RU2254822C1 - Method for a single-row interrupted intestinal suture - Google Patents

Abstract

FIELD: medicine, abdominal surgery.

SUBSTANCE: one should perform marginal serous-muscular-submucous suturing for every wall of intestinal wound in oblique direction against cross-sectional intestinal axis being parallel to lateral branches of intraparietal intestinal vessels at an angle being opened towards mesenteric edge. Puncturing in and puncturing out of stitches at the serous membrane of every further suture should be performed being on the same line with puncturing in and puncturing out of stitches at the border of submucous and mucous layers of previous suture. Sutures should be tightened at forming the knots at serous membrane. The innovation suggested enables to decrease the frequency in developing failed sutures.

EFFECT: higher efficiency.

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Description

The invention relates to medicine, namely to surgery, and can be used for suturing wounds of the gastrointestinal tract and the formation of anastomoses between its departments.

As an analogue, Kirpatovsky I.D. is proposed. the method of a double-row regional nodular intestinal suture (Semenov G.M., Petrishin V.L., Kovshova M.V. Surgical suture. - St. Petersburg: Peter, 2002. - S.162-163).

The disadvantages of this method are: suturing without taking into account the architectonics of the lateral branches of the intra-intestinal vessels, impaired blood supply to the intestinal wall along the suture line, the formation of a moderately expressed “tissue shaft”, rigidity of the suture line, infection of closed cavities between the rows of sutures. These shortcomings contribute to the development of suture failure, which is the cause of common peritonitis, abscesses of the abdominal cavity and fistulas of the gastrointestinal tract.

A. Bier, a single-row nodular serous-muscular intestinal suture (Semenov G.M., Petrishin V.L., Kovshova M.V. Surgical suture. - St. Petersburg: Peter, 2002. - p. Is proposed as an analogue. .159-160).

The disadvantages of this method are: the lack of hemostatic properties and the need to perform additional hemostasis, suturing without taking into account the architectonics of the lateral branches of the intraventricular intestinal vessels, impaired blood supply to the intestinal wall along the suture line, lack of full adaptation of the submucous and mucous membranes, insufficient mechanical strength, insufficient physical and biological hermeticism. These shortcomings provoke the development of inconsistency of the sutures and, as a consequence of this, various forms of peritonitis and fistulas of the gastrointestinal tract.

The closest in technical essence to the proposed method is Pirogova N.I. Method of single-row nodal intestinal suture, including regional suturing of the serous, muscle and submucous layers of both walls of the intestinal wound with the formation of a node on the serous membrane (Semenov G.M., Petrishin V.L., Kovshova M.V. Surgical suture. - St. Petersburg: Peter , 2002. - S.160-162).

There are common signs of this method of intestinal suture with the claimed method, which are expressed in the following:

- the method is used in the surgical treatment of injuries and diseases of the gastrointestinal tract;

- the method includes flashing the serous, muscle and submucosal layers of the intestinal wall;

- the method involves the formation of a node on the serous membrane;

- the method provides layer-by-layer adaptation of the walls of the stitched organs with preservation of the case structure;

- the method provides for sufficient physical tightness;

- the method provides healing of wounds and anastomoses by primary intention.

However, the known method is not without some drawbacks, which are: insufficient biological integrity of the suture and a violation of the blood supply to the intestinal tissues along the suture line, since the sutures are applied without taking into account the architectonics of the lateral branches of the intra-intestinal vessels.

These shortcomings serve as the basis for the development of suture failure and the resulting peritonitis and intestinal fistula.

The objective of the invention is the development of a method of single-row nodal intestinal suture with high biological and mechanical strength.

The solution of this problem allows to reduce the incidence of suture failure, which is achieved by sero-muscular-submucosal flashing of each wall of the intestinal wound in an oblique direction with respect to the transverse axis of the intestine parallel to the lateral branches of the intraparietal intestinal vessels at an angle open to the mesenteric edge of the intestine. In this case, the injection and stitching of stitches on the serous membrane of each subsequent suture is performed in line with the stitching and injection of stitches at the border of the submucosal and mucous layers of the previous suture.

The drawing shows a General scheme for applying a single-row nodal intestinal suture.

The method is as follows.

A needle is injected into the serous membrane (1) of the intestinal wall at a distance of 5-6 mm from the edge of the wound. The needle is passed through the muscular (2) and submucosal layers (3) in an oblique direction with respect to the transverse axis of the intestine parallel to the lateral branches of the intraparietal intestinal vessels at an angle open to the mesenteric edge of the intestine. The injection is carried out to the wound edge at the border of the submucosal layer with the mucous membrane (4). Then an injection is performed at the border of the mucous membrane and the submucosal layer of the opposite edge of the wound and the needle is drawn in the reverse order through the submucosal and muscle layers also at an angle open to the mesenteric edge of the intestine. The needle is punctured on the serous membrane at a distance of 5-6 mm from the edge of the wound. The next stitch is applied similarly to the previous one, while the stitches are injected and punctured on the serous membrane in the same line as the stitches are punctured and punctured at the border of the submucosal and mucous layers of the previous stitch. The first seam is tied with the formation of a node on the serous membrane. Then they impose a third seam and tie a second one. And so on until the wound is completely closed.

As a result, a line of single-row nodal intestinal sutures is formed with maximally preserved intra-intestinal blood flow and two cross levels of intestinal contact: submucosal and serous, while the serous level of each subsequent suture overlaps the submucosal level of the previous one. The indicated moments give the seam lines high biological and mechanical strength.

The method was studied in an experiment, after which it was applied in a clinic in 16 patients. Complications associated with the technique of applying an intestinal suture were not noted.

Thus, the proposed method of single-row nodal intestinal suture has high biological and mechanical strength and can be recommended in wide surgical practice.

Claims (1)

A method of a single-row nodal intestinal suture, including regional sero-muscular-submucosal flashing of the intestinal wound and the formation of a node on the serous membrane, characterized in that each of the walls of the intestinal wound is flashed in an oblique direction relative to the transverse axis of the intestine parallel to the lateral branches of the intrathecal intestinal vessels at an angle open toward the mesenteric margin of the intestine; injection and stitching of stitches on the serous membrane of each subsequent suture is performed in line with the stitching and injection of stitches at the border of the submucosal and mucous layers of the previous stitch.