RU2194462C2 - Method for developing an interintestinal anastomosis - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: a "side-to-side" anastomosis is formed with double-row suture. External row of serous-muscular sutures is carried out. Serousmuscular layer is resected. Electrocoagulation for the vessels of submucous layer is performed. Internal row of serous- muscular-submucous sutures is carried out along posterior line of an anastomosis. Mucosa is resected. One should finish the internal suturing. External serousmuscular sutures are made along anterior line of an anastomosis. EFFECT: higher asepticity.

Description

 The invention relates to surgery and can be used to create continuity of the intestinal tract after resection of the small or large intestine or to create a bypass inter-intestinal anastomosis, without resection of the intestine.

There are many ways to create intestinal anastomoses:
1. Longitudinal, transverse.

 2. Isoperistaltic, antiperistaltic.

 3. "End to end", "side to side", "end to side".

 4. Single row, double row, three row.

 5. Using nodal or continuous seams.

 6. Open, semi-hermetic, hermetic anastomoses.

 The closest in the set of essential features, selected by the authors as a prototype, is a method for forming an intestinal anastomosis, developed by Mateshuk VP [1].

 The method of forming an intestinal anastomosis is as follows. At the border of the proposed anastomosis from the side opposite to the mesentery, two sutures are placed connecting the anastomosing loops of the intestines. The threads of these seams are not temporarily cut off and serve as “holders”. Serous and muscle layers of anastomosed intestinal loops are cut with a sharp scalpel for 4-5 cm and single-row intranodal sutures are applied to the posterior line of the anastomosis after 0.5 cm. After opening the intestinal lumen, single-row intranodular sutures are applied to the anastomosis anterior line without trapping the mucosa. However, the inter-intestinal anastomosis described above does not prevent contamination of the surgical field with intestinal contents after opening the intestinal lumen.

 Therefore, the objective of the invention is the prevention of infection, increasing the asepticity of the formation of the anastomosis and reducing purulent-septic complications.

 The problem is solved, thanks to the method of forming an intestinal anastomosis "side to side", which includes matching the walls of fragments of the adducting and abducting intestines along the anterior and posterior lines of the anastomosis, performing sequentially in each layer of the walls, namely in the serous-muscular, submucous and mucous membranes, dissecting the tissue and suturing the edges of the fragments, in which, in accordance with the invention, the anastomosis is formed by double-row nodular serous-muscular sutures, with the outer row of sutures along the posterior line an astomosis, then dissect the tissue of the serous-muscular layer between the comparable walls of the intestines, conduct electrocoagulation of the submucosal and mucous layers, apply the inner row of sutures without trapping the mucous layer along the back line of the anastomosis, then part of the inner row of sutures is applied along the front line of the anastomosis, dissect the tissue in the mucous layer , complete the imposition of the inner row of sutures and impose external sutures along the anterior line of the anastomosis.

 Distinctive features of the proposed technical solution were not identified as a result of a search on the sources of scientific, technical and patent information. Therefore, the authors believe that this technical solution is new and also meets the criterion of "inventive step".

 The range of parameters given by the forms was chosen in accordance with the creation of intestinal continuity during resection of the small and large intestines and the creation of bypass interintestinal anastomoses.

 The method in accordance with the alleged invention is carried out in the following way. The adducting and diverting intestines are sutured 0.5 cm from the mesentery with separate nodular serous-muscular sutures through 0.8-1 cm over 3 cm. 0.5 cm apart from the suture line, both intestines are dissected longitudinally to the mucous layer without opening it. Electrocoagulation of the mucous and submucosal layers is carried out, the inner row of intranodular sutures is applied without trapping the intestinal mucosa along the back line, then along the anastomosis front line, the last two sutures of the inner row are tied at the last moment, after opening the mucosa between them. The application of the anastomosis ends with the application of external serous-muscular sutures along the anterior line of the anastomosis.

Advantage of the technique:
1. A modified method for applying an inter-intestinal anastomosis prevents infection of the surgical field with intestinal contents, reduces intestinal bleeding, and operating time with open hollow organs.

 2. The formation of the intestinal "aseptic" anastomosis "side to side" allows you to avoid the use of intestinal pulp on the wall of the intestine during the application of the anastomosis in emergency resection of the intestine.

 3. The technical simplicity and reliability of the method allows us to recommend this anastomosis in the category of severe patients, to reduce the risk of operations performed by "young" surgeons.

Here are the medical records:
1. Yezhov A. A, 48 years old, medical history 2951/375, was operated on at the Oncology Department of the Pavlovsk Central District Hospital on July 9, 1996. Diagnosis: back melanoma, combined treatment in 1994. Dissemination in the abdominal cavity, chronic intestinal obstruction. Superimposed 5 bypass anastomoses (1 duodenojejunal anastomosis, 3 inter-intestinal anastomoses, 1 ileotransverse anastomosis) without complications. Discharged in satisfactory condition for outpatient treatment.

 2. Varenova A. D., 68 years old, medical history 6517/767, was operated on December 17, 1996 in the oncology department of the Pavlovsk Central Hospital. Diagnosis: "Cecum cancer of the fourth century. Partial intestinal obstruction." Operation: the imposition of ileotransverse anastomosis. The postoperative course is smooth, discharged in satisfactory condition for outpatient treatment.

 Operated by this technique 22 people. There were no fatal outcomes. Complications 2 (phlegmon of the abdominal wall 1, suppuration of the postoperative wound 1).

Sourse of information
1. V.P. Mateshuk, E.Ya. Saburov. "Technique for resection of anastomoses using a homogeneous intragranular suture." Yaroslavl, 1962

Claims (1)

 A method of forming an intestinal anastomosis "side by side", including comparing the walls of fragments of the adducting and abducting intestines along the posterior and anterior lines of the anastomosis, performing tissue dissection and suturing on the edges of the fragments in a serous-muscular, submucous and mucous membrane, characterized in that the anastomosis is formed double-row nodular serous-muscular and serous-muscular-submucosal sutures, matching fragments "side to side", while first applying the outer row of serous-muscular sutures on the back line of the anastomosis then the tissue of the serous-muscular layer between the comparable walls of the intestines is dissected, the vessels of the submucosal layer are electrocoagulated, the inner row of serous-muscular-submucous sutures is applied without grasping the mucous layer along the anastomosis back line, then a part of the internal row of sutures is applied along the anastomosis front line, the tissue is dissected in the mucous layer, complete the imposition of the inner row of sutures and impose external serous-muscular sutures along the anterior line of the anastomosis.