation in satisfactory condition.

 PRI me R 2. Patient S., 46 years old, medical history N 1073, was admitted to the clinic 02.02.91 g with pain in the lower abdomen. After examination, the patient was diagnosed with acute appendicitis, peritonitis, and the patient was admitted to the operating room. Under endotracheal anesthesia, the patient underwent lower pararectal laparotomy. Serious exudate was found in the pelvic cavity. The appendix was sharply hyperemic, thickened, covered with fibrin. After ligation and intersection of the mesentery of the appendix, a loop-shaped knife 8 is applied to its base, with which the appendix is squeezed. The vermiform appendix is isolated from the surrounding tissues in the cylinder. On the dome of the cecum, retreating 1.3 cm from the base of the appendix, a serous-muscular purse string suture was applied. The abdominal cavity is dried and drained through a separate contraperture in the right iliac region. The postoperative course is smooth. On the eighth day after the operation, the patient was discharged from the clinic for outpatient monitoring.

 The described method of appendectomy and a device for its implementation are aimed at preventing such complications of appendectomy as infiltrates and abscesses in the stump of the appendix, infiltrates and abscesses of the abdominal cavity, suppuration of postoperative wounds, and others.

 Over the past year, we described 49 patients with acute appendicitis aged 18 to 67 years who were operated on using the described method. The pathomorphological form of inflammation of the appendix is different. Complications logically associated with the proposed method of appendectomy were not observed.

 Thus, the proposed method of appendectomy reduces the number of postoperative complications, reduces the length of hospital stay.

 Performing an appendectomy of the proposed method determines a number of advantages. The working conical part of the cylindrical case facilitates the invagination of the base of the appendix in the lumen of the cecum. The intersection of the appendix in the lumen of the intestine, isolated from the free abdominal cavity, the placement of the appendix in the cylindrical case prevents infection of the abdominal cavity and tissues that form the surgical field.

 Thus, the proposed method of appendectomy and a device for its implementation can simplify the technique of surgery and prevent a number of complications of appendectomy associated with infection of the surgical field during the operation, therefore, improve the treatment outcomes of patients with acute appendicitis.

 (56) Copyright certificate of the USSR N 961683, cl. A 61 B 17/00, 1982.

 USSR copyright certificate N 1662516, cl. A 61 B 17/28, 1991.

Claims (2)

 1. The method of appendectomy, including the intersection of the mesentery and base of the appendix, immersing it in the cavity of the cecum and peritonization of the stump with purse-string and Z-shaped sutures, characterized in that after the intersection of the mesentery, the appendix is placed in a hollow cylindrical case, the conical working end of which is invaginated together with the base of the appendix, intersect the appendix with a metal loop located in the case, and then remove it along with the appendix and simultaneously tighten the pouch stitch.  2. Appendectomy device containing two articulated jaws with a rack and working jaws made with an insulating element, characterized in that an additional loop-shaped knife and a drive made in the form of a curved finger mounted on one of the jaws connected to a knife by a metal a rod, while the insulating element is made in the form of detachable parts of a hollow cylinder equipped with a conical end fairing, and a metal rod is placed in the wall of the insulator made under it a ruling element through a longitudinal through hole.

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