RU2226077C2 - Method for producing inferior colorectal anastomosis in performing abdomino-anal rectum resection - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves evaginating anorectal stump. Sigmoid colon is descended. Their walls are sutured on perineal side. Suture lines are arranged 4-6 cm far from transition fold. Edges of the walls to be sutured are juxtaposed with three holders. The holders are drawn in different directions to give triangular shape to colon lumen. Each side is sutured with mechanical suture above the holders. Suture end of the adjacent sutured side is caught. Tantalum clamps are left in colon lumen. EFFECT: enhanced effectiveness of treatment; prevented inconsistency from taking place. 6 dwg

Description

The invention relates to medicine, namely to surgery, and can be used when performing abdominal-anal resection of the rectum by the evagination method in cases of treatment of tumors localized in the middle and lower ampullar regions.

Known methods for resection of the rectum using the apparatus AKA-2 Knysh V.I. Colorectal cancer. - M., 1997, p. 94, 155, a one-time stapler of the EEA system (USA) (CTAPLING TECHNIQUES CENTRAL SURGERI, UNITED STATES SURGICAL CORPORATION, 1988, p. 136-137) and operation Grekov - 1 (Shalimov A.A. Digestive tract surgery. - K., 1987, p.430).

When a colorectal anastomosis is formed using the AKA-2 apparatus, two fastened mechanical rings remain between the anastomosis, between which are sewn with needles and the connected sections of the intestine are squeezed. Within 12 days there is an accretion of the stitched ends of the intestine and necrosis of parts of the walls squeezed by rings tearing into the lumen of the intestine.

Disadvantages: the technical complexity of applying an anastomosis at a distance of 4-6 cm from the transition fold, a qualitative assessment of the viability of the anastomosis and, if necessary, the application of reinforcing sutures; violation of the blood supply to stitched surfaces, slowing healing in the anastomosis.

When using a disposable stapling stapling device of the EEA system (TA 30), the triangulation principle is applied: the mucous membranes of the stitched intestinal walls are compared, three everting holders are applied at an equal distance from each other and each side of the triangle is closed with a separate hardware suture. This seam allows you to maintain a sufficient width of the anastomosis.

The disadvantages of the method include the economic unprofitability of the method, the complexity of the peritoneal overlay of such a suture with low colorectal anastomoses due to the limited operating space and low mobility of the intestinal walls, as well as the abandoned sutures, which increases the risk of infection.

The closest method to the invention, chosen as a prototype, is Grekov-1 operation, in which, after evagination of the affected area through the anus, the intestine is resected from the perineum and the edges of the anorectal stump are sutured with the sigmoid colon reduced to the perineum by a manual double-row suture that is fixed to perineal skin for two weeks, followed by invagination of it into the pelvic cavity.

The disadvantages include the unsatisfactory function of the sphincter due to its atony as a result of the prolonged presence of the reduced intestine in the anal canal and incontinence, the extraorgan arrangement of the anastomosis, which contributes to its infection, the development of insolvency and stricture.

The objective of the invention is to improve the quality of life of the patient and reduce the degree of disability in low tumors of the rectum.

The problem is solved in that in the method of forming a low colorectal anastomosis during abdominal-anal resection of the rectum, including evagination of the anorectal stump with the sigmoid colon and stitching of their walls from the perineum, the suture line is located at the level of 4-6 cm from the transition fold the edges of the stitched walls with inverting holders, above which each side is stitched with a mechanical double-row stitch seam, capturing the end of the seam of the adjacent stitched side, leave tantalum brackets in intestinal lumen and anastomosis invaginate into the pelvic cavity by hand.

The invention is illustrated by drawings.

Figure 1 shows the invagination of the anorectal stump through the anus;

figure 2 - inverting equidistant holders;

figure 3 - triangular comparison of stitched walls;

figure 4 - the imposition of a hardware seam;

figure 5 - stitching of the ends of the intestine is completed;

figure 6 shows the anastomosis in the final form after intussusception, in a section where 1 is the anorectal stump, 2 is the sigmoid colon, 3 is the inverting triangular holder, 4 is the apparatus for applying a mechanical suture, 5 is a mechanical suture.

The proposed method is implemented after resection of the affected area of the rectum via peritoneal access with mechanical suturing. The proximal 2 and distal 1 ends are cut off below the sutures. The edges of the anorectal stump 1 are stitched through all layers with three holders 3. Equidistant from each other. After the anodivulsion, the ends of the holders are brought out through the anus and, pulling them, evaginate the anorectal stump 1 towards the perineum (Fig. 1 and Fig. 2). Through the lumen of the evaginated stump with the help of Allis clamps, the sigmoid colon 2 is reduced. The mechanical suture is cut off. The edge of the reduced intestine is captured in the inverting holders 3, superimposed on the anorectal stump, and stretched to the sides. While stitched intestinal walls are compared with serous surfaces and give a triangular shape to the lumen of the intestine (figure 3). Around the edges of the connected tissues over any two holders impose the apparatus UO-40 for a mechanical staple seam 4 (figure 4). Before removing the apparatus, the excess tissue protruding above its branches is cut off. Apical holders are left intact. The branch of the apparatus on the remaining sides of the triangle is superimposed with the end of the staple joint 5 of the adjacent stitched side being locked into the seam line, which ensures the integrity of the anastomosis. Then the holders are removed. The formation of the anastomosis is completed (figure 5). Ready anastomosis is invaginated by hand into the pelvic cavity (Fig.6).

The advantages of the proposed method are:

- maintaining the urge to defecate;

- preservation of the retention function of the sphincter and the accumulative function of the rectum, the prevention of stenosis of the anastomosis by creating a wide mechanical anastomosis;

- ease of manipulation in the absence of restrictions on the operating space and ease of implementation of the method;

- the achievement of almost complete social rehabilitation of a patient with a "low" tumor of the rectum and the possibility of recovery.

These conclusions are confirmed by the results obtained in the abdominal department of the Omsk Regional Oncology Center, where since 1999 anastomoses have been performed using this technique for abdominal-anal resections in 9 patients. Complications associated with anastomotic insufficiency were not observed, there were no fatal outcomes. The postoperative period in comparison with similar methods was reduced by 11 days.

Claims (1)

The method of forming a low colorectal anastomosis during abdominal-anal resection of the rectum, including evagination of the anorectal stump with the reduced section of the sigmoid colon and stitching of their walls on the perineal side, characterized in that the suture line is located at a level of 4-6 cm from the transitional fold, and the edges of stitched the walls with three inverting holders, stretch them to the sides and give a triangular shape to the lumen of the intestine, above the holders each side is stitched with a mechanical double-row stitch seam, capturing end of the suture of the adjacent stitched side, tantalum brackets are left in the intestinal lumen and the anastomosis is invaginated in the pelvic cavity.

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