RU2373872C1 - Method of small-large intestine anastomosis formation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery, and can be used in case of operative intervention, requiring connection of small and large intestine. On distal part of small intestine subjected to anastomosis 3.5-4 cm long "proboscis" with section of mesentery and end feeding vessel is formed. Wall of large intestine is cut transversally. Small-intestine "proboscis" is invaginated into its lumen with fixation of the latter to walls of large intestine by means of interrupted sutures. Invagination of small-intestine "proboscis" into large intestine lumen is carried out simultaneously with its controlled turning out and complete adaptation of mucous-submucous layers of small and large intestine due to application of single-layer interrupted suture. Each of sutures is formed in the following way. At the first stage longitudinal serous-muscular sewing of small intestine wall is carried out with width 0.5-0.6 cm on proximal border of "proboscis". At the second stage at the distance 0.5-0.6 cm from loose end of "proboscis" serous-submucous sewing of intestine wall is performed with pricking out into loose end of "proboscis". At the third stage wall of large intestine is caught into suture by marginal submucous-serous sewing with width 0.5-0.6 cm.

EFFECT: method allows to create reliable hemostasis, sufficient valve properties of anastomosis due to adequate performance of process of intestine wall turning out during valve formation, completely adapt mucous-submucous layers of both intestines.

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Description

The invention relates to medicine, namely to surgery, and can be used in surgical interventions requiring the connection of the small and large intestines.

As an analogue, a method is proposed for the formation of a terminal-end small bowel anastomosis [2]. The disadvantages of this method are the mismatch of the diameters of the stitched small and large intestines; the complete absence of valve properties of the anastomosis, its inflammation and the throwing of feces into the small intestine. These shortcomings in the early postoperative period contribute to the development of insolvency of the anastomosis, in the late - its scarring, provoke the development of reflux enteritis and dysbiosis.

As an analogue, a method is proposed for forming a longitudinal lateral colonic anastomosis [3]. The disadvantages of this method are the violation of blood supply and innervation in the anastomosis zone, its aperistalticity, lack of valve properties and, as a result, gaping with inevitable inflammation and throwing stool into the small intestine. These shortcomings in the early postoperative period contribute to the development of insolvency of the anastomosis, in the late - they provoke the development of reflux enteritis and dysbiosis.

The closest in technical essence to the proposed method is the Vitebsk method of forming a transverse end-lateral invagination small-intestinal anastomosis, including the formation of a proboscis with a mesenteric section and an end feeding vessel on the distal section of the anastomosed small intestine, a transverse dissection of the colon wall, invagination of the small intestine "proboscis" into her lumen with fixation of the latter to the walls of the colon by interrupted sutures [1].

There are common features of this method with the claimed:

- the method is used in the surgical treatment of diseases and injuries of the ileum and colon;

- the method involves the formation on the distal part of the anastomosed small intestine "proboscis" with a length of 3.5-4 cm with a section of the mesentery and the terminal feeding vessel;

- the method includes a transverse section of the wall of the colon;

- the method is aimed at invagination of the small intestine "proboscis" into the lumen of the colon;

- the method involves fixing the invaginated small intestine "proboscis" to the walls of the colon with interrupted sutures;

- the method is aimed at modeling in the anastomosis of the valve function by analogy with that in the ileocecal connection.

However, the known method is not without some drawbacks: immersion of the small intestine "proboscis" into the lumen of the colon is carried out without preliminary hemostasis at its distal end, the calculation for independent uncontrolled inversion of the "proboscis" and spontaneous adaptation of the mucous-submucous layers of the small and large intestines inevitably leads to contact of serous proboscis membranes with infected colon contents and the development of inflammatory changes in it. These shortcomings can provoke the occurrence of bleeding from the distal end of the small intestine "proboscis", a violation of the process of turning the "proboscis" and incomplete adaptation of the mucous-submucous layers of the small and large intestines, which, in turn, contributes to the disruption of regenerative processes, the development of purulent-inflammatory and cicatricial complications in the area of the anastomosis, impaired patency and valve function.

The objective of the invention is the development of a method for forming a lateral transverse invagination of the small intestine anastomosis, which ensures the reliability of hemostasis, the adequacy of the process of eversion of the small intestine proboscis immersed in the lumen of the colon and the full adaptation of the mucous-submucous layers of both intestines.

The solution of this problem allows us to reduce the frequency of complications from the anastomosis and improve its valve properties, which is achieved by invagination of the small intestine "proboscis" into the lumen of the colon simultaneously with its controlled inversion and complete adaptation of the mucous-submucous layers of the small and large intestines due to the use of single-row nodal sutures , each of which is formed as follows: the first step is the longitudinal sero-muscular stitching of the wall of the small intestine 0.5-0.6 cm wide by proxima the proboscis flax border, in the second stage, at a distance of 0.5-0.6 cm from the proboscis free edge, serous-submucosal flashing of the intestinal wall is carried out with a puncture in the proboscis free margin; in the third step, the submucosal marginal wall is taken into the suture of the colon -serous stitching with a width of 0.5-0.6 cm. The width of the stitches of 0.5-0.6 cm provides sufficient for adequate matching and healing the capture of the walls of stitched organs.

Figure 1 and 2 presents a diagram of the formation of a single-row transverse end-lateral invagination of small intestinal anastomosis.

The method is as follows. On the anastomosed distal end of the small intestine, a “proboscis” is formed with a length of 3.5-4.0 cm with a portion of the mesentery and a feeding end vessel (1). The wall of the colon (2) along the line of the future anastomosis is dissected strictly in the transverse direction to a length exceeding the width of the small intestine "proboscis" by 0.2-0.3 cm (when performing resection interventions on the colon, the distance from the muffled proximal end of the colon to the line anastomosis should be 5-6 cm). They begin to form an anastomosis with single-row interrupted sutures, each of which is applied as follows: the first step is the longitudinal sero-muscular flashing of the wall of the small intestine with a width of 0.5-0.6 cm along the proximal border of the "proboscis" (3), the second step at a distance of 0 , 5-0.6 cm from the free edge of the "proboscis" carry out serous-submucosal stitching of the intestinal wall with a puncture into the free edge of the "proboscis" (4), the third step is taken into the suture of the colon wall with marginal submucosal serous stitching with a width of 0.5- 0.6 cm (5). In order to provide control over the process of inverting the small intestine "proboscis", hemostasis and the full adaptation of the mucous-submucous layers of the small and large intestines, two sutures are placed on both sides of the proboscis mesentery (6) and one suture along its mesenteric edge (7). The next step, these seams form first the front, then the back lips of the anastomosis. As a result, a single-row transverse lateral invagination thin-colonic anastomosis is formed, which has the reliability of hemostasis, the adequacy of the process of eversion of the small intestine “proboscis” immersed in the lumen of the colon, the complete adaptation of the mucous-submucous layers of both intestines and sufficient valve properties.

The method was used in a clinic in 8 patients. No complications from the anastomosis were noted in any case.

Thus, the proposed method of invagination colonic anastomosis can be recommended in wide surgical practice.

Used Books

1. Vitebsk Y.D. Essays on the surgery of the ileocecal intestine. - M .: 1973. - S.75-77. - The prototype.

2. Fedorov V.D., Vorobev G.I., Rivkin V.L. Clinical surgical coloproctology. - M .: SSC Proctology, 1994. - S.115-121.

3. Yukhtin V.I. Colon Surgery. - M .: 1988. - S.242-244.

Claims (1)

A method of forming a small intestinal anastomosis, including the formation of a proboscis with a length of 3.5-4 cm with a mesenteric section and a terminal feeding vessel on the distal section of the anastomosed small intestine, transverse dissection of the colon wall, invagination of the small intestine proboscis with its fixation to the walls colon with interrupted sutures, characterized in that the invagination of the small intestine "proboscis" into the lumen of the colon is performed simultaneously with its controlled eversion and full adaptation of the mucosal of the mucous layers of the small and large intestine due to the use of single-row nodal sutures, each of which is formed as follows: the first step is the longitudinal sero-muscular stitching of the wall of the small intestine with a width of 0.5-0.6 cm along the proximal border of the "proboscis", the second step on a distance of 0.5-0.6 cm from the free edge of the "proboscis" carry out serous-submucosal stitching of the intestinal wall with a puncture in the free edge of the "proboscis", the third step is taken into the suture of the colon wall with marginal submucosal serous stitching 0.5-0.0 wide 6 cm

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