RU2184496C2 - Method for closing double-stem colostoma - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves transcutaneously suturing a stoma in transverse direction through all intestine layers. Two skin incisions are made around the stoma. The first one is done around the sutured colostoma line. The second one is done circumferentially 4 cm apart from the colostoma to the line the colostoma is attached to the peritoneum. The abdominal cavity is opened in this place. Mesenterium deformity and spur are removed. The colostoma is sutured by means of suturing device in transverse direction. Suture line is covered with interrupted seromuscular sutures. The anastomosis is extraperitonized. The wound is sutured. EFFECT: reduced risk of infectious complications in postoperative wound. 4 dwg

Description

 The invention relates to medicine, namely to surgery, and can be used when closing a double-barreled colostrum.

 A known method of extraperitoneal closure of a double-barreled colostomy by suturing the stoma with a manual suture with fixation of the formed anastomosis is nonperitoneal (Melnikov R.A., Simonov N.N., Pravosudov I.V. et al. Diagnostic and tactical errors in the surgical treatment of colorectal cancer / / Surgery. 1987. 11. - P. 146-149), a hardware method for suturing parietal fistulas without opening the abdominal cavity, used for small fistulous openings (Gritsman Yu.Ya., Borisov A.I. Postoperative intestinal fistulas // M.: Medicine, 1972).

 Method R.A. Melnikova et al. (1987) was taken as a prototype, since there are common signs with the claimed object: first, the stoma is sutured with percutaneous sutures, when the adducting and abducting knees of the colon are selected, the abdominal cavity is opened, the stoma is sutured and fixed extraperitoneally.

Significant disadvantages of the prototype are:
1. The colostomy is sutured with a manual suture in the transverse direction on the open intestine, which increases the risk of infection of the postoperative wound.

 2. The quality of the suture depends on the suture material used and the individual skill of the surgeon.

 The essence of the claimed method consists in suturing a double-barreled colostomy with a hardware suture in the transverse direction with the application of a second row of serous-muscular sutures to the wall of the colon after intraperitoneal dissection of the joints and spurs of the colostomy followed by extraperitonization of the formed anastomosis.

 The method is as follows. The operation begins with suturing the outlet of the colostomy with percutaneous sutures through all layers of the intestine in the transverse direction with respect to its length 1 (Fig. 1). A gauze strip 2 is tied to the line of the stitched seam, the sutured stoma is pulled up by the strings 3 above the stoma. After that, two skin incisions are made around the stoma: the first is around the sutured line of the colostomy 4 to the wall of the intestine A, as close as possible to its edge 1, the second incision 5 is made around the circumference from the extracted colostomy, 4 cm away from it, to the line of colostomy fixation to peritoneum B (figure 2). The abdominal cavity B is opened, the adducting G and the abducting knee D of the colon are secreted, continuously pulling the sutured stoma up by the threads 3. The joints around the intestine and mesentery dissect and eliminate the colostomy spur. Under the mobilized cutaneous-intestinal rim of the sutured colostomy, the UO-60 stapler is inserted transversely with respect to the gut, the gut 6 is stitched, and the skin flap with a part of the sutured edge of the colostomy is cut off (Fig. 3). A second row of nodular serous-muscular sutures is applied 7. The sutured section of the intestine is sutured to the peritoneum of the anterior abdominal wall 8 for extraperitonization. The wound of the abdominal wall is sutured through all layers with Blair-Danati 9 sutures (Fig. 4).

 The method is used in the treatment of patients in the Samara Regional Hospital. M.I. Kalinina (Design Bureau).

 Example 1. Patient A., 37 years old, and / b 2829, was admitted to the surgical department of the OKB on 04.15.98 with complaints about a functioning double-barreled sigmoid stoma, which was superimposed on 12.01.97 in connection with damage to the sigmoid colon during opening of a tubo-ovarian abscess . 04/23/98, an operation was performed - extraperitoneal suturing of the stoma with a two-row suture with the application of the first row of sutures with the UO-60 apparatus in the transverse direction. There were no complications after the operation. On the 7th day, all skin sutures were removed, the wound healed by first intention, and on April 30, 1998, the patient was discharged for outpatient treatment.

 Example 2. Patient L., 52, and / b 39151, was admitted to the surgical department of the OKB on 10/19/98 with complaints about a functioning double-barreled transversostoma, which was superimposed on 02/14/97 in connection with the formation of an unformed fistula of the splenic corner of the colon intestines due to pressure sores from the drainage tube in the treatment of subphrenic abscess on the left. 10/27/98, an operation was performed - extraperitoneal suturing of a transversostomy with the application of the first row of sutures with the UO-60 apparatus in the transverse direction. There were no complications after the operation, the wound healed by first intention, the patient was discharged from the hospital on 5.11.98.

 The applied method of suturing double-barreled colostomy allowed to reduce the number of complications after surgery and improve the results of treatment of patients.

Thus, the significant advantages of the proposed method of hardware suturing double-barreled colostrum in comparison with the prototype are:
1. Suturing of the colostomy is performed on the closed intestine in a hardware way, which reduces the risk of infection of the postoperative wound.

 2. The proposed double-row suture when suturing a colostomy is more reliable, its quality depends on the operation of the stapler and, to a lesser extent, on the skill of the surgeon.

Claims (1)

 A method of closing a double-barreled colostomy, including hardware suturing of the colostomy, characterized in that at first the stoma is sutured percutaneously in the transverse direction through all layers of the intestine, after which two skin incisions are made around the stoma, the first incision is made around the sutured colostomy line to the intestinal wall, the second incision is performed according to the circumference from the removed colostomy, departing from it 4 cm, to the line of fixation of the colostomy to the peritoneum, fused with the bringing and removing knees of the intestine, then the abdominal cavity is opened in this place, the deformity is eliminated In July, the mesentery and the spur between the abdominal and adducting knees of the intestine, the colostomy are sutured with a suturing device in the transverse direction under the formed cutaneous-intestinal roller, the latter is cut off, the sutured line is covered with nodular serous-muscular sutures, the created anastomosis is extraperitonized and the wound is sutured with Danati sutures.

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