RU74061U1 - DEVICE FOR FORMING A COMPRESSION INTERESTINEAL ANASTOMOSIS IN PURULENT PERITONITIS - Google Patents

Abstract

For the formation of an intestinal anastomosis in conditions of purulent peritonitis with the possibility of regulating the degree of compression of the intestinal walls in the postoperative period, the device contains two polymer tubes connected by the principle of “tube in tube” with the possibility of longitudinal movement relative to each other, while at one end of each tube in the transverse in the direction there is a compression element containing a plate ring monolithically connected to the surface of the tube, the edge of which is ring-shaped on one side o reinforced round in cross section, malleable when squeezing the rim, and the rims of the inner and outer tubes are located towards each other with the possibility of contact of their surfaces during the longitudinal movement of the tubes.

Description

The utility model relates to surgery and is intended for applying a compression inter-intestinal anastomosis in conditions of purulent peritonitis.

Known surgical stapler ASK, designed to form compression interintestinal anastomoses, in which one of the two halves of the compressing element (such as Murphy's button) is made soft (1).

The closest analogue is a method of forming an ileorecto-anastomosis using a silicone tube. This technique provides good anastomosis fusion with ulcerative colitis, i.e. with an inflamed state of the rectal mucosa, but without the presence of purulent peritonitis (2, 3).

The disadvantages of the known solutions include the inability to use them in conditions of purulent peritonitis, because purulent-inflamed intestinal walls in the zone intended for growth (to the periphery from the zone of ischemic necrosis) do not have time to firmly grow together with each other until the pressure structure is rejected. The disadvantages of the known solutions include the inability to control the degree of compression of the intestinal walls in the postoperative period.

The objective of this technical solution is to create a device that provides the formation of an intestinal anastomosis in conditions of purulent peritonitis with the ability to control the degree of compression (squeezing) of the intestinal walls in the postoperative

period.

The proposed device consists of two polymer (for example, silicone rubber) tubes connected by the principle of “tube in tube” with the possibility of longitudinal movement relative to each other, while at one end of each tube in the transverse direction there is a compression element containing the surface of the tube is a dense lamellar ring (for example, of reinforced silicone rubber), on the edge of which, on one side, round in cross section is annularly strengthened, malleable when squeezed SRI bezel (e.g., porous silicone rubber), wherein the assembly device rims inner and outer tubes are arranged in opposite directions, with their contact surfaces in the longitudinal displacement of the tubes. The opposite ends of the tubes have annular colored marks and a locking device for fixing the longitudinal movement of the tubes in the desired position relative to each other.

The technical result of using the utility model is the formation of an intestinal anastomosis in the conditions of purulent peritonitis with the possibility of regulating the degree of compression (squeezing) of the intestinal walls in the postoperative period, and this degree of compression of the intestinal walls is ensured that there is no disturbance of blood supply in the intestinal tissues, while complete decompression is ensured lumen of the adducting gut in the area of the formed anastomosis.

The device assembly is illustrated by drawings, which depict:

In Fig.1 - the location of the polymer tubes to the contact surfaces of the rims.

In Fig.2 - the same, when these surfaces come into contact (without intestinal walls) at the level of the extreme lower annular mark.

The drawings show the following elements:

1 - inner tube

2 - outer tube

3 - compressive elements,

4 - plate rings,

5 - rims

6 - ring marks on the surface of the inner tube,

7 - locking device

8 - internal cavity.

The sequence of use and advantages of using the proposed device.

The device is used to impose an endo-lateral entero-entero-anastomosis in the conditions of purulent peritonitis.

The formation of a compression anastomosis is as follows. Initially, the inner 1 and outer 2 tubes of the device are used separately. The end face of the bringing end of the crossed small intestine is sheathed with a continuous circular ("purse string") suture. A squeezing element of the device’s inner tube 1 is introduced into the intestinal lumen. The circular ("purse string") seam is tightly tightened and tied. The opposite end of this tube is sideways. Through the end face of the second (discharge) end of the intestine, the outer tube 2 of the device is introduced forward by a squeezing element 3 forward. After that, the squeezing element 3 of the outer tube 2 is pressed against the intestinal wall and, through a small incision in the intestinal wall, the free end of the inner tube 1 is drawn into the lumen of this element and it is pulled to a moderately tight contact of the intestinal walls between the rims 5 of the squeezing elements 3 of both tubes 1, 2.

This position of the compression elements 3 is fixed by a locking device 7 with a dense plate ring 4 at the extreme

lower annular mark 6 (figure 2). At the same time, the tissue of the intestinal wall, assembled by a “purse-string” suture, fits in the inner cavity 8 between the rims 5 of the compressing elements 3. At this stage, compliance with compression and the circular cross-section of the rims 5 of the compressing elements provide only a low degree of compression of the intestinal walls located between the compressing elements but without disturbance of blood supply in intestinal tissues. The end face of the abdominal intestinal loop is brought out through contraperture in the form of an end enterostomy (preferably according to the “seamless” technique of N. N. Kanshin) ([3], p. 36).

A thin elastic probe is passed through the formed enterostomy into the outlet section of the small intestine to allow utilization in the postoperative period of the small intestinal chyme released by the compression stapling device into the collection vessel. Treatment of peritonitis is carried out by conventional methods.

After the lapse of time necessary for reliable fusion of the intestinal walls in contact with each other, the inner tube 1 is pulled from the outer tube 2 to the level of the upper annular mark 6 and fixed in this position using the locking device 7. Due to this, the degree of compression (compression) increases intestinal walls with squeezing elements 3 of the device and the blood supply to the intestinal walls inward from the zone of contact of the rims stops. Moreover, as noted above, due to the round cross-section of the squeezing rims 5, as in any other squeezing devices designed to form compression anastomoses, bleeding of the intestinal walls beyond the limits of compression (compression) does not occur. In addition, the proposed device provides complete decompression of the lumen of the adducting gut in the area of the formed anastomosis.

After rejection of necrotic tissue, the compression device can be easily removed. Intestinal anastomosis is formed. End enterostomy can be removed surgically.

The proposed device can also be used in planned and emergency surgery for applying colorectoanastomosis with the removal of the tubes forming the anastomosis out through the anus.

Literature

1. The journal "Health and medical technology", 2004, No. 6, p. 37

2. AC No. 1161091 dated 05/11/1983

3. N.N. Kanshin. Unformed intestinal fistulas and purulent peritonitis (surgical treatment), Moscow, Biogenformservice, 1999, p. 64, 65.

Claims (2)

1. A device for forming a compression inter-intestinal anastomosis with purulent peritonitis, containing two polymer tubes connected by the principle of “tube in tube” with the possibility of longitudinal movement relative to each other and made of silicone rubber, while at one end of each tube in the transverse direction is a compression element comprising a plate-shaped ring of reinforced silicone rubber monolithically connected to the surface of the tube, the edge of which is ring-shaped on one side n is round in cross section, malleable when squeezed, the rim is made of porous silicone rubber, and the rims of the inner and outer tubes are located towards each other with the possibility of contact of their surfaces during longitudinal movement of the tubes. 2. The device according to claim 1, characterized in that it is equipped with a locking device for fixing the longitudinal movement of the tubes in the desired position relative to each other, while the opposite ends of the tubes are made with annular color marks.