RU2612984C1 - Method for appendicular stump processing during appendectomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: during acute appendicitis surgery, in case of destructive inflammation at the appendix base or at the blind colon head. The appendix is cut. A ligature is passed through the stump edge on the mesenteric side and back. Appendix tump is bent in half to the base. The appendix stump base is sutured on its sides. Then the appendix stump bend is sutured. The ligature ends are pulled to the base, the stump folded in half, is bent again. The ligature ends are passed through the stump base. The ligature is tied at the appendix stump base on the side opposite to the mesenteric one.

EFFECT: reduced surgery trauma and risk of inflammatory postoperative complications development due to stump peritonization without dipping into the blind colon head.

1 ex, 4 dwg

Description

The invention relates to medicine, namely to abdominal surgery, and can be used in operations for acute appendicitis.

There is a method of treating the stump of the vermiform appendix according to Seeling-Kimbarovsky during appendectomy, which consists in the fact that after cutting off the appendix, his stump is bandaged from non-absorbable material, is not peritonized and remains free in the abdominal cavity (see Diagnosis and treatment of acute appendicitis / S.A. Fomin // Yaroslavl, 2010, 120 pp.).

However, this method is contraindicated in case of destructive inflammation at the base of the appendix, the dome of the cecum.

The reasons that impede the achievement of the following technical result when using the known method adopted for the prototype include the lack of peritonization of the stump of the appendix and its free location in the abdominal cavity.

The objective of the invention is to provide a method for treating the stump of the appendix with appendectomy, which provides a technical result consisting in the possibility of peritonization of the stump without immersion in the dome of the cecum, reducing the invasiveness of the operation, and the risk of developing purulent-inflammatory postoperative complications.

The specified technical result is achieved in that the method of processing the stump of the appendix in appendectomy involves cutting off the appendix.

The peculiarity is that the ligature is carried out by injecting a needle along the upper edge of the stump of the vermiform appendix from the mesenteric side, poking out on the opposite mesenteric side of the upper edge of the stump of the vermiform appendix, then injecting it on the opposite mesenteric side of the upper edge of the stump of the vermiform process, departing from the edge 2-3 mm, the needle is punctured along the upper edge of the stump of the vermiform appendix from the mesenteric side, pulling the ends of the ligature toward the dome of the cecum, the stump of the appendix is bent in half with the upper paradise down to the base, spend the ends of the ligature alternately on the opposite side by injecting a needle through the base of the stump of the process on the right and left, departing from the edge of each side by 2-3 mm, then the ends of the ligature alternately on the mesenteric side by injecting a needle through the middle of the stump of the process opposite the mesenteric side on the right and left, deviating from the edge of each side by 2-3 mm, then pulling at the ends of the ligature towards the dome of the cecum, the stump of the process is bent again, the ends of the ligature are alternately opposite ozhnuyu by side puncture needle through the base of the stump process right and left, departing from each side edge 2-3 mm, the ends of ligature tied at the base on the opposite limb outgrowth mesenteric side.

The invention is illustrated by drawings,

where in FIG. 1 shows the conduct of ligature 1 along the upper edge of the stump 2 of the appendix, 3 - the dome of the cecum;

in FIG. 2 - the stump 2 of the appendix is folded in half with the upper edge down to the base, the ends of the ligature 1 are drawn to the mesenteric side by pricking the needle through the middle of the stump 2 of the appendix to the opposite mesenteric side on the right and left;

in FIG. 3 - the stump 2 of the appendix is folded again in half, the ends of the ligature 1 are alternately drawn to the opposite side by injecting a needle through the base of the stump of the appendix to the right and left, deviating from the edge of each side by 2-3 mm;

in FIG. 4 (final view) - the stump of the 2 vermiform appendix, curled up, the ends of the ligature 1 are tied at the base of the stump 2 of the vermiform appendix on the opposite mesenteric side.

The method is as follows.

Access the vermiform appendix by any known method. After cutting off the vermiform appendix, ligature 1 is carried out (Fig. 1) by injecting a needle along the upper edge of the stump 2 of the vermiform appendix from the mesenteric side, a puncture on the opposite mesenteric side of the upper margin of the stump 2 of the appendix, and then injection on the opposite mesenteric side of the upper mesenteric stump 2 of the worm process, departing from the edge of 2-3 mm, a needle sticking out on the upper edge of the stump of the 2 vermiform process from the mesenteric side. Pulling the ends of the ligature 1 toward the dome of the cecum 3 (down), the stump 2 of the appendix is bent in half (Fig. 2) with the top edge down to the base. The ends of the ligature 1 are drawn alternately on the opposite side by injecting a needle through the base of the stump 2 of the appendix to the right and left, retreating from the edge of each side by 2-3 mm. Next, the ends of the ligature 1 are alternately carried out on the mesenteric side by injecting a needle through the middle of the stump 2 of the appendix, opposite the mesenteric side, to the right and left, departing from the edge of each side by 2-3 mm. Then pulling the ends of the ligature 1 towards the dome of the cecum 3 (down), the stump 2 of the appendix is bent again (Fig. 3), draw the ends of the ligature 1 alternately on the opposite side by injecting a needle through the base of the stump 2 of the appendix to the right and left, departing from the edge of each side by 2-3 mm, the ends of the ligature 1 are tied at the base of the stump 2 of the appendix in the opposite mesenteric side (Fig. 4).

Thus, sequential U-shaped stitching of the stump 2 of the appendix is carried out, as a result of which the stump 2 is folded in the form of a cochlea, peritonized, achieving the necessary tightness.

Clinical example

Patient I., 36 years old, was admitted to the 6th Department of Surgery at the Municipal Clinical Hospital of the Ulyanovsk State Medical Pedagogical University in Ulyanovsk with a diagnosis of Acute appendicitis.

Upon admission, the patient complained of pain in the right iliac region, lower abdomen, nausea. Sick for 8 hours

Inspection: general state of moderate severity; the skin is moist, pale; pulse of weak filling and tension - 100 beats per minute; blood pressure - 120/60 mm Hg

The tongue is dry, coated with a white coating. The abdomen is of the correct form, it is not swollen, symmetrical, it participates unevenly in the act of breathing, the right half lags behind in the act of breathing. On palpation, tense and sharply painful in the right iliac region. Hepatic dullness is present. There is no dullness. Intestinal motility preserved. Symptom Shchetkina-Blumberg negative.

Diagnosed with acute appendicitis.

Operation. Appendectomy, debridement and drainage of the abdominal cavity. An incision was made in the skin and subcutaneous tissue in the right iliac region according to Volkovich-Dyakonov, then the peritoneum was opened. During the audit, a tense, hyperemic, fibrin-covered vermiform appendix 9.0 × 2.0 cm in size was found, the cecum dome was edematous, hyperemic, fibrin-covered, the vermiform appendix was located in the right ileal fossa. Given the possible occurrence of technical difficulties due to severe inflammation of the cecum dome (tiflitis), namely the eruption of sutures when the stump of the appendix is immersed, an appendectomy was performed, the stump was treated by the proposed method. The ligature was drawn by injecting a needle along the upper edge of the stump of the vermiform appendix on the mesenteric side, poking on the opposite mesenteric side of the upper edge of the stump of the vermiform appendix, then injecting it on the opposite mesenteric side of the upper edge of the stump of the vermiform appendix, retreating from the edge of the stump of the needle 2 mm from the edge of 2 mm of the vermiform appendix from the mesenteric side, pulling the ends of the ligature towards the dome of the cecum (down), the stump of the appendix is folded in half with the top edge down to the base, held the ends of the leagues atura alternately on the opposite side by injecting a needle through the base of the stump of the appendix to the right and left, departing from the edge of each side by 2 mm. Further, the ends of the ligature were alternately held on the mesenteric side by sticking a needle through the middle of the stump of the appendix to the opposite mesenteric side on the right and left, departing from the edge of each side by 2 mm. Then pulling the ends of the ligature towards the dome of the cecum (down), the stump of the process is folded again, draw the ends of the ligature alternately on the opposite side by injecting a needle through the base of the stump of the process on the right and left, backing away from the edge of each side by 2 mm, the ends of the ligature are tied at the base of the stump of the process on the opposite mesenteric side, debridement and drainage of the abdominal cavity.

The postoperative period was uneventful. In satisfactory condition on the 6th day the patient was discharged from the hospital under the supervision of a surgeon in the clinic at the place of residence. Examined after six months. No complaints, the result of the operation is rated as good.

Thus, the proposed method is indicated for destructive inflammation at the base of the process of the dome of the cecum provides peritonization of the stump without immersion in the dome of the cecum, reduces the invasiveness of the operation, and the risk of developing purulent-inflammatory postoperative complications.

Claims (1)

A method of treating a stump of the vermiform appendix during appendectomy, including cutting off the appendix, characterized in that the ligature is performed by injecting a needle along the upper edge of the stump of the vermiform appendix from the mesenteric side, a puncture on the opposite mesenteric side of the upper edge of the stump of the vermiform appendix, then performing an injection in the opposite b the edges of the stump of the appendix, having departed from the edge of 2-3 mm, poke the needle along the upper edge of the stump of the appendix from the mesenteric side, pulling I bend the ends of the ligature towards the dome of the cecum, the stump of the appendix is bent in half with the top edge down to the base, draw the ends of the ligature alternately on the opposite side by injecting a needle through the base of the stump of the appendix to the right and left, departing from the edge of each side by 2-3 mm , then the ends of the ligature are alternately carried out on the mesenteric side by injecting a needle through the middle of the stump of the vermiform appendix to the opposite mesenteric side on the right and left, deviating from the edge of each side by 2-3 mm, then under they pull at the ends of the ligature towards the dome of the cecum, bend the stump of the vermiform appendix again, draw the ends of the ligature alternately on the opposite side by injecting a needle through the base of the stump of the vermiform appendix to the right and left, retreating from the edge of each side by 2-3 mm, tie the ends of the ligature at the base of the stump of the appendix of the vermiform on the opposite mesenteric side.

Images