RU2459586C2 - Method of antireflux device formation in creation of neorectum - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to surgery and can be applied for formation of antireflux device. Ileoascendocecal segment is formed. Proximal part of ascending colon is brought down on perineum. Proximal part of ileum is anastomised with remaining part of ascending colon, and distal part of ileum - with sigmoid. Plasty of ileascendus is performed by interrupted sutures in reversed ileascendocecal complex.

EFFECT: method makes it possible to prevent reflux, ensure barrier function.

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Description

The invention relates to medicine, namely to surgery of the colon. As you know, low resections of the rectum are accompanied by the loss of its ampoule. Numerous proposals for the restoration of reservoir function are reduced mainly to the creation of neorectum from the overlying sections of the colon and are aimed at creating large-capacity devices. They use dissection of the intestinal wall, suturing it, which subsequently leads to scarring of these segments of the intestine, which is why the final goal is not achieved. [5] At the same time, with these resections, the sphincter of the rectosigmoid department (O'Bern, Pirogov, Moutier) is eliminated. The role of the latter is very important in the complex scheme of the act of defecation. It plays a leading role in the prevention of reflux of intestinal contents - its movement in the opposite direction during emptying of the rectum. [1, 3] The existing attempts to restore it carry in themselves the same purely mechanical approaches. [1] The use in recent years as a neorectum of the ileoascendocecal complex of the intestine. [5] At the same time, great hopes are laid on the preservation of the bauginium damper and the entire given complex, which could replace the lost rectosigmoid sphincter. However, as you know, low resections are performed mainly in the tumor process, which in 45-80% leads to varying degrees of colostasis, which in turn contributes to the emergence of secondary cecoileal reflux disease. [2]

A method for the formation of an antireflux device when creating a neorectum, which improves functional results after low rectal resection, is proposed.

A method for forming an antireflux device includes forming an ileascenocecal segment, reversing it, lowering the proximal ascending colon to the perineum, anastomosing the proximal ileum with the remaining ascending colon, and the distal ileum with the sigmoid colon. Next, plastic ileoscendeus is performed with interrupted sutures in the reversed ileascendocecal complex.

The method is as follows: after low resection of the rectum, the right half of the colon and cecum is mobilized while the right bend of the colon is preserved. The parietal peritoneum of the right lateral canal is dissected. Next, an appendectomy, the intersection of the ascending colon, ileum. The proximal ileum anastomoses with the remaining section of the ascending colon. The reversal of the ileoascendocecal complex, the reduction of the ascending colon, its proximal section to the perineum is performed. The distal ileum is anastomosed with the sigmoid colon. Plastic ileoascendes is performed - an element of the ileocecal obturator, the main part of the bauginium damper, where correction is necessary [2].

The figure 1 shows a diagram of the formation of an aitireflux device, where the proximal section of the ascending colon is 1, the distal ileum is 2, the cecum is 3, the bauginium flap is 4, the ileoascenduus is 5, and the stitches are 6.

The method can significantly improve the reservoir function of neorectum due to plastic ileoascendeus, the elimination of its acute angle malleable and more capacious cecum. With increasing pressure in it, the locking capabilities of the upper and lower lips of the bauginium damper, frenulum, and, as a result, the ileocecal locking apparatus increase. Together, it restores the barrier function of the ileocecal apparatus, therefore, it is a prevention of reflux - retrograde reflux of contents from an ampoule into the sigmoid colon and ensures a high-quality act of defecation.

Literature

1. Zherlov GK, Bashirov SR., Ahagvabtayar K. - Modeling of the rectal ampoule and rectosigmoid closure mechanism with anterior resections of various levels. Surgery, 2007. C - 54-58.

2. Mukhin V.I. - Insolvency of the ileocecal valve, Yoshkar-Ola, 2007. C - 74, 309, 504.

3. Shafik A. - Rectosigmoid joint. Anatomical and physiological considerations for determining the rectosigmoid pacemaker and reflex of the sigmorectal joint, their role in constipation and incontinence. IV All-Russian Conference “Actual Problems of Coloproctology: Abstracts. doc. Irkutsk, 1999. S - 423-424.

4. Yaitsky P. A., Vasiliev S. V., Chania Z. D., Kovalev V. K., Vasiliev A. S. - The quality of life of patients after surgery for colorectal cancer.

5. Maricus O, von Flue, MD, Lukas Degen MD e.n. Ileocecal Reservoir Reconstruction with Physiologic After Total Mesorectal Cancer Excision. Annal of surgery vol., 224, 1996. No. 02, 204-212.

Claims (1)

A method for forming an antireflux device includes forming an ileoascendececal segment, reversing it, lowering the proximal colon of the ascending colon to the perineum, the proximal ileum and the remaining part of the ascending colon, and the distal ileum with sigmoid, plastic and ilescenoscene resection of the nodes .

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