RU2272586C1 - Method for creating interintestinal anastomosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves suturing efferent intestine along mesenterial edge in U-shaped way forming blind and efferent part. Intestine lumen is opened in efferent part. The afferent intestine is placed on efferent part of the efferent intestine. The afferent intestine is invaginated to 1.5 cm into efferent part lumen and fixed. The blind part of the efferent intestine is suture to the efferent part over invagination anastomosis and afferent intestine for having additional cover.

EFFECT: high anastomosis reliability; enhanced effectiveness in creating anastomosis under peritonitis conditions.

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Description

The present invention relates to medicine, namely to surgery of the gastrointestinal tract, and can be used for resection of the small intestine.

The formation of an intestinal anastomosis during resection of the small intestine is an important final stage of the operation. When resecting the small intestine, several typical methods of forming anastomoses are used: “end to end”, “end to side”, “side to side”. Unfortunately, none of the methods used provides a full guarantee against the development of anastomotic suture insolvency, the most common and formidable complication. The causes leading to insolvency are various, but the main one is ischemic changes in the suture area of the anastomosis, leading to necrosis of the intestinal wall in the suture band (Chibis OA Surgical suture. // Moscow, Medicine, 1987). This is because the mesenteric edges are mobilized during intestinal resection, and the mesenteric arteries inevitably intersect. It has been proven that at a distance of 1.5-2 cm from the last stored artery, the intramural blood flow of the intestinal wall decreases to 15% of the norm (Delaney SP, Grim E. Collateral blood flow to a devascularized segment of small intestine. // Surg. Ginecol. Obst. - 1993. - Vol.116. - No. 4. - P.404-496).

The prototype of the invention is an invaginal esophageal-intestinal anastomosis of Gilyarovich. The principle of the formation of anastomosis is as follows. The outlet and lead loops of the small intestine are sutured. The esophagus is placed on a discharge loop and an anastomosis of "end-to-side" with a two-row suture is applied. The anastomosis is covered with the lead loop of the intestine and stitched with the discharge loop (Shalimov A.A., Polupan V.N. Atlas of operations on the esophagus, stomach and duodenum. // Moscow, Medicine, 1975 - p. 81 - Fig. - 146). This method also does not exclude the development of anastomotic suture failure.

The technical result when using the invention is to increase the reliability of the anastomosis, improve the results of surgical treatment, the possibility of formation in conditions of peritonitis.

The specified technical result is achieved by the fact that the diverting intestine is sewn along the mesenteric edge in a U-shape, forming the blind and diverting parts, the intestinal lumen is opened in the diverting part, the adducting intestine is placed on the diverting part of the diverting intestine, invaginated by 1.5 cm in the lumen of the diverting part, and fix, and the blind part of the abducting intestine is sutured to the abduction on top of the invagination anastomosis and adduction intestine for additional shelter.

The proposed method for the formation of inter-intestinal anastomosis is as follows. After resection, the end of the abducting intestine 1 is sutured tightly with a purse string suture. The intestine is folded U-shaped in a section of 7-8 cm and stitched along the mesenteric edge with gray-serous interrupted sutures, forming a blind 2 and leading 3 parts. On its outlet part, a longitudinal incision of 3 cm is performed and the intestinal lumen is opened. The adducting gut 4 is laid on a U-shaped abduction gut. The end of the adducting intestine is invaginated through the incision into the lumen of the outlet part of the outlet intestine by 1.5 cm. The invaginated adducting intestine is fixed along the edge of the incision with nodular sero-muscular sutures 5. The blind part of the abducting intestine is sutured over the adducting intestine with the nodular serous-muscular sutures 6 forming the second row of sutures, additionally covering the adducting gut and anastomosis. Anastomosis is formed (Figs. 1-5).

Figure 1 shows the formation of the cecum and abduction parts of the abducting intestine; figure 2 - hemming of the adducting intestine into the abducent part of the abducent intestine; figure 3 - the first row of sutures of the intestinal anastomosis; figure 4 - the imposition of the second row of seams; figure 5 is a General view of the formed anastomosis.

The advantages of the proposed method for the formation of the inter-intestinal method in comparison with the traditional ones are as follows:

1. During the formation of the anastomosis, there are no disorders of the microcirculation of the intestinal wall, since the vessels of the mesentery of the abdominal intestine do not intersect, the adduction loop is laid between two knees of the abdominal intestine and immersed in the lumen of the abdominal part.

2. Anastomosis has a large contact surface of the serous surfaces of stitched intestinal loops, a large margin of safety, in comparison with traditional methods, which allows the use of the proposed method in conditions of peritonitis.

3. The lead gut invaginated by 1.5-2.0 cm into the lumen of the abduction loop is an additional factor in the prevention of interintestinal anastomosis insolvency.

After theoretical justification, the method has been tested and implemented in clinical practice. Using this method, 10 small bowel resections were performed. There are no complications associated with the use of this method. Using the proposed method allows the formation of interintestinal anastomosis with significant violations of the microcirculation of the intestinal wall - in conditions of acute intestinal obstruction and peritonitis.

The proposed method is illustrated by the following example.

Patient K., 59 years old, was admitted to the hospital with a diagnosis of Acute abdomen. After clinical examination and preoperative preparation of the patient, an emergency operation was performed - median laparotomy. When revising organs in the abdominal cavity to 800.0 ml of serous-hemorrhagic effusion, the loops of the small intestine are inflated to 4 cm, contain liquid contents. A further audit revealed a stenotic tumor of the small intestine 70 cm from the ileocecal angle. Diagnosis: Blastoma of the small intestine. Acute obstructive small bowel obstruction. Spilled serous hemorrhagic peritonitis. Resection of the small intestine with the tumor, open bowel decompression was performed. Formed interintestinal anastomosis by the proposed method. The abdominal cavity is drained, drained, and sutured in layers. The postoperative course is smooth. The patient was discharged from the clinic on the 10th day.

At the control examination carried out after 3 months, the patient's condition is satisfactory, no complaints, gastrointestinal tract dysfunction is not observed.

Claims (1)

A method of forming an intestinal anastomosis during resection of the small intestine, including invagination of the adducting intestine into the abducent followed by suturing, characterized in that the abducting intestine is sutured along the mesenteric edge in a U-shape, forming the blind and abdominal portions, the intestinal lumen is opened into the efferent portion, the intestine leading on the outlet part of the outlet intestine, are invaginated by 1.5 cm into the lumen of the outlet part of the intestine and fixed, and the blind part of the outlet intestine is sutured to the outlet part on top of the invagination anastomosis and lead gut for additional shelter.

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