RU52697U1 - DEVICE FOR SURGICAL TREATMENT OF HESNOSES OF THE ESOPHAGEAL HOLES OF THE IRIS - Google Patents

Abstract

The device relates to medicine, namely to surgery. It is made of porous biomaterial of polytetrafluoroethylene, 6 × 10 in size, of rectangular shape with rounded corners, in the center of which there is a hole with a diameter of 2.5 cm, from which a radial cut passes to the edge of the rectangle. The use of the device increases the reliability of fixation of the gastroesophageal cuff, prevents the occurrence of adhesions, and also eliminates injury to the esophagus, legs and walls of the diaphragm due to the porosity of the microstructure, good flexibility and infiltration by cells and tissues.

Description

The utility model relates to medicine, in particular to surgery, gastroenterology, and can be used in the surgical treatment of hiatal hernia.

The prototype is a device for the surgical treatment of sliding hernias of the esophageal opening of the diaphragm, patent for PM No. 47646, 2005, proposed by O.V. Galimov; E.Kh. Gaptrakipov; V.O. Khanov, which is a 7 × 11 polypropylene mesh, rectangular in shape with rounded corners, in the center of which a hole with a diameter of 2.5 cm is made, communicating due to the radial cut with the outer border of the rectangle. The experience of using a polypropylene prosthesis revealed the side effects of the operation. A significant disadvantage of this device is that the polypopylene prosthesis has a cellular, rigid structure, which leads to trauma to injuries of the diaphragmatic legs, diaphragm wall and intestines, due to which the adhesion process occurs. As a result, patients experienced complications, manifested as pain in the chest.

The objective of the utility model is to develop a device to prevent postoperative complications.

The technical result is an increase in the effectiveness of surgical treatment, namely the prevention of a postoperative adhesive process in the abdominal cavity.

The proposed device is a grid 1 of polytetrafluoroethylene with dimensions of 6 × 10, rectangular in shape with rounded corners 2, in the center of which a hole 3 with a diameter of 2.5 cm is made, communicating due to a radial section 4 with the outer border of the rectangle.

The device is used as follows. Under intubation anesthesia, an upper median laparotomy is performed. The stomach is mobilized by pulling it in the caudal direction and cutting the peritoneum over the abdominal esophagus. Bypassing the esophagus, they pass a rubber tube around it and pull it in a ventrocaudal direction. The device is installed so that the esophagus is in the cut out opening of the device. The edges of the radial incision are sutured, while the right leg of the diaphragm and esophageal-diaphragmatic ligament are seized in the seam. Separate interlocking seams around the perimeter, the device was fixed to the diaphragm. Additionally, the device is attached to the diaphragm at the corners. An option for performing the operation laparoscopically.

Figure 1 shows the proposed device, a General view.

Clinical example. Patient L., 38 years old, (medical history No. 1243/05), was admitted to the hospital with complaints of pain in the epigastrium, chest, and periodic heartburn.

X-ray displacement of the cardia in the posterior mediastinum, Gastroesophageal reflux revealed. According to fibroesophagoscopy with pH-metry - cardia failure, erosive reflux - esophagitis, in the adminal section of the esophagus in a horizontal position, the pH drops to 2.3. Esophagomanometry: the gradient of the esophageal-gastric transition is reduced to 50 mm. Water.

Surgical intervention performed. Under intubation anesthesia, an upper median laparotomy was performed. The stomach is mobilized, pulled e in the caudal direction and the peritoneum over the abdominal esophagus is cut with scissors. A device was prepared from polytetrafluoroethylene of dimensions 6 × 10, rectangular in shape with rounded corners, in the center of which a hole with a diameter of 2.5 cm was made, communicating due to the radial cut with the outer border of the rectangle. The device is installed as follows that the esophagus is in the cut out opening of the device. The edges of the radial section are stitched together, while the right leg of the diaphragm and the esophageal-diaphragmatic ligament were captured into the suture. Separate interlocking seams around the perimeter (one or two), the device is fixed to the diaphragm. Additionally, the device is mounted to the diaphragm around the corners.

The postoperative course is smooth, the patient was discharged on the 8th day after the operation.

We used the proposed utility model in a clinic in 8 patients with hiatal hernia. There were no complications with the use of the device.

Thus, the results of clinical studies show that the proposed model increases the reliability of fixation of the gastroesophageal cuff, prevents the occurrence of adhesions, and also eliminates injury to the esophagus, legs and walls of the diaphragm due to the porosity of the microstructure, good flexibility and infiltration by cells and tissues.

Claims (1)

A device for the surgical treatment of hiatal hernia of the diaphragm containing a grid of rectangular biomaterial with rounded corners, in the center of which a hole with a diameter of 2.5 cm is made, from which a radial incision passes to the outer border of the rectangle, characterized in that it is made of polytetrafluoroethylene of size 6 × 10.