RU2115373C1 - Method for formation of anastomosis after resection of large intestine - Google Patents

Abstract

FIELD: medicine; surgery. SUBSTANCE: method includes suturing of distal part of intestine to wall of proximal part. Passive electrode in the form of flat ring is sutured to intestine wall. In this case, contact surface is located at the level of upper boundary of intestine distal part. Later, anastomosis is formed by burning-through the walls with active electrode under visual control. EFFECT: prevented complications in application of large intestine anastomosis. 4 dwg

Description

 The invention relates to medicine, in particular to surgery, proctology and for the surgical treatment of diseases of the colon and rectum.

 A known method of resection of the colon or rectum according to Skibenko (A.S. N 1123653). With this method, a resection of the affected segment is performed, the leading segment is displayed in the form of a single-barrel colostomy. The distal segment is sutured and sutured by the side wall to the proximal segment. After that, in the zone of the future anastomosis, the intestine is stitched through all layers with a ligature, the ends of which are left in the lumen of the abducting intestine, and at the second stage, the patency of the intestine is restored by tightening the specified ligature using an endoscope, after which the colostomy is sutured (Surgery. -1988. N 3. -С . 108-111).

 A significant drawback of this method is that when using silk or kapron ligatures it is very difficult to achieve pulling it through an endoscope, sufficient for necrosis of the intestinal wall in the area of the formed anastomosis. At the same time, the creation of a slit-like opening in the anastomotic zone, obtained by ligature cutting through the intestinal wall, makes the anastomosis functionally inferior due to the small size of the formed opening both in the early postoperative period due to anastomositis and in the long term due to the development of cicatricial strictures. When trying to form a hole in the zone of a larger diameter anastomosis, there are difficulties with tightening the ligature through the endoscope, as well as complications associated with the development of erosive bleeding from the anastomosis area, which often require repeated surgical interventions with a significant expansion of their volume.

 The purpose of the invention is the prevention of complications in the formation of anastomosis after resection of the colon.

 In FIG. 1 to 4 illustrate a method for forming an anastomosis after resection of the colon, where in FIG. 1 shows a passive electrode, a top view; in FIG. 2 - the same side view; in FIG. 3 - fixation of the electrode in the distal intestine; in FIG. 4 - hemming of the distal intestine to the proximal.

 The method is as follows.

 After laparotomy, a resection of the affected segment of the colon is performed. The leading segment is displayed on the anterior abdominal wall in the form of a colostomy. A passive electrode is introduced into the distal segment of the intestine (Figs. 1, 2), consisting of a hollow latex ring 1 with perforated holes 2. On the upper surface of the ring, protruding above its plane, is contact 3, which connects using an insulated wire 4 with a coagulator. A passive electrode is made in different sizes depending on the diameter of the intestinal tube and is sterilized before surgery. After insertion into the distal segment of the intestine, the passive electrode is fixed by sewing with catgut thread through perforated holes to the intestinal wall 5, so that the contact surface is located at the level of the upper boundary of the distal segment of the intestine (Fig. 3). The connecting wire is brought out through the distal part of the intestine. Then, hemming of the distal segment of the intestine to the proximal end-to-side type is performed using double-row interrupted sutures (Fig. 4). The zone of location of the passive electrode is marked with a colored ligature from the mucous membrane of the wall of the adducting segment of the intestine. The laparotomy wound is sutured.

 After 5 to 8 days after the operation, the passive electrode is connected to the electrocoagulator through the connecting wire. An active electrode is inserted through a rectoscope or anoscope inserted into the colostomy and coagulation of the intestinal wall in the anastomotic zone marked with a colored ligature is performed. After checking the patency of the anastomosis (on the 2nd day), the colostomy is closed.

 Example. Patient M., 64 years old (source: N-2445), was admitted to the hospital with complaints of bloating, constipation, weight loss. As a result of clinical and instrumental studies, the diagnosis was established: cancer of the sigmoid colon, chronic intestinal obstruction. 04/06/94, under endotracheal anesthesia performed laparotomy, resection of the affected segment of the colon. The leading segment of the intestine is displayed on the anterior abdominal wall in the form of a colostomy. A passive electrode consisting of a hollow latex ring with perforated holes was inserted into the distal segment of the intestine. On the upper surface of the ring, protruding above its plane, there was a contact connected using an insulated wire with a coagulator. The passive electrode is installed with a diameter of 4.5 cm in accordance with the diameter of the intestinal tube. After insertion into the distal segment of the intestine, the passive electrode is fixed by stitching with catgut thread through perforated holes to the intestinal wall so that the contact surface is located at the level of the upper boundary of the distal segment of the intestine. The connecting wire is brought out through the distal part of the intestine. Then, the distal segment of the intestine was sutured to the proximal end-to-side type with double-row interrupted sutures. The location area of the passive electrode is marked with a colored ligature from the mucous membrane of the wall of the adducting segment of the intestine. The laparotomy wound is sutured. 6 days after the operation, the passive electrode is connected to the electrocoagulator through the connecting wire. An active electrode was introduced through a rectoscope inserted into the colostomy and the intestinal wall was coagulated in the anastomosis zone marked with a colored ligature. After checking the patency of the anastomosis (on the 2nd day), the colostomy is closed. On the 12th day after the operation, the patient was discharged from the hospital in a satisfactory condition. Examined after 3 months, there are no complaints of intestinal obstruction.

 In this way, 4 patients were operated on for colon cancer. No complications were noted.

Claims (1)

 A method of forming an anastomosis after resection of the colon, including suturing the distal segment of the intestine to the wall of the proximal segment, followed by recanalization of the anastomosis by electrocoagulation and eliminating the colostomy, characterized in that the passive electrode, made in the form of a hollow ring, is fixed by suturing through perforated holes to the intestinal wall so that the contact surface is located at the level of the upper border of the distal segment of the intestine, and the formation of the anastomosis is performed wall firing with an active electrode under visual control.

Images