RU2372856C1 - Method of sewing perforated opening with uninterrupted two-level suture - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery, can be applied for sewing perforated opening in treatment of perforated ulcer of pyloroduodenal part of gastrointestinal tract. Uninterrupted serous-muscular two-level suture is applied using knots-fixers. For this purpose during application of first level of suture first stitch is made at distance 0.5-1.0 cm more aborally than perforated opening in transversal direction from lesser curvature side. Further, second stitch is applied in longitudinal direction at distance 0.5 cm from perforated opening. Third stitch is made 0.5-1.0 cm higher than perforated opening in transversal direction. Further, fourth stitch is made parallel to second at distance 0.5 cm from perforated opening. Then fifth stitch is made parallel to first with outgoing of thread on the opposite edge of duodenum wall. First level of suture is fixed with knot-fixer at the beginning of thread before first stitch and knot-fixer by applied at the end of first level suture after tightening the thread till tissue contact. Application of second level of suture is performed with the same thread. For this purpose stitch on stomach is applied successively in transversal direction 1.0-2.0 cm higher than perforated opening. After that stitch on duodenum is applied in transversal direction 1.0 cm lower than perforated opening and stitch on stomach in transversal direction 1.0-2.0 cm higher than perforated opening. After that thread is tightened until full tissue contact. Ends of threads are tied to each other.

EFFECT: method allows to sew perforated opening reliably due to increase of area of contact of sewn walls serous membranes, reduces probability of stricture formation in pyloroduodenal part due to application of knots-fixers.

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Description

The invention relates to medicine, namely to surgery, and can be used for suturing a perforated hole in the treatment of perforated ulcers of the pyloroduodenal section of the gastrointestinal tract.

There is a method of suturing a perforated hole with two-row sutures: nodal catgut sutures are applied to the edges of the perforated hole longitudinally to the axis of the stomach or intestine through all layers of the wall of the stomach or duodenum and tightened until the edges of the perforated hole come into contact. The second row of nodular gray-serous sutures enhance the tightness of the wound, forming a fold transverse to the axis of the stomach (A.A.Shalimov, V.N. Polupan. Atlas of operations on the esophagus, stomach and duodenum. - M .: Medicine. S.203-204 )

The disadvantage of this method is:

- the application of the first row of sutures through all layers leads to a more prolonged inflammatory reaction,

- when nodal sutures are applied longitudinally to the axis of the stomach or intestine and severe perifocal infiltration, ligature eruption may occur.

There is also a method of sewing according to Opel-Polikarpov, which consists in stitching the end of a large omentum on a leg with catgut thread, both ends of which, through a perforated hole, stitch the wall of the stomach or duodenum at a distance of 1.5-2.0 cm from holes and 1.0-1.5 cm from each other on one side. In the future, when pulling on the threads and invagination of the omentum, “sealing” of the latter occurs. Then, a fold is formed from the omentum leg, which covers the opening on the second floor, the catgut ligature node, and is fixed with separate sutures (A.A.Shalimov, V.N. Polupan. Atlas of operations on the esophagus, stomach and duodenum. - M .: Medicine. S.203-204). The known method of Podgorbunsky M.A. (1941), which recommends suturing perforated pyloroduodenal ulcers by the suturing method. The essence of the method is as follows: a catgut thread is passed through all layers of the pyloric or duodenal wall, retreating 0.5-0.75 cm from the edge of the perforated hole along the axis of the duodenum and is tied until the edges come closer and come together. In the overwhelming majority of cases, the application of the 1st seam is sufficient and only with large perforated holes may a need for 2-3 seams arise. (Ponomarev A.M. Abstract of dissertation for the degree of candidate of medical sciences. Kemerovo. 1966)

The objective of the invention is to provide a reliable method of suturing a perforated hole.

The problem is solved in that in the method of suturing a perforated hole, including the imposition of a serous-muscular suture, the first injection is made on the duodenum, with the capture of the serous-muscular layer, from the side of lesser curvature at a distance of 0.5-1.0 cm aborally from the perforated hole, the first stitch being made in the transverse direction, after the puncture, they are injected more orally in the longitudinal direction and the stitches alternate in the directions, the fifth stitch parallel to the first and the thread comes out from the side of the large curvature of the intestinal edge, the thread ivayut to contact tissue and tie knot. It is important that the first row of seams is fixed with a knot at the beginning of the thread before the first stitch and at the end of the first row of stitches an additional fixing unit is imposed, as a result of which, when the thread is tightened, the possibility of thread cutting and narrowing of the intestinal lumen is excluded. The second level of the suture is performed in the transverse direction with the same thread, starting with the stitch on the stomach, oral to the perforated hole, at a distance of 1.0 - 2.0 cm, alternating with the screed on the 12th duodenum, aboral to the perforated hole. Both ends of the thread of the first and second row extend from the side of small curvature. The thread is pulled until the fabrics are in full contact and the ends of the thread are tied together.

The proposed method of suturing is illustrated in figures 1-4 (where the legend from 1 to 11: 1 - stomach, 2 - 12 duodenal ulcer, 3 - perforated hole, 4 - 11 - injection site when suturing).

Figure 1 shows the step of applying the first level of a continuous seam;

figure 2 shows a view of the organs after fixing (tying) at the first level;

figure 3 shows the step of applying the second level of a continuous seam;

figure 4 shows a curtained view of the sutured perforated holes continuous two-level seam.

The method is as follows: suturing the perforated hole with perforated pyloroduodenal ulcer is performed after the upper-median laparotomy and revision of the abdominal organs.

The first injection 4 is made on the duodenum in the transverse direction with the capture of the serous-muscular layer 5-7 mm wide, more aboral than the perforated hole by 0.5-1.0 cm. After the puncture and pulling of the thread, make injection 5 in the longitudinal direction at a distance of 0 , 5 cm from the perforated hole. The next injection 6 is 0.5-1.0 cm above the perforated hole in the transverse direction to the axis of the stomach. Vkol 7 is parallel to the second 5, at a distance of 0.5 cm from the perforated hole 3. Vkol 8 is produced parallel to the first, and the thread goes to the opposite edge of the wall of the duodenum 2. All injections are done to the depth of the serous-muscular layer.

The thread is pulled until the fabric is in close contact and a knot is tied, which prevents divergence.

The second level is applied with the same thread to the depth of the serous-muscular layer: the first injection 9 is made on the stomach in the transverse direction 1.0-2.0 cm above the perforated hole; the next injection 10 - on the wall of the duodenum in the transverse direction 1.0 cm below the perforated hole; vkol 11 on the stomach in the transverse direction 1.0-2.0 cm above the perforated hole. The thread is pulled until the fabric is in close contact, the ends of the thread are tied together.

Sewing the perforated hole of the proposed method, in contrast to the classical methods, has the following advantages:

- increases the area of contact of the serous membranes of stitched walls and, therefore, the mechanical strength of the suturing site;

- reduces the likelihood of stenosis of the pyloroduodenal region due to the use of fixing nodes when applying the first level;

- reduced trauma to the intestinal and gastric walls due to the use of absorbable atraumatic suture material.

Claims (1)

A method of suturing a perforated hole with a perforated pyloroduodenal ulcer, including suturing, characterized in that a continuous serous-muscular two-level suture is used using fixative nodes, for which, when applying the first level of the suture, the first stitch is performed at a distance of 0.5-1.0 cm aboral to the perforated hole in the transverse direction from the side of small curvature, then a second stitch is applied in the longitudinal direction at a distance of 0.5 cm from the perforated hole, the third stitch is 0.5-1.0 cm above the perforated hole in the transverse direction, then the fourth stitch is parallel to the second one at a distance of 0.5 cm from the perforated hole, then the fifth stitch is parallel to the first with the thread going to the opposite edge of the duodenal wall, while the first level of the suture is fixed with a fixing unit at the beginning the threads in front of the first stitch and the fixing unit, applied at the end of the first level of the seam after pulling the thread to the contact of fabrics; the second level of suture is applied with the same thread, for which a stitch is sequentially applied on the stomach in the transverse direction 1.0-2.0 cm above the perforated hole, the stitch on the duodenum in the transverse direction 1.0 cm below the perforated hole and the stitch is the stomach in the transverse direction is 1.0-2.0 cm above the perforated hole, after which the thread is pulled until the tissues are completely in contact, the ends of the threads are tied together.

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