RU2123807C1 - Method for repairing end colostoma aggravated by paracolostomic hernia - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out herniotomy and frontal abdominal wall plastic repair. The plastic repair being done, retroperitoneal canal is created on the side of laparotomic cut. It is started at the base of sigmoid mesentery through an opening in aponeurosis lateral relative to the available one. The distal part of the sigmoid colon is pulled through the so formed canal and brought on the anterior abdominal wall through the previously made opening. EFFECT: prevented recidivation of the disease.

Description

 The invention relates to operative coloproctology, when it is necessary to perform reconstructive surgery on a colostomy of complicated paracolostomy hernia.

Currently, in clinical practice, two main types of reconstruction of a complicated paracolostomy colostomy hernia are used:
1. Reconstruction of complicated colostomy with leaving the colostomy in the same place.

 2. Reconstruction of the colostomy with the transfer of the stoma to a new location.

 The essence of the first technique is as follows: after suturing the skin over the colostomy, a skin incision is made that borders the colostomy. The inner edges of the skin wound are sutured. Dissections around the hernial sac and excreted intestine are dissected. The hernial sac is opened in the most free place. The peritoneal incision is continued around the excreted intestine. The released contents of the hernial sac (omentum, loops of the small intestine) are immersed in the abdominal cavity. The distal part of the colon is exempted from scars and adhesions, after separation of the adhesions it is necessary to place the excess intestine in the abdominal cavity and fix it in the proper position (with a significant excess of the distal part of the sigmoid colon after separation of the adhesions, the excess intestine is resected), the hernial sac is cut off, and the edges of the parietal the peritoneum is sutured with separate sutures to the excreted intestine. After this, the aponeurosis is freed from adhesions and scars and sutured around the excreted intestine to match its diameter. The skin wound is sutured tightly. (Unnatural anus. Kiev. 1984. Savchik A.B. et al., Pp. 90 - 91).

 When eliminating a paracolostomy hernia with reconstruction and moving the colostomy to a new location, the hernia sac and excreted intestine are isolated as described above. Then, retreating 6-7 cm to the side of the main incision, a new hole is formed in the anterior abdominal wall to excrete the distal part of the colon. The colon is removed into the newly formed hole after excision of the scar-modified sections. The peritoneum at the site of the former colostomy is sutured after excision of the hernial sac. Then, the plastic surgery of the anterior abdominal wall is performed at the site of the colostomy and hernia gate (Gadzhiev G.I.

 Analyzing the results of treatment of patients with late paracolostomy complications, we came to the conclusion that the reason for such a large number of complications is that all previously proposed methods for surgical correction of complications repeat the shortcomings of previously used methods of intraperitoneal colostomy, and do not eliminate them (the presence of slit-like spaces between the distal part of the excreted colon and the left side wall of the abdomen).

 The aim of the proposed method is to prevent recurrence of paracolostomy hernia.

 The technique of the proposed method for reconstruction of the colostomy is as follows. The operation is performed from the mid-laparotomy incision with excision of the old postoperative scar after preliminary closure of the lumen of the colostomy. A revision of the abdominal organs is performed to exclude a possible relapse of the tumor process (the majority of patients were operated on for a malignant tumor of the colon), dissection of adhesions, isolation of the omentum and loops of the small intestine from the hernial sac, and then removal of the portion of the colon from the thickness of the anterior abdominal wall . The wall of the excreted intestine stands out along the entire circumference, and in the presence of an excess of the latter in the abdominal cavity, its distal part is resected. The aponeurosis is performed according to the type of duplicate, and then the retroperitoneal canal is formed to the left of the aortic bifurcation at the base of the mesentery of the sigmoid colon. At the same time, the skin hole in the left iliac region remains in place of the previously existing colostomy, and the hole in the aponeurosis is formed 1–2 cm more laterally of the suture line after the plastic of the latter. The distal part of the sigmoid colon must be of sufficient length for excretion through the retroperitoneal canal to the anterior abdominal wall, but also without tension of the intestine and leaving a free loop in the abdominal cavity. Then the prepared segment of the colon is discharged through the retroperitoneal canal to the anterior abdominal wall. The middle wound of the anterior abdominal wall is sutured in layers tightly.

 The last step is the formation of a flat colostomy: after circular dissection of the serous-muscular layer to the mucous membrane of the excreted intestine, the stoma is formed by separate sutures behind the serous-muscular layer of the intestine to the edge of the skin, after which the intestinal mucosa is cut off at the skin level. Thus, the formation of a colostomy occurs on the closed intestine.

 Example: Patient D., 66 years old, medical history N 2648-93, was in the SSCC about paracolostomy hernia. 11/15/93 the patient was operated on in a planned manner, a colostomy was reconstructed with plastic surgery of the anterior abdominal wall, hernia repair and the distal part of the sigmoid colon through the formed retroperitoneal canal. The postoperative period was uneventful. Examined 1 year after surgery. Data for recurrence of paracolostomy hernia was not revealed. Used by a bag holder. Stoma functions well.

 Example: Patient R., 47 years old, medical history N 1727-95, was in the SSCC for paracolostomy hernia. 08/10/95 in a planned manner, the colostomy was reconstructed using the proposed technique. The postoperative period was uneventful. Examined 3 months after surgery. No data were available for relapse. Stoma functions well. It is used by a kalopriemnik, uses a method of irrigation.

 Thus, in comparison with the prototype methods, the new method has the following advantages: it completely eliminates the possibility of pockets and "slit-like spaces" between the distal colon and the left side wall of the abdomen, significantly increases the total area of adhesion of the intestine to the surrounding tissues, which avoids such complications such as paracolostomy hernia and prolapse, the formation of a flat colostomy in a closed intestine without trapping the mucous membrane, reduces the risk of purulent complications ies and the development of marginal necrosis, which reduces the percentage of scar strictures.

Claims (1)

 A method for reconstructing a colostomy complicated by paracolostomy hernia, including hernia cutting, plastic surgery of the anterior abdominal wall and the formation of a new colostomy, characterized in that after the plastic surgery of the anterior abdominal wall, a retroperitoneal canal is formed from the side of the laparotomy incision, starting from the base of the mesentery of the sigmoid colon through an opening in the aponeurosis laterally existing and then the distal part of the sigmoid colon is passed through the formed channel with the output to the anterior abdominal wall through the old skin cavity rstie.