RU2351288C1 - Method of application of intestinal seam - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely surgery, can be used in planned and emergency surgery at sealing of wounds and applying of anastomoses on organs of gastroenteric tract. Intestinal wall is pierced. Thread on serous cover is fastened. Inside puncture is performed using needle with thread, having recessed from edge of serous cover for thread carrying out, through all layers of intestinal wall. The outside puncture is made on mucosa. Further the inside puncture is carried out in edge of mucosa from intestine lumen. Then thread from opposite side is pulled through the same layers in the opposite direction. The outside puncture is performed on serous cover. The thread extremities are fastened.

EFFECT: method allows framing optimum conditions for wound repair with conservation of trophicity of tissues in the field of formed seam at the expense of adaptation of all layers of intestinal wall, reduces cicatrisation of anastomoses at the expense of reduction of inflammation in the field of seam.

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Description

The invention relates to medicine, namely to surgery, to methods of surgical treatment, and can be used for suturing wounds and applying anastomoses to the organs of the gastrointestinal tract.

An intestinal suture is used when applying the first row of sutures of the anterior “lip” of the anastomosis (intestinal or gastroenteroanastomosis) or suturing the wounds of the anterior wall of any hollow organ of the abdominal cavity. The edge of the wound of the hollow organ looks uneven so that an excess of the muscle membrane protrudes above the serous membrane, and beyond it an excess of the mucous membrane. When suturing the anterior “lip” of the anastomosis or wounds of the anterior wall of the hollow organ with interrupted sutures, difficulties arise associated with the interposition of the mucous membrane between the stitched walls and the complete adaptation of the shells of the stitched organs to each other. The consequence of poor adaptation of the membranes of stitched organs, as a rule, is the delayed healing of the sutured wound, its prolonged inflammation and subsequent scarring. Interposition of the mucous membrane between the seams also leads to a decrease in the tightness of the sutures.

Known methods of applying intestinal sutures aimed at improving the adaptation of all layers of the intestinal wall. So, there is a method of applying an adaptive intestinal suture by suturing the walls of a hollow organ from the inside to the inside, including a cross of threads at the border of the muscle and submucosal layers, with tying the ends of the thread from the mucous membrane (patent RU No. 2132651, IPC АВВ 17/00). However, when applying such an intestinal suture, technical difficulties arise, especially when suturing the anastomosis anterior wall due to the fact that knotting is done from the mucous membrane. A known method of applying a single-row nodular serous-muscular-submucosal intestinal suture without capturing the organ mucosa according to RU patent No. 2202293, however, in this case, a “gaping” of the edges of the mucous membranes is formed, which, as a rule, is susceptible to infection. A known method of applying an intestinal suture according to patent RU No. 2007127 (prototype), including piercing the intestinal wall, passing the thread subserosally through the muscle and submucosal layers of the intestinal wall from the end side from one side, and then from the opposite side through the same layers in the opposite direction, and tying the thread on the serous membrane. In accordance with the description of the invention, this method allows you to accurately adapt the homogeneous intestinal layers of the wall. However, the seam "eight" uses a large amount of ligature in the wound, in addition, in the known method, the mucous layer is also not captured.

The objective of the invention is to create optimal conditions for wound healing while maintaining trophic tissue in the area of the formed suture.

The technical result is a complete and strict adaptation of all layers of the intestinal wall.

The problem is solved by the method of applying an intestinal suture, including piercing the intestinal wall and tying the thread on the serous membrane, in which a through needle is inserted with the thread, departing from the edge of the serous membrane to guide the thread through all layers of the intestinal wall with a puncture on the mucous membrane and subsequent injection to the edge of the mucous membrane from the side of the intestinal lumen, and then the thread is passed from the opposite side through the same layers in the opposite direction with a puncture on the serous membrane, after which the ends of the thread are tied.

Figure 1 shows the moment of flashing and the course of the needle; figure 2 shows the position of the layers after tying the ligature.

When implementing the proposed method, a through needle injection is made with the thread departing from the edge of the serous membrane. Further, from the side of the lumen of the hollow organ, the mucous membrane is pierced closer to its free edge. Then, on the opposite wall, flashing is performed in the reverse order. The needle is injected at the edge of the mucosa, and it is punctured into the lumen. After that, at a distance of 3-4 mm, the entire thickness of the organ wall is pierced distally. When the ligature is tightened, the stitched layers of the wall are fully adapted, and the mucosa is not interposed between the walls of the stomach or intestine. If there is an excess of the mucous membrane and it protrudes beyond the edge of the wound, then its excision is performed. Hemostasis during bleeding from the vessels of the submucosal layer is usually carried out by electrocoagulation.

Example 1

Patient K., 60 years old. I was admitted to the surgical department with a diagnosis of Right-sided strangulated femoral hernia. An emergency operation was performed - hernia of the femoral hernia on the right, laparotomy, resection of the necrotic loop of the small intestine. The operation revealed a necrotic section of the loop of the small intestine at a distance of 140 cm from the ileocecal angle. A resection of the altered loop of the small intestine within viable tissues was performed. An inter-intestinal anastomosis was applied with the application of the first row of the adapted intestinal suture as described above. The postoperative period is smooth. Discharged 12 days after surgery. Examined after a month - no complaints.

Example 2

Patient Sh., 25 years old, and / b No. 9919, was admitted as scheduled for surgical treatment with a diagnosis of Duodenal ulcer, complicated by penetration into the pancreas and decompensated stenosis. After preoperative preparation, an operation was performed - resection of 2/3 of the stomach in Vitebsk. The duodenal stump was treated according to Nissen in a modification of the clinic. After mobilization of the stomach, a 2/3 resection was performed. The upper half of the stomach stump is sutured with a two-row suture, and the lower half is anastomosed with a short loop of jejunum. When gastroenteroanastomosis was applied, the excess gastric mucosa was removed, the first row of sutures was applied using an adapted intestinal suture as described above. When applying the second row of sutures, a nodular serous-muscular suture was used. The postoperative period is smooth. There were no anastomositis phenomena. Discharged 14 days after surgery. Examined after 3 months - the appetite is preserved, no complaints.

The inventive method of applying an intestinal suture adapts well the walls of stitched organs, as a result of which the healing process of the walls of the anastomoses improves. The phenomena of inflammation are less pronounced and, as a result, scarring of the anastomoses is reduced. The inventive method of applying an intestinal suture can be used in operations on the organs of the gastrointestinal tract in both planned and emergency surgery, has good clinical results.

Claims (1)

A method of applying an intestinal suture, including piercing the intestinal wall and tying the thread on the serous membrane, characterized in that they make a through needle of the needle with the thread, departing from the edge of the serous membrane to guide the thread through all layers of the intestinal wall with a puncture on the mucous membrane and subsequent injection into the edge of the mucous membrane from the side of the intestinal lumen, and then the thread is passed from the opposite side through the same layers in the opposite direction with a puncture on the serous membrane, after which the ends of the thread are tied.

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