RU2750590C1 - Method for forming 8-shaped single-row nodal inter-intestinal suture - Google Patents

Abstract

FIELD: medicine, abdominal surgery in particular.

SUBSTANCE: invention relates to medicine, namely to abdominal surgery. An injection is performed on the first wall from the side of the serous membrane, with the passage of the needle sequentially through the serous, muscular layer and the injection in the submucosal layer. The second injection is carried out from the submucosal layer of the second intestinal wall, with the needle passing through the submucosal, picking up the mucous layer in the thickness, the muscle layer and pricking it out. The third injection is carried out on the first wall from the side of the muscle layer with the passage of the muscle, submucosal layer with the capture of the mucous layer in the thickness and the injection in the submucosal layer. The fourth injection is carried out from the submucosal layer of the second wall, with the passage of the needle through the submucosal and muscular layer, followed by the injection through the serous membrane. The ends of the thread are connected to each other, similar sutures are formed along the circumference of the anastomosis.

EFFECT: method provides a complete comparison of all layers of the intestinal wall, which helps to reduce the number of inconsistencies in the suturing of the intestinal wall and the imposition of inter-intestinal anastomoses, improve the quality of treatment and reduce the cost of treatment and rehabilitation of the patient.

1 cl, 1 dwg

Description

The invention relates to medicine, namely to surgery and can be used for suturing defects of the intestinal wall and the imposition of interintestinal anastomoses.

In emergency surgery during operations on the abdominal organs, it is not uncommon to form a manual suture to close the defect of the intestinal wall and to form interintestinal anastomoses. Currently, one- and two-row, interrupted and continuous intestinal sutures are used. In connection with the large assortment of modern antibacterial drugs and modern absorbable suture materials with an antibacterial coating in medical practice, the use of single-row intestinal sutures is increasingly observed. But the frequency of suture failure according to various authors is from 6 to 40%, and postoperative mortality in case of anastomotic failure reaches 40% [3]. Such a high percentage of inconsistencies is directly related to the technique of forming the interintestinal suture.

The prototype is the method of forming the interintestinal anastomosis RF patent No. 2663648

A method of forming an interintestinal anastomosis, including passing a thread through the serous, muscular membrane of the intestine, characterized in that the first injection of the needle is made at a distance of 1.0 cm from the edge of the serous membrane of the intestine, while the needle is passed obliquely outward and as deep as possible with the capture of the muscular membrane of the intestine , moreover, on the opposite side, the thread is carried out symmetrically, and the places of injection and puncturing of the needle on the line of the serous membrane of the intestine are placed at the same distance from the edges of the incision, then on the side of the first injection, with an indent of 7 mm, the thread is carried out only in the serous membrane of the intestine, while the threads are pulled and spread apart, and homogeneous tissues are compared, and the thread passing only through the serous membrane of the intestine is screwed in, and the thread passing through the serous and muscular membranes of the intestine covers the previous thread [1].

The disadvantage of the prototype is the lack of comparison of the submucosal layer of the intestinal wall, with this suture, only a comparison of the serous and muscle layers is observed. As you know, the strength of the anastomosis on the first day depends on the correct juxtaposition of the serous membrane, but at a later date, the strength of the anastomosis by 70% depends on the correct juxtaposition of the submucosal layer, rich in collagen fibers, fibroblasts and histiocytes [2]. In the absence of submucosal matching, an increase in the number of anastomotic leaks may be observed.

The purpose of the invention is to improve the efficiency of treatment of patients who need manual suturing of a defect in the intestinal wall or the imposition of a manual interintestinal anastomosis.

To eliminate this drawback, we have developed a method for forming an 8-shaped single-row nodal interintestinal suture.

The method is carried out as follows:

On the first wall, the injection is made from the side of the serous membrane (position 1 in Fig. 1), the needle passes sequentially through the serous, muscular and punctured in the submucosal layer (position 2 in Fig. 1). The second injection is carried out from the side of the submucosal layer of the second intestinal wall (position 3 in Fig. 1) with the pickup of the mucous layer in the thickness, the needle passes through the muscle layer and is punctured in it (position 4 in Fig. 1). The third injection is carried out on the first wall from the side of the muscle layer (position 5 in Fig. 1) with the passage of the muscular, submucous layer and the capture of the mucous layer in the thickness, the injection is carried out in the submucosal layer (position 6 in Fig. 1). The fourth injection is carried out from the side of the submucosal layer (position 7 in Fig. 1) with the passage of the needle through the submucosa and muscle layer, followed by an injection through the serous membrane (position 8 in Fig. 1). The ends of the thread are tied together (position 9 in Fig. 1). Similar sutures are formed around the circumference of the anastomosis. When forming the suture, a monofilament suture material with a long resorption period of 4/0 is used.

The advantage of this method is the tight juxtaposition of all layers of the intestinal wall, which form the strength of the suture. The suture technique allows you to match the serous, muscular, submucous and mucous layers without puncture into the intestinal lumen, keeping the suture "clean".

Comparison of the proposed method with those known in the field of medicine showed its compliance with the criteria of the invention.

The method is illustrated in Figure 1, depicting a seam formation diagram.

The seam formation diagram in FIG. one.

Thus, the proposed method provides a complete comparison of the layers of the intestinal wall, which can help to reduce inconsistencies of sutures, improve the quality of treatment and reduce the cost of treatment and rehabilitation of the patient.

INFORMATION SOURCES

1. A new way of forming an interintestinal anastomosis. Aidemirov A.N., Shakhnazaryan N.G., Vafin A.Z., Shakhnazaryan A.M., Aidemirova E.A. Bulletin of the National Medical and Surgical Center. N.I. Pirogov. 2019.Vol. 14.No. 1. S.27-29.

2. A look at the mechanical strength of the intestinal anastomosis. Aliev F.Sh., Chernov I.A., Molokova O.A., Kecherukov A.I., Gunther V.E., Baradulin A.A. Bulletin of Siberian Medicine. 2003.Vol. 2.S. 89-93.

3. Failure of sutures of the colorectal anastomosis (literature review). Akhmetzyanov F.Sh., Egorov V.I. Siberian Journal of Oncology. 2016.Vol. 15.No.2. S. 107-112.

Claims (1)

A method of forming an 8-shaped single-row interrupted intestinal suture, including closing the defect with a single-row interrupted suture with full matching of the layers of the intestinal wall, characterized in that the injection is performed on the first wall from the side of the serous membrane, with the passage of the needle sequentially through the serous, muscular layer and an injection in the submucosa layer, the second injection is carried out from the side of the submucosal layer of the second intestinal wall, with the passage of the needle through the submucosa, picking up the mucous layer in the thickness, the muscle layer and an injection in it, the third injection is carried out on the first wall from the side of the muscle layer with the passage of the muscle, submucosal layer with a pick-up the mucous layer in the thickness and punctured in the submucous layer, the fourth injection is carried out from the side of the submucosal layer of the second wall, with the passage of the needle through the submucosal and muscular layer, followed by an injection through the serous membrane, after which the ends of the thread are tied together, similar sutures are formed around the circumference of the anastomosis.

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