RU2301635C1 - Method for creating large intestine compression anastomosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out forming triangular zone directed with its apex towards mesenterial edges by placing three seromuscular sutures. Two pierces in intestinal wall are produced in the center of the triangle base. Titanium nickelide spiral possessing shape memory properties is introduced through the pierces. The second anastomosis suture row is placed at the level of the triangular zone.

EFFECT: enhanced effectiveness of treatment; prevented anastomosis loops from slipping out of spiral window.

Description

The invention relates to medicine, namely to surgery, and can be used in coloproctology, if necessary, the formation of anastomosis on the colon.

There is a method of end-end compression colonic anastomosis with a design consisting of two metal rings, the compression of which is carried out by a nickel-titanium spring with a "shape memory", which consists in mounting a compression device by tightening the purse string sutures of the anastomosed sections of the intestine on the compression rings and creating a compression zone around the circumference of the anastomosed sections after restoration of the shape of the nickel-titanium spring, which is part of the device (patent for invention No. 2062052 prior tête from 07.07.1993). After rejection of the device, a compression anastomosis is formed.

However, the bulkiness of the device, difficulties in evacuating it, and technical difficulties in tightening the purse string suture, due to the time limit caused by the memory effect, limit the use of this technique in most patients.

There is a method of end-end compression colonic anastomosis with a three-turn nickel-titanium spiral with a “shape memory", which consists in ligation of the adducting and abducing parts of the colon, resection of its segment, alignment of the oral and aboral parts of the intestine by converging and linking the ligatures of the stump, puncture the intestinal wall anastomosed loops, introducing into them turns of a cooled device (spiral) so that the associated stumps are located in the window of the compression count tsa, restoration of primary patency by dissecting tissues of the compression spiral restrained in the window, suturing punctures of the intestinal walls and the formation of a second row of serous-muscular sutures along the perimeter of the anastomosis (A.I. Kecherukov, I.A. Chernov, V.E. Gunter and others. "Surgery" No. 11, 2005, S.64-70).

However, in connection with the conical shape of the anastomosed areas, difficulties arise associated with the premature slipping of stitched sections from the window of the compression spiral.

The aim of the invention is to prevent complications associated with the slip of anastomosed loops from the compression ring with a "shape memory".

This goal is achieved by the fact that in the method of end-end compression colonic anastomosis, which includes centering the leading and outlet segments of the anastomosed loops of the intestine by tying the ligatures of their stumps, puncture the intestinal walls along the mesenteric edge, introducing a compression three-turn spiral through them, suturing the punctures and forming muscle joints, create a triangular platform in the plane perpendicular to the longitudinal axis of the anastomosis, facing the apex to the mesenteric edges of the it overlay the three sero-muscular sutures at the level of the second row of anastomotic sutures.

The method is as follows. After mobilization of the colon segment to be resected, the latter intersects between two ligatures on each side. Ligatures of the bringing and taking loops are connected and the anastomosed loops are centered. Then three serous-muscular arms are superimposed, retreating 1.5 cm from the stumps so that when they approach each other, an isosceles triangle is formed, with its apex facing the mesentery. In the middle of the base of the obtained triangular platform, two punctures of the intestinal wall are formed, through which the implant is inserted towards the apex of the triangle. In this case, the connected stumps easily fall into the center of the spiral. After compression of the graft and the creation of the primary patency of the anastomosis, intestinal wall punctures are sutured, and a second row of nodular serous-muscular sutures is applied between the holders. Thus, a two-row compression term terminal colonic anastomosis is formed.

Example: B-th L., 61 years old, medical history No. 6198, was hospitalized in the clinic on December 6, 2005 for planned surgical treatment. In August 2005, she was operated on for a restrained ventral hernia with a gangrene of the transverse colon. A herniolaparotomy, resection of the transverse colon and splenic angle according to the type of Hartmann operation was performed. After preoperative preparation was operated as planned 09.12. In an operation after mobilization of the colostomy and stump of the sigmoid colon, the anastomosis is formed as follows: the stoma-bearing loop is ligated with a catgut ligature. The stump of the sigmoid colon is mobilized and also tied up. By drawing together and tying up the ligatures, the sections of the colon were centered. 2 cm away from the stumps, sero-muscular sutures were applied at the mesenteric edges of the anastomosed loops and at equal distance to both sides to the mesenteric edge. After stretching the sutures with an electric knife, the intestinal walls were punctured based on the obtained triangular platform. Through punctures, a two-turn cooled nickelide-titanium spiral of 20/10 mm was introduced into the lumen towards the mesenteric edges so that the connected stumps were in the “window” of the spiral. By dissecting the tissues in the spiral window, the primary patency of the anastomosis is created. The second row of serous-muscular sutures is imposed. The rectal mesentery defect is eliminated. The postoperative period was uneventful. Migration of the spiral from 6 days after surgery. On day 8, the structure was evacuated naturally. Discharged 10 days after surgery.

According to the proposed technique, 8 patients were operated on. Complications in the postoperative period were not observed.

Information sources

1. Patent for invention No. 2062052, priority from 07/07/1993. DEVICE FOR CREATING INTESTINAL ANASTOMOSIS "END TO END" Ziganshin Rashid Valievich, Kecherukov Alamat Ibragimovich, Monasevich Leonid Abramovich, Gunter Victor Eduardovich (RU).

2. A.I. Kecherukov, I.A. Chernov, V.E. Gunter and others. "Surgery" No. 11, 2005, S.64-70.

Claims (1)

A method for compressing the end-terminal colonic anastomosis, including ligation of anastomosed loops of the colon, aligning them by drawing together and linking the ligatures of the stumps, introducing a nickel-titanium spiral with shape memory through punctures of the intestinal wall along the mesenteric edges of the intestinal loops, creating a primary pathway to pass through the intestines the window of the device tissue and the imposition of the second row of serous-muscular sutures, characterized in that they form a triangular platform in a plane perpendicular to the anastomosis birth axis directed by the apex to the mesenteric edges, by applying three serous-muscular sutures, form two punctures of the intestinal wall in the middle of the base of the obtained triangular platform, introduce a spiral through the punctures, impose a second row of anastomotic sutures at the level of the triangular site.