RU2162301C2 - Corrugated constrictor for resection of stomach and intestine - Google Patents

Abstract

FIELD: medicine, applicable in surgical operations of gastroenteric tract. SUBSTANCE: the corrugated constrictor has branches in the form of two non-detachable parts with handles, whose working surfaces face each other. The handle has a toothed lock, and the working surfaces have a toothed concave shape and slots for the injection needle for fixing the walls of the stomach and intestine. EFFECT: simplified design, reduced traumatism, full asepsis during resection. 1 dwg

Description

 The present invention relates to medicine, namely to surgery of the gastrointestinal tract.

 The prototype of the invention is a tool according to USSR author's certificate N 103854, A 61 B 17/04, 1956, containing jaws in the form of two movable integral parts with handles having a gear lock and with working surfaces of gear-like shape with grooves facing each other under the needle.

 This device is rather cumbersome due to the presence of a large number of components and inconvenient when performing operations on the organs of the upper floor of the abdominal cavity. In addition, this device is highly traumatic and does not provide the necessary asepsis.

 The aim of the invention is to reduce the morbidity, ensuring complete aseptic during resection, simplification of the device. This goal is achieved by the fact that the device is made in the form of two movable branches with tooth-concave-shaped working surfaces facing each other with longitudinal grooves for a straight-shaped injection needle and serving to fix the walls of the stomach and intestines, with handles having a toothed lock.

 The drawing shows a General view of the corrugating pulp for resection of the stomach and intestines.

 The corrugating pulp contains two movable jaws 1 connected by a hinge 2, with working surfaces of a dentate-like shape 3, mutually falling into each other, with longitudinal grooves 4 for an injection needle, with handles 5 having a toothed lock 6. The working surfaces of the movable jaws allow you to fully corrugate everything layers of the wall of the stomach or intestine, as well as reliably fix with a needle the lumen of the resected organ after removing the pulp and perform the resection in a closed way.

 Corrugating pulp works as follows. The stomach and duodenum are mobilized in the usual way. The mobile branches 1 are opened, the corrugating pulp is applied in the transverse direction to the bulb of the duodenum 12, the branches 1 are pressed with handles 5, and then the pulp is closed with a toothed lock 6. An injection needle of a straight shape is inserted into the longitudinal groove 4, which penetrates through the walls of the intestine, crimped by the pulp , above the pulp 2-3 mm the intestine intersects, hemostasis is performed, after which the corrugating pulp is removed. The walls of the duodenum 12 are fixed with a needle, its lumen is closed.

 The lesser curvature of the stomach is crossed along the intended line of resection and stitched in the usual way. On the remainder of the large curvature, having previously opened the movable branches 1, a corrugating pulp is applied, the jaws 1 are pressed with handles 5, and then the pulp is closed with a toothed lock 6. A second straight needle is inserted into the longitudinal groove 4, which penetrates through the stomach walls, corrugated by the pulp. Below the pulp 2-3 mm the stomach intersects, hemostasis is performed, after which the corrugating pulp is removed. The walls of the stomach are fixed with a needle, its lumen is closed.

 Stump of the stomach and duodenum are compared. A single-row end-to-end anastomosis is formed using nodular nylon serous-muscular sutures. First, the back walls of the stomach and duodenum are stitched together, then their front walls are stitched. The fixing needles are removed, after which the side walls of the anastomosis are likewise sutured. Anastomosis is formed.

 Example. Billotroth-I subtotal gastrectomy for cancer of the pyloric stomach.

 The history of the disease N 1373. Patient N. 65 years.

 Upper midline laparotomy, mobilization of the stomach and duodenum in the usual way. A corrugating pulp is applied in the transverse direction on the bulb of the duodenum 12, the jaws 1 are pressed with handles 5, and then the pulp is closed with a toothed lock 6. An injection needle of a rectilinear shape is inserted into the longitudinal groove 4, which penetrates through the intestinal wall, grounded by the pulp, 2 higher than the pulp -3 mm the intestine intersects, hemostasis is performed, after which the corrugating pulp is removed. The walls of the duodenum 12 are fixed with a needle, its lumen is closed.

 The apparatus UKL-60 is superimposed on the lesser curvature of the stomach. After flashing and crossing along the marked line, the remaining part of the large curvature, having previously opened the movable branches 1, is covered with a crimping pulp, the branches 1 are compressed with handles 5, and then the pulp is closed with a toothed lock 6. A second straight-shaped injection needle is inserted into the longitudinal groove 4, which penetrates through the walls of the stomach, corrugated pulp. Below the pulp 2-3 mm the stomach intersects, hemostasis is performed, after which the corrugating pulp is removed. The walls of the stomach are fixed with a needle, its lumen is closed.

 Stump of the stomach and duodenum are compared. A single-row gastroduodenoanastomosis is formed - an end-to-end anastomosis in a closed way, using nodular nylon serous-muscular sutures. The diameter of the anastomosis is 2.5-3 cm.

 The immediate postoperative period was uneventful. Evacuation-motor complications were not noted, drinking is allowed for 3 days, food is allowed for 4 days. Sutures were removed on the 8th day. Discharged in satisfactory condition for outpatient treatment on the 10th day.

 At the control examination after 3 and 6 months - the condition is satisfactory, no complaints.

 For the period from 1993 to 1997, 84 resections of the stomach were performed using corrugating pulp. Complications in the form of insolvency of the anastomosis, bleeding from the anastomosis were not noted in any case.

 The corrugating pulp allows you to resect the stomach and intestines in a closed way, i.e. the lumen of the hollow organs when performing a resection remains closed with a fixing needle.

 This simplifies the resection of the hollow organ and allows the formation of gastrointestinal anastomoses using a single-row suture, eliminating the contamination of the abdominal cavity with intestinal microflora.

 When performing resections using this technique, suture and dressing materials, as well as anesthetic preparations, are saved, as the operation time is shortened. In the near postoperative period, insolvency of the sutures of the anastomosis and motor evacuation disorders were not noted.

 Thus, the use of corrugating pulp during resection of the stomach and intestines greatly simplifies the course of the operation while reducing time and consumables.

Claims (1)

 Corrugating pulp for resection of the stomach and intestines, containing jaws in the form of two movable integral parts with handles having a toothed lock, and with tooth-concave-shaped working surfaces facing each other, with grooves for the needle, characterized in that the grooves are made for the injection needle for fixing the walls of the stomach and intestinal walls.