RU2802424C1 - Method of forming temporary enterostomy with interinestinal anastomosis for patient nutrition - Google Patents

Abstract

FIELD: medicine; gastroenterology; oncology.

SUBSTANCE: invention can be used to form a temporary enterostomy for feeding patients when enteral nutrition is impossible. The leading and abducting sections of the loop are sewn with separate gray-serous sutures over a distance of 20 cm. A “double-barrel” part and enteroenteroanastomosis of “side to side” type at mesenterial part of the “double-barrel” part are formed. A hole is made in the wall of the outlet loop of the small intestine proximal to the anastomosis and a PVC tube is inserted into it, which is passed behind the anastomosis in the distal direction at a distance of 15 cm. By bracing the intestinal wall with purse suture around the tube, with the help of gray-serous sutures a canal over the tube is formed, one of the walls of the canal is the afferent loop of the small intestine. The tube is passed through an additional puncture in the anterior abdominal wall in the area of the left hypochondrium outward and fixed to the skin, and the formed ileostomy is fixed to the peritoneum with 4 separate sutures.

EFFECT: method allows to avoid narrowing of the lumen of the small intestine, optimize the nutrition of patients and avoid repeated surgical intervention.

1 cl, 1 dwg

Description

The invention relates to the field of medicine, namely oncology, and can be used to form a temporary enterostomy for feeding patients when it is impossible to provide enteral nutrition, including through a tube or gastrostomy.

The frequency of failure of esophageal-intestinal anastomoses, depending on the choice of method for forming an anastomosis, ranges from 4.5 to 9.63% [1]. This complication of the postoperative period continues to serve, apparently, as the main reason for the persisting rather high mortality after gastrectomy, the frequency of which ranges from 6 to 25.4% according to various sources [3, 4]. There are 2 fundamental methods for correcting anastomotic leaks in this area: the first is conservative, when a feeding tube is installed in the patient much distal to the anastomotic area for nutrition, and antiseptic solutions, antibiotics, and oils are prescribed per os. The second is active surgical tactics, one of the options of which is resection and re-formation of the anastomosis with removal of the enterostomy for feeding the patient [2].

Currently, the Witzel-Eiselsberg technique is widely known. Its essence is as follows: after laparotomy, a loop of the small intestine is removed into the wound, an incision up to 0.5 cm in diameter is made in the wall of which, and a rubber or plastic tube of the same diameter is inserted into it in the distal direction to administer nutrients; the wall is tightened with a purse-string suture. intestines around the tube, after which separate gray-serous sutures above the tube form a channel from the intestinal wall, as with gastrostomy according to the Witzel method. Littre suggested fixing the intestine to the parietal peritoneum with several sutures, and the wound of the anterior abdominal wall is sutured to the removed tube. Meidl proposed his own modification of this technique by forming an additional interintestinal anastomosis. After the removed tube is removed, the enterostomy closes on its own within a few days. The disadvantage of these methods of forming an enterostomy is a significant narrowing of the lumen of the small intestine due to the creation of a channel for a rubber tube with gray-serous sutures.

Technical result: creation of an effective, safe enterostomy, which allows optimizing the nutrition of patients and avoiding repeated surgical intervention.

The proposed modification is the following algorithm: after laparotomy and revision of the abdominal organs, a loop of the small intestine is selected to form an enterostomy with an interintestinal anastomosis. A section 40 cm long is required. Then, the adducting and efferent sections of the loop are sutured with separate gray-serous sutures over a length of 20 cm. Thus, a “double-barreled shotgun” is formed, which is fixed to the anterior abdominal wall from the inside using separate sutures, but first, an interintestinal anastomosis is formed, of the “side to side” type ”, manually or using hardware closer to the mesenteric part of the “double-barreled shotgun”. The next step is to make a hole in the wall of the outflow loop of the small intestine 10 cm proximal to the anastomosis and insert a polyvinyl chloride tube with a diameter of 1 cm into it, intended for the introduction of nutritional mixtures, pass it beyond the anastomosis in the distal direction by 15 cm. The diagram is presented in Fig. 1. Having tightened the intestinal wall around the tube with a purse-string suture, a channel is created above the tube using gray-serous sutures using the afferent loop as one of the walls along the entire length of the tube. Next, the tube is passed through an additional puncture in the anterior abdominal wall to the outside and fixed to the skin, and the formed ileostomy is fixed to the peritoneum with 4 separate sutures.

Description of drawings:

Fig. 1

1 - afferent loop of the small intestine;

2 - efferent loop of the small intestine;

3 - interintestinal anastomosis;

4 - hole in the efferent loop of the small intestine;

5 - polyvinyl chloride tube.

This operation was performed in 8 patients in whom it was impossible to provide enteral nutrition (including tube feeding or through a gastrostomy tube). In all patients, the postoperative period was without complications. The enterostomy functioned from 2 to 3 days, providing the optimal method and amount of nutrition. No reflux of intestinal contents was observed. After removing the tube from the enterostomy, the latter closed on its own within 2–4 days. No repeated surgical interventions were required.

This technique allows you to avoid the above-mentioned disadvantages of the Meidl enterostomy method by forming a channel for the insertion tube using the afferent loop of the small intestine as one of the walls of the channel using gray-serous sutures, which leads to its larger diameter and a much less pronounced narrowing of the lumen of the small intestine.

Information sources

1. Davydov M.I. Modern strategy for surgical treatment of gastric cancer / M.I. Davydov, M.D. Ter-Avanesov // Modern oncology. 2000. T. 2, No. 1. P. 4-10.

2. Davydov M.I., Stilidi I.S. Esophageal carcinoma. M.: Practical Medicine, 2007, 392 pp., p. 277.

3. Seagal M.Z. Gastrectomy and gastric resection for cancer / M.Z. Segal, F.Sh. Akhmetzyanov. Kazan: Kazan Publishing House. Univ., 1987. 217 p.

4. Tsatsanidi K.N. Esophageal-intestinal and esophageal-gastric anastomoses / K.N. Tsatsanidi, A.V. Bogdanov M.: Medicine, 1969. 170 p.

Claims (1)

A method for forming a temporary enterostomy with an interintestinal anastomosis, including performing a laparotomy and revision of the abdominal organs, after which a loop of the small intestine is selected, an interintestinal anastomosis is formed, the enterostomy is fixed to the peritoneum, characterized in that the adducting and efferent sections of the loop are sutured with separate gray-serous sutures along the 20 cm, form a “double-barrel” and an interintestinal anastomosis of the “side-to-side” type manually or using hardware at the mesenteric part of the “double-barrel”, then a hole is made in the wall of the outflow loop of the small intestine 10 cm proximal to the anastomosis and a polyvinyl chloride tube with a diameter of 1 is inserted into it cm, which is carried out beyond the anastomosis in the distal direction at a distance of 15 cm; Having pulled the intestinal wall around the tube with a purse-string suture, using gray-serous sutures a channel is created above the tube, with one of the walls of the channel being the adductor loop of the small intestine, then the tube is passed through an additional puncture in the anterior abdominal wall in the area of the left hypochondrium outward and fixed to the skin , and the formed ileostomy is fixed to the peritoneum with 4 separate sutures.