RU2207058C2 - Method for treating high atresia of duodenum - Google Patents

Abstract

FIELD: medicine, juvenile surgery. SUBSTANCE: the present innovation deals with treating defects in development gastrointestinal tract. One should develop "end-to-end" anastomosis between duodenum and jejunum by applying seroserous suture. Adducting jejunal section is sutured into redeveloped duodenal opening being 1.5-2.0 cm above developed anastomosis invaginationally with one-row seroserous suture. The method enables to restore passage of duodenal content. EFFECT: higher efficiency of therapy.

Description

 The invention relates to medicine, namely to pediatric surgery, and can be used to treat malformations of the gastrointestinal tract.

 A known method of treating atresia of the duodenum by creating a bypass anastomosis between the duodenum and jejunum. (Yu.F. Isakov, E.A. Stepanov, T.V. Krasovskaya // Abdominal surgery in children //. M: Medicine, 1988, p. 125-143).

 The disadvantage of this method is the discharge of gastric contents into the leading section of the jejunum, which leads to the development of "congestive bowel" syndrome, the formation of peptic ulcers in the leading section of the jejunum.

 Known methods of treating atresia of the duodenum 12, which include the creation of gastrounoanastomosis in both cases of high and low atresia of the duodenum (K. U. Ashcraft, T.M. Holder // Pediatric Surgery // St. Petersburg, 1996, p. 341 -357).

 A disadvantage of the known methods is the injection of bile into the stomach, the formation of peptic ulcers, the need for an additional anastomosis between the adducting and abducting intestines (inter-intestinal anastomosis according to Brown).

 The closest to the achieved positive result is a method of treating high atresia of the duodenum by applying a side-by-side anastomosis between the duodenum and jejunum by the type of “side to side” double-row suture on the tube drawn through the anastomosis zone to the initial section of the jejunum (G.A.Bairov, Yu.L. Doroshevsky, T.K. Nemilova // Atlas of operations in newborns // M.: Medicine, 1984, p. 47-72). The disadvantage of this method is the significant narrowing of the lumen of the anastomoses of the stitched intestines, which already have a small diameter in this pathology.

 A positive result of the proposed method is to increase the effectiveness of the treatment of high atresia of the duodenum 12 due to the fact that when creating the necessary to restore the passage of the contents of the duodenum 12 anastomoses, the latter do not narrow the lumen of the stitched intestines and have reliable tightness.

 A positive result is achieved by the fact that an end-to-end anastomosis between the “blind” segment of the duodenum and the discharge loop of the jejunum is formed on the tube of the corresponding diameter and a single-row suture, which creates complete sealing of the anastomosis, protects the anastomosis zone from aggressive food and allows start early feeding the baby.

 The method is as follows. The position of the patient on the back. Under endotracheal anesthesia, an upper median laparotomy is performed. When revising the abdominal cavity, the anatomical features of atresia are evaluated. At a distance of about 10 cm from the duodenojejunal fold, the intestine is crossed across, a hole is formed in the mesentery of the transverse colon, the duodenum is mobilized in the retroperitoneal space. The outlet section of the jejunum is anastomosed with the leading “blind” segment of the duodenum 12 behind the transverse colon of the end-to-end type by a single-row serosa-serous suture on a tube drawn through the nasal passage into the lumen of the created anastomosis and distally by 15-20 cm. The leading segment of the jejunum is inserted into the hole of the corresponding diameter of the duodenum above the created main anastomosis by 1.5-2 cm in the type of "proboscis" end to side for the receipt of bile. The operation is completed by the introduction of a nasogastric tube for decompression of the stomach and duodenum.

 In the postoperative period, patients are fed through a probe on the next day, if necessary, physiotherapy, antibacterial therapy are prescribed. On the 10-12th day after the operation, the probe is removed and the child begins to eat naturally.

The high efficiency of the method of treating high atresia of the duodenum 12 is ensured by the technical execution of the created anastomoses, which allows to eliminate the narrowing of their gaps, creates complete tightness, protects against the aggressive action of food and digestive juices and at the same time allows you to start early feeding of the baby
Clinical example
Patient K. (medical history 390), born January 10, 1998, was admitted to the pediatric surgery clinic of the Altai Regional Children's Hospital on January 22, 1998, on the 12th day after birth in a very serious condition with severe exicosis, weight loss due to prematurity (body weight at birth 1850 g; upon admission 1320 g). From 2 days after birth, the child began vomiting of food eaten without an admixture of bile. Mekonium departed from the end of 1 day, stained. Within 10 days, the child was treated for perinatal damage to the central nervous system, conjugation hyperbilirubinemia in the central district hospital at the place of residence. Due to the lack of effect of the therapy, ongoing persistent vomiting in the child, congenital high intestinal obstruction was suspected and the patient was transferred to the clinic.

 A clinical and radiological examination made the diagnosis: atresia of the duodenum 12 above the Vater’s nipple, high complete intestinal obstruction. "

 After preoperative preparation for 4 days (warming in the incubator, infusion therapy, hemostatic therapy, antibiotic therapy, oxygen therapy, parenteral nutrition), the child underwent surgery. The position of the child on the back. Anesthesia endotracheal. An upper middle laparotomy was made from the xiphoid process to the navel. When revising the abdominal cavity, there is an expansion of the stomach and the initial part of the duodenum, distal intestines are collapsed. The preoperative diagnosis is confirmed. An intersection of the jejunum was made in the transverse direction at a distance of 10 cm from the Treitz ligament. A hole has been formed in the mesentery of the transverse colon. The duodenum is mobilized in the retroperitoneal space. The outlet section of the jejunum was anastomosed with the duodenum of the end-to-end type by a single-row suture without grasping the mucous layer, retreating from the edges of the wound by 3 mm on a tube drawn through the nasal passage into the stomach and then through the lumen of the created anastomosis at a distance of 20 cm The lead segment of the jejunum is inserted into the opening of the corresponding diameter of the duodenum, immediately above the previously created anastomosis by 2 cm in the type of "proboscis" "end to side" with a single-row suture. The defect in the mesentery of the colon is sutured. A constant nasogastric tube is left in the stomach. The abdominal cavity is stitched tightly in layers. Bandage.

 The postoperative period was uneventful. The probe from the small intestine was removed on the 7th day. Mouth-feeding has been started since 10 days. Infusion therapy for 2 weeks. Sutures were removed on the 10th day, wound healing is primary. Discharged from the clinic on the 38th day after surgery with recovery. Weight at discharge 2910 g, the level of bilirubin returned to normal. The patient was examined after 6 months. The child's condition is satisfactory, all age-specific complementary foods are introduced into the diet, vomiting is not noted, the child's weight is 7170 g.

 The inventive method is highly effective in the treatment of high atresia of the duodenum, allows you to restore the passage of food and bile through the duodenum in the early stages, to avoid known complications characteristic of other methods of treatment. The method can be used to treat other malformations of the gastrointestinal tract in newborns requiring restoration of patency of small diameter intestinal tubes.

Claims (1)

 A method of treating high congenital atresia of the duodenum, which consists in creating an anastomosis on the tube between the duodenum and jejunum by applying a gray-serous suture, characterized in that the anastomosis is formed by the end-to-end type of the corresponding diameter and strengthened by a single-row gray-serous suture, leading a section of the jejunum is sutured into the newly created opening of the duodenum above the created main anastomosis by 1.5-2.0 cm by invagination single-row gray-serous suture.