RU2346658C1 - Oblique pararectal miniapproach in appendectomy - Google Patents

Abstract

FIELD: medicine; surgery.

SUBSTANCE: right iliac region is incised. Anterior abdominal wall is incised from linea biiliaca or 1-2 cm lower. Incision length is 2 to 5 cm depending on patient's constitution and body-weight index. Incision direction from the point between external and middle third of line, connecting navel and right anterior superior iliac spine, in parallel to femoral arch to right lateral edge of rectus. Further aponeurosis of abdominal external oblique muscle is dissected along aponeurotic fibres from border of muscle fibre ending and transition to anterior wall of rectus sheath. Rectus sheath is dissected completely. Aponeurosis of abdominal external oblique muscle is 2-4 cm longer than skin incision. Abdominal internal oblique muscle and transverse muscle of abdomine are bluntly pulled apart at junction of muscle fibres of abdominal internal oblique muscle and aponeurotic.

EFFECT: lower operational injury within incisions along fibres, visualised small pelvis in women without incision dilatation, expanded upward and lateral approach with small injury number.

Description

The invention relates to medicine, namely to surgery, and can be used in the surgical treatment of acute appendicitis.

The known method of appendectomy selected as the closest analogue (prototype) is that access is performed with a right oblique incision according to Volkovich-Dyakonov (see Surgery and topographic anatomy. / Edited by V.V. Kovanov, Moscow: Medicine, 1978 .). An incision 6-10 cm long is carried out parallel to the inguinal ligament through the Mac Burney point located between the outer and middle third lines connecting the navel to the right anterior superior iliac spine. One third of the section is located higher, two thirds - below the specified line. The cut length should be sufficient to allow wide access.

However, this method is quite traumatic.

The aim of the invention is to reduce operational injury.

This goal is achieved by the fact that with appendectomy, oblique pararectal mini-access is performed. An incision is made in the right iliac region. The incision is made in the direction from the point of Mac Burney, located between the outer and middle third lines connecting the navel to the right anterior superior iliac spine, parallel to the inguinal ligament to the right lateral edge of the rectus abdominis muscle. The incision of the anterior abdominal wall begins from linea biiliaca or 1-2 cm lower, while the length of the incision is from 2 to 5 cm, depending on the physique and body mass index of the patient.

With this access, a skin incision is only 2 to 5 cm long. Fascial formations are cut, nerves and blood vessels are preserved, which makes the operation less traumatic.

Oblique pararectal mini-access during appendectomy is as follows.

The patient lies on his back horizontally, if the patient’s body mass index is greater than 30 (Obesity), then his body is turned to the left at an angle of 30 °. The surgeon is located on the right, the assistant to the left of the patient.

Make a cut. The direction of the cut is from the Mac Burney point, located between the outer and middle third lines connecting the navel to the right anterior superior iliac spine, parallel to the inguinal ligament to the right lateral edge of the rectus abdominis muscle.

A section of the anterior abdominal wall begins from linea biiliaca or 1-2 cm lower, 2 to 5 cm long, depending on the physique and body mass index of the patient.

Dissect the skin and subcutaneous tissue. The aponeurosis of the external oblique muscle of the abdomen is dissected along the aponeurotic fibers, from the border of the end of the muscle fibers with the transition to the anterior wall of the vagina of the rectus abdominis muscle. The vagina of the rectus abdominis muscle is not completely opened. A section of the aponeurosis of the external oblique muscle of the abdomen is 2-4 cm longer than the skin incision.

The internal oblique muscle of the abdomen and the transverse abdominal muscle are stupidly pushed apart at the border of the muscle fibers of the internal oblique muscle of the abdomen into aponeurotic, in the immediate vicinity of the lateral edge of the vagina of the rectus abdominis muscle (spigel line). The muscles are stretched with hooks along the length of the skin wound.

If it is necessary to expand access upward, the muscle fibers of the external oblique muscle of the abdomen are spread apart bluntly, without dissection. The internal oblique muscle is dissected along the spigel line.

The peritoneum is captured with two clamps, raised in the form of a cone and cut with scissors for a short distance. The wound is plugged with gauze napkins, to which the edges of the peritoneum are fixed with Mikulich's clamps.

With this access, a skin incision is only 2 to 5 cm long. Fascial formations are cut, nerves and blood vessels are preserved, which makes the operation less traumatic.

The proposed access combines a number of advantages:

1. Smaller size of the wound surface.

2. A section in the projection of the dome of the cecum.

3. All incisions are made along the tissue fibers.

4. A visual audit of the pelvic organs in women is possible and, if necessary, surgery on the right appendages without widening the incision.

5. It is possible with less trauma to expand the incision upward and laterally by additionally dissecting the aponeurosis of the external oblique muscle of the abdomen and dissecting the fibers of the internal oblique muscle of the abdomen along the spigel line with an atypical location of the appendix and technical difficulties during surgery.

6. The lower epigastric vessels are not damaged (a. Et v. Epigastrica inferior).

7. He is damaged by the branches of the iliac-hypogastric nerve (item Ileohypogastricus).

8. The least damaged branches of the intercostal nerves nn. Cutanei abdominis lateralis and Cutanei abdominis anteriores.

Patients after such operations are activated faster, their rehabilitation time is reduced.

Claims (1)

Oblique pararectal mini-approach during appendectomy, including an incision in the right iliac region, characterized in that the incision of the anterior abdominal wall begins from linea biiliaca or 1-2 cm lower, while the length of the incision is from 2 to 5 cm, depending on the physique and mass index the patient’s body, the direction of the cut from the point located between the outer and middle third lines connecting the navel to the right anterior superior iliac spine, parallel to the inguinal ligament to the right lateral edge of the rectus abdominis muscle; then the aponeurosis of the external oblique muscle of the abdomen along the aponeurotic fibers is dissected, from the border of the end of the muscle fibers to the anterior wall of the rectus sheath, the rectus sheath is not completely opened, while the aponeurosis of the external oblique abdominal muscle is 2 times longer than the skin incision -4 cm; the internal oblique muscle of the abdomen and the transverse muscle of the abdomen are stupidly pushed apart at the border between the muscle fibers of the internal oblique muscle of the abdomen and aponeurotic.