RU2174370C2 - Surgical method for treating the cases of chronic colostasis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves mobilizing colon, transecting ligaments and embryonic commissures. Excessive descending and sigmoid intestine are removed. Trasversorectostomy is created. Cecal and ascending intestine are attached to iliac muscle. The newly created transverse colon is attached to mesenterium root and the descendent intestine to the parietal peritoneum. EFFECT: prevented recurrence of colostasis syndrome. 5 dwg

Description

 The present invention relates to medicine, namely to surgery, and can be used in coloproctology.

 Relevance. Chronic colostasis due to constitutionally-congenital structural features of the colon, with decompensation of digestive function with the development of left-sided stasis colitis and the corresponding severe symptomatology, is subject to surgical treatment.

 Until 1980, treatment of chronic colonic stasis was usually conservative. Moreover, in 80% of patients, temporary disability from 2 to 6 months per year was noted. Disability among them was 2-2.5%. Currently, there is a tendency to move from conservative methods of treating the disease to operative with decompensated colostasis.

 The search for the nature of surgery is ongoing. Some authors advocate resection methods of treatment - from segmental to left- or right-sided hemicolectomy and even subtotal and total colectomy, while others prefer various methods of fixing the mobile parts of the colon without its resection (Pikin V.B., Lavrov V.V., Ioakimis K.D. ., Romanov P.A., Us V.G., Ghosh S., Brown SR, Pluta H., Platell C. Nyam DC) [1-9].

 Analogs

 1. Plastic surgery of colysis according to Payr consists in dissecting the diaphragmatic colon ligament to eliminate the mechanical obstacle associated with high fixation and acute angle of the splenic bend of the colon.

 2. Pikin's operation consists in retroperitoneal fixation of the sigmoid colon.

 3. Operation P.A. Romanova and V.G. The mustache provides for the fixation of the mobile parts of the colon during coloptosis to the parietal peritoneum and fascial nodes of the posterolateral abdominal wall [4].

 The listed interventions are aimed at eliminating one of the manifestations of the pathology, while the remaining pathogenetic links of the syndrome of chronic colonic stasis of congenital origin remain uncorrupted.

 Pathogenetically the most justified operations can be considered interventions that combine left-sided hemicolectomy with position correction and fixation of the colon (Litvinenko MD, 1976) [3]. But even so, the symptoms of the disease do not completely disappear in all patients. Currently, unsatisfactory results of surgical treatment are observed in 19 and more percent of the operated. Temporary disability up to 2 months per year occurs in 18% of patients. Relapses occur in 6-10% of cases.

 Prototype. For the prototype taken "Method for the treatment of chronic stasis of the colon" proposed by M. D. Litvinenko [3]. Its essence lies in the total mobilization of the colon by dissecting the peritoneum, adhesions, ligaments (including the gastro-colon), moving it from right to left and down so that the transverse colon and omentum occupy a descending position, excess descending and sigmoid colon are resected, produce transversorectostomy. The colon is fixed to the peritoneum and the remnants of the gastro-colon ligament.

 The disadvantage of this method is that the colon is sutured to mobile formations, which does not provide reliable fixation of it. In some cases, the colon sags or falls, mechanical obstructions are created for normal emptying, and a relapse occurs.

 The purpose of the invention is the prevention of relapse of colostasis syndrome by developing a method for reliable fixation of the colon.

 Task. To develop a method in which, along with the removal of mechanical obstructions for bowel movement, portocaval discharge through vascularized embryonic ligaments and membranous deposits, elimination of left-sided stasis colitis to prevent recurrence of colostasis syndrome, colon fixation to non-replaceable formations will be proposed.

 The essence of the invention is the fixation of the cecum and ascending colon to the ileum, the newly formed transverse colon to the root of the mesentery, and the descending intestine to the parietal peritoneum.

 The method is as follows. Access is made according to Popescu-Urlueni for the convenience of manipulations on the usually highly fixed splenic flexure of the colon. Access is corrected by Seagal expanders. In the right lateral canal, the blind and ascending intestines and the liver bend are mobilized by dissecting the parietal peritoneum, embryonic ligaments and membranous deposits. The hepatic bend of the colon is isolated, continuing to excise the ligaments, embryonic films and peritoneum at the upper lateral edge of the intestine. After that, these sections of the intestine are straightened. The mobilization of the transverse colon is carried out by separating it from the gastro-colon ligament and the greater omentum with careful hemostasis. To mobilize the splenic bend, the peritoneum and all ligaments, including the embryonic ones, highly fixing it in the form of a "double-barreled shotgun" cross. This difficult moment of the operation is facilitated by the access we have chosen, which also allows us to avoid damage to the spleen. Then, by cutting the parietal peritoneum and ligaments of the left lateral canal, the descending and sigmoid colon, often represented by a large loop located in the right ileal region, is mobilized. As a result, the colon is fully mobilized to the rectum, which, when expanded, is very long and no longer fits in its former place.

 Next, the mobilized colon is placed along the perimeter of the abdominal cavity without sharp bends in the liver and spleen. In this case, the entire colon is moved so that the transverse intestine takes the place of the descending and sigmoid. The cecum and ascending intestine are fixed for lateral shading from bottom to top with 3-4 sutures to the ileum. The lateral edge of the dissected parietal peritoneum is sutured to the intestine with separate sutures.

 The newly formed transverse intestine (the displaced ascending intestine and the hepatic bend of the colon) is fixed for shading with separate sutures for 14-15 cm to the root of the mesentery, which is known to be an unremovable formation, since it is fixed by ligaments to the body of the II vertebra. Excessive descending and sigmoid colon, usually affected by stasis colitis, are resected. Impose a transverse rectal anastomosis with precision stitches according to Tupa. In the event that the mesentery does not allow to freely lead the transverse colon to the rectum, the left colon artery at the base is cut and ligated.

 The large intestine is fixed in the left lateral canal with separate sutures to the parietal peritoneum.

 A method for the treatment of chronic colostasis was tested in the clinical conditions of the Krasnodar Department of Clinical Hospital S.K.Zh.d., hospital of the Department of Internal Affairs, 1st city clinical hospital for 57 patients. Good and excellent results were obtained in 86% of patients.

 Example 1. Patient L., 34 years old. Complaints: pain and bloating, persistent headaches, joint and heart pains, general weakness, stool retention of 5 or more days. The loss of body weight over the past 2 years was 20 kg. Conservative methods of treatment (diet, laxatives, enemas) have recently been ineffective. Temporary disability during the last year was 4 months. Functional irrigography (Fig. 1) established: megadolichocolon, pronounced inflection of the terminal section of the transverse colon, high fixation at an acute angle of the splenic loop loop, pronounced looping of the sigmoid colon. On the irrigogram after emptying, a longitudinal restructuring of the mucosa of the left half of the colon is noted. Diagnosis: Chronic decompensated colostasis, left-sided stasis colitis. 10/14/80, the operation was performed - dissection of the embryonic adhesions, mobilization of the colon, left-sided hemicolectomy, transversorectostomy with fixation of the colon to the parietal peritoneum and to the remnants of the gastro-colon ligament according to the method of M. D. Litvinenko. The postoperative course is smooth. On the 4th day, the chair is independent. There are no complaints upon discharge.

 1 year after the operation, the patient's well-being worsened. On the control irrigograms in an upright position (Fig. 2), a downward shift of almost all sections of the newly formed colon is noted. There were complaints of periodic pain in the lower abdomen, but of less intensity than before the operation, constipation resumed, which, however, can be corrected by diet and herbal laxatives. General condition remains satisfactory.

 Example 2. Patient M., 38 years old. Complaints: pain and bloating, persistent headaches, joint pain, general weakness, stool retention of 6 or more days. The loss of body weight over the past year was 11 kg. Conservative methods of treatment (diet, laxatives, enemas) have recently been ineffective. Functional irrigography (Fig. 3) established: dolichomegacolon, cecum in the pelvis, ascending and transverse colon form an inflection in the form of a "double-barreled shotgun". The transverse colon sags, the left bend of the colon has a high location with a pronounced double-barreled phenomenon. The sigmoid colon has 2 loops of considerable length located in the pelvis. Diagnosis: Chronic colonic stasis, left-sided stasis colitis. An operation was performed - correction of the colon with left-sided hemicolectomy and fixation of the colon according to the developed technique for non-displaceable formations. The postoperative course is smooth. On the 5th day, the chair is independent. When discharged, she feels good, no complaints.

 1 year after the operation, the patient feels well, independent stool, daily. I gained 5 kg in weight. On the control irrigograms in a horizontal position (Fig. 4), the colon has gently sloping contours without kinks, hyperfixations and loops. In the vertical position (Fig. 5), the architectonics of the colon practically does not change. The result is regarded as excellent.

 Medical and social effect. When using the method, as a result of fixation of the colon after left-sided hemicolectomy and correction of its position, it is possible to eliminate relapse of the disease and disability, reduce the number of patients with temporary disability to 2-3%, and the period of temporary disability - up to 10-18 days a year.

LITERATURE
1. Lavrov V.V. Retroperitoneal fixation of S-romani to prevent inversion of S-romani. Festive composition for the 140th anniversary of the Obukhov hospital. Leningrad 1924.

 2. Litvinenko M.D. A method for the treatment of chronic stasis of the large intestine. Auth. testimonial. 511936, M Cl2 A 61 B 17/00 from 12/26/75

 3. Joachimis K.D. Retroperitoneal immobilization in diseases of the mobile cecum. Heer, 1971, 12, pp. 75-77.

4. Romanov P.A., Us V.G. A method of treating colostasis. Auth. testimonial. 936896, M. CL ³ A 61 B 17/00.

 5. Ghosh S., Papachrysostomou M., Batool M., Eastwood M.A. // Long-term results of subtotal colectomy and evidence of noncolonic involvement in patients with idiopathic slow-transit constipation. Scand J Gastroenterol, 1996 Nov, 31:11, 1083-91.

 6. Brown S.R., Shorthouse A.J. // Restorative proctocolectomy for idiopathic megarectum: postoperative recovery of hypotonic anal sphincters. Report of two cases. Dis Colon Rectum, 1997 May, 40: 5, 625-7.

 7. Pluta H., Bowes K.L., Jewell L.D. // Long-term results of total abdominal colectomy for chronic idiopathic constipation. Value of preoperative assessment. Dis Colon Rectum, 1996 Feb. 39: 2,160-6.

 8. Platell C., Scache D., Mumme G., Stitz R. // A long-term follow-up of patients undergoing colectomy for chronic idiopathic constipation. Aust N Z J Surg 1996 Aug 66: 8.525-9.

 9. Nyam D.C., Pemberton J.H., Ilstrup D.M., Rath D.M. // Long-term results of surgery for chronic constipation [published erratum appears in Dis Colon Rectum 1997 May, 40 (5): 529] Dis Colon Rectum, 1997 Mar, 40: 3, 273-9.

Claims (1)

 A method for the surgical treatment of chronic colostasis by mobilization of the colon, dissection of ligaments and embryonic adhesions, elimination of all excesses, resection of excess descending and sigmoid colon with transversorectostomy, characterized in that, in order to prevent relapse of the syndrome due to displacement of the colon, the blind and ascending intestine are fixed to the ileum, the newly formed transverse colon - to the root of the mesentery, the descending intestine - to the parietal peritoneum.

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