RU2307607C1 - Method for protecting colorectal anastomosis in elderly women - Google Patents

Abstract

FIELD: medicine, proctology.

SUBSTANCE: the suggested innovation deals with covering a colorectal anastomosis with the superior part of posterior vaginal wall, and from the sides, below and above the anastomosis about 0.5-1.0 cm one should fix broad uterine ligaments which should be additionally sutured to the edges of the dissected pelvic peritoneum. The innovation enables to provide hermetic nature of intestinal anastomosis and prevent the failure of colorectal anastomosis.

EFFECT: higher efficiency of protection.

1 dwg, 1 ex

Description

The present invention relates to medicine, namely to surgery, and can be used in proctology.

It is known that the problem of colorectal anastomosis insolvency is always relevant and far from being solved, since the numerous proposed methods of anastomosis both manually and hardware do not give absolute confidence in the reliability of the anastomosis and, according to literature data, from 1.3% to 44%, colorectal anastomosis insolvency is recorded [Fontanili M., Caforio M., Asteria C. Le complicanze perioperatorie nella chirurgia tradizionale del retto // Minerva Chir. - 1997 .-- Vol.52. - No 3. - P.217-224; Remzi FH, Fasio VW, Gorgun E, Zutshi M et al. Quality of life, functional outcome, and complication of coloplasty pouch after low anterior recection // Dis Colon Rectum. 2005 Apr; 48 (4): 735-43; Laurent A, Parc Y, McNamara D, Parc R, Tiret E. Colonic J-pouch anastomosis for rectal cancer: a prospective, randomized study comparing handsewn vs. stapled anastomosis // Dis Colon Rectum. 2005 Apr; 48 (4): 729-34].

Known protection of colorectal anastomosis, which is carried out by local influences - by immersing it under the pelvic peritoneum [Baltaitis Yu.V. Korsunovsky A.I. \ Method for restoration of intestinal tract continuity during colon resection, A.S. No. 1007655], by creating protection due to excess mesentery, fat pendants, omentum and capsule of the rectum [RCSC, Onopriev V.I., Pavlenko S.G., Yargunin S.A. A method of protecting a colorectal anastomosis. RF patent No. 2231983].

The disadvantages of this method are that with a high colorectal anastomosis, its immersion under the pelvic peritoneum is impossible, and in the case of a "fat" mesentery its use to protect the anastomosis is difficult.

For the closest analogue, we adopted the method [P. Zhelobtsova and Fomicheva A.L. author testimonial. SU No. 1158169], in which cooked rags on the legs cut from a large omentum are hemmed from three sides to the anastomosis line to protect it. For this purpose, the authors used flaps 1.5-2.0 cm wide as the most optimal and hemmed them at a distance of no more than 1.2 cm from each other.

The disadvantages of this method are that it is not always possible to mobilize a large omentum in a small pelvis, either because of its small size or its loss in previous operations. In addition, the anastomosis sometimes turns out to be insolvent due to insufficient thickness of the omentum.

Tasks: ensuring the integrity of the intestinal anastomosis, preventing the failure of the colorectal anastomosis.

The technical novelty of the invention is that after the creation of a single-row colorectal anastomosis, the latter is wrapped in the upper part of the posterior wall of the vagina, and from the sides below and above the anastomosis 0.5-1.0 cm wide ligaments of the uterus are fixed, which are also fixed to the edges of the pelvic peritoneum. The technical result of the proposal is the use of wide ligaments of the uterus, providing a much more reliable and tight anastomosis in comparison with its formation with the help of flaps cut from a large omentum, due to the high strength of the tissue structures of the uterine ligaments.

The method is performed as follows. After the colorectal anastomosis 1 is applied (see drawing), it is protected by covering the front of the upper part of the back wall of the vagina 2 (covered by the peritoneum in the drawing) and laterally by the wide ligaments of the uterus 3. The ligaments are fixed with separate sutures below the anastomosis by 0.5-1.0 cm around the circumference and above the anastomosis also 0.5-1.0 cm around the circumference. The fixation of the wide ligaments of the uterus is also performed to the edges of the mobilized pelvic peritoneum on both sides. In older women, the implementation of such manipulation becomes possible due to a decrease in the tone of organs and tissues.

Clinical example. Patient L., 65 years old, was hospitalized in the surgical department of the Krasnodar Clinical Hospital for war veterans from 04/26/05 to 05/17/05, East. disease number 3278. Diagnosis: Crohn’s disease, terminal colostomy after obstructive resection of the sigmoid colon due to bowel perforation and peritonitis, cholelithiasis, calculous cholecystitis. 05.05.05, the operation was performed: cholecystectomy, reconstruction of the colon. In the formation of a direct single-row colorectal anastomosis, anastomosis was omenized with an excess of the mesentery of the colon, omental pendants. Additionally, the region of the anastomosis is covered in front by the upper part of the posterior wall of the vagina, and on the sides by wide ligaments of the uterus, which were fixed around the circumference 0.5-1.0 cm above and below the line of the colorectal anastomosis, in addition, the edges of the wide ligaments of the uterus are stitched with the edges of the pelvic peritoneum iliac vessels. The postoperative period was uneventful, the patient was discharged on the 11th day after the operation.

In this way, 11 elderly women were operated on: 1 patient with Crohn’s disease, 6 patients with sigmoid colon cancer and 1 patient with colorectal cancer, 3 patients underwent colon reconstruction with colorectal anastomosis. For all patients, the region of the anastomosis was additionally covered in front by the upper part of the posterior wall of the vagina (covered by the peritoneum in the drawing) and from the sides by wide ligaments of the uterus. There were no complications in the postoperative period. Patients were discharged with recovery.

Medical and social effect: the use of the proposed method allows you to create the most favorable anatomical conditions for sheltering the line of colorectal anastomosis, which almost completely eliminates such a formidable complication as the failure of anastomotic sutures.

Claims (1)

A method of protecting a colorectal anastomosis in elderly women, including its fixation, characterized in that the anastomosis is covered in front by the upper part of the posterior wall of the vagina, and from the sides, below and above the anastomosis, 0.5-1.0 cm wide ligaments of the uterus are fixed, which are additionally sutured to the edges of the dissected pelvic peritoneum.

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