RU92780U1 - DEVICE FOR DRAINING WOMEN OF ABDOMINAL CAVITY AND ABDOMINAL WALL - Google Patents

Abstract

 A device for draining the wounds of the abdominal cavity and abdominal wall, containing drainage tubes, characterized in that the device of bioinert material has the shape of a truncated hollow cone with base diameters of 5-6 cm and 7-8 cm, two perforated drainage tubes adjacent to the outer surface of the cone and outputting directed ends in opposite directions, with the ends of the tubes located above the larger base of the cone by 8-15 cm, and the edge of the lower base is stale.

Description

The proposed utility model relates to medicine, namely to surgery, in particular, to the treatment of inconsistency of sutures of a colorectal anastomosis, in addition, it can be applied to other localizations of anastomoses in cases of inconsistency of sutures and the inability to bring the anastomosis out.

According to Russian and foreign authors, the formation of colorectal anastomosis still often leads to inconsistency of the sutures, which leads to high postoperative mortality (45-92.8%). For the treatment of such complications, the best way is to remove the anastomosis on the abdominal wall. This operation with low colorectal anastomoses is not feasible. In these cases, many authors apply a laparostomy of various modifications. Used laparostomy is not without significant drawbacks, as it does not eliminate the possibility of eventuation, the danger of suppuration of the wounds of the abdominal wall, does not provide an effective outflow of contents from the abdominal cavity, and does not prevent the formation of intestinal abscesses and deformation of the colorectal anastomosis. All this emphasizes the relevance of modernization of laparostomy.

A device for laparostomies is known [Neindhardt JH, 1979] -containing a semi-rigid ring with a transparent plastic cone, which is suspended above the patient’s bed, through which a catheter for permanent or fractional lavage of the abdominal cavity is passed / from the monograph Gostishev V.K., Sazhin V.P. , Avdovenko A.L. Peritonitis. - M.: Medicine, 1992, p. 69., Ill. - ISBN 5-22502037-2 /

With open evisceration, a “wound-protector” is introduced into the wound - a semi-rigid ring with a transparent plastic cone that is suspended above the patient’s bed. A catheter was inserted through the apex of the cone for permanent fractional lavage of the abdominal cavity. The solution flows through tubular or banded drains located at various points in the abdominal cavity and brought out.

This device has the following disadvantages:

1) Removal of infected contents from the abdominal cavity is carried out not through a cone, but through drains through other anatomical areas.

2) Lavage of the abdominal cavity, as well as the location of the drainage can contribute to the spread of infection in the abdominal cavity and leads to a deficiency of the patient's protein and electrolytes.

3) Such a device requires constant monitoring with the presence of an individual post and the need for continuous measurement of the volume of fluid introduced and removed from the abdominal cavity.

4) This device does not facilitate the diagnosis and elimination of paracolostomy phlegmon.

For the closest analogue, a device for abdominal fenestration is taken. A body is made of transparent bioinert material in an oval section, having a flange at the base with holes located around its perimeter and designed to fix the device to the anterior abdominal wall (aponeurosis) and two articulated bushings for endoscopy and a drainage tube system / R.A. Nikhinson , E.P. Danilina, V.R. Kembel, D.E. Zdzitovetsky. "Treatment of common peritonitis with abdominal fenestration." Journal "Surgery named after N.I. Pirogov ", Moscow, 1994, No. 4., p.31-33 /

The device is sewn into the anterior abdominal wall with interrupted sutures after preliminary insertion into the abdominal cavity of perforated irrigators laid along the lateral channels and draining subphrenic spaces and a small pelvis. On the end sides there are two tubes that allow to fix irrigators with numerous holes for supplying drugs and aspirating the contents of the abdominal cavity inside the body. On the flat surface of the apparatus above are two movable ball bushings designed for insertion into the abdominal cavity of a laparoscope and manipulator.

This device has the following disadvantages:

1. The impossibility of direct visual control

2. It is located in the surface layers of the laparotomy wound, which does not allow to isolate the abdominal cavity from the pathological focus

3. It does not allow to constantly drain the wound of the abdominal wall to prevent its suppuration.

The objectives of this proposal are:

1) To increase the efficiency of drainage of the abdominal cavity in case of failure of the sutures of the colorectal anastomosis.

2) Provide constant visual and instrumental monitoring of the anastomosis and adjacent areas of the abdominal cavity, as well as aspiration of intestinal contents and pus from the abdominal cavity.

3) Partially isolate the abdominal cavity from the pathological focus

4) Protect the laparotomic wound from the infected contents of the abdominal cavity and prevent its suppuration.

5) Provide the ability to protect the walls of the wound of the intestine in the phase of regeneration through the lumen of the cone

6) Provide the possibility of emptying the abscesses through the laparostomy in cases of their formation in adjacent areas of the abdominal cavity.

The tasks are achieved in that the device made of bioinert polyethylene material has the shape of a truncated hollow cone and the system for autonomous flow drainage is strengthened in the wound in the left iliac region and placed over the anastomosis suture failure zone. The height of the cone is selected individually depending on the thickness of the abdominal wall and the size of the abdomen and can range from 8-15 cm. At the lower base of the cone, a longitudinally dissected tube is strengthened along the edge of the entire circumference, for example, from an intravenous infusion system. Staggering of the edges of the lower base of the cone prevents injury to organs and tissues of the abdominal cavity. The diameter of the upper opening of the cone is 7-8 cm, and the opening of the lower base is 5-6 cm. The base of the cone is strengthened to the parietal peritoneum of the left iliac fossa with separate interrupted sutures, and the upper edge of the cone to the skin. A single-lumen drainage tube 0.5 cm in diameter with perforated holes along the entire length is circularly fixed on the outer surface of the cone at the level of the peritoneal tissue. The ends of this tube are led to the anterior abdominal wall through separate incisions to the outside. Similarly, the second tube is strengthened at the level of subcutaneous fat. Both tube systems are used to flush antiseptics and aspirate contents from the space between the cone and the wound wall. Through the lumen of the cone into the abdominal cavity spend double-lumen drainage and set over the hole in the area of insolvency of the joints. The lumen of the cone was loosely filled with a gauze large napkin with an antiseptic to prevent intestinal eventuation.

Technical result: the device improves drainage of the abdominal cavity, reduces the risk of suppuration of the wounds of the abdominal wall, removes not only liquid contents, but also formed fragments of the colonic contents under visual control, sutures the wound of the intestinal wall after it has been cleaned, and empties paracolostomy abscesses through the cone in cases of their formation . The device was tested on 42 patients in the purulent ward of the KASNODAR REGIONAL CLINICAL HOSPITAL No. 1 (KKB) named after Professor Ochapovsky SV and showed good results. All patients succeeded in eliminating local or diffuse peritonitis in a short time (10-14 days), avoiding the development of diffuse peritonitis and preventing suppuration of the surgical wound, and in 40 patients it was possible to suture the wound in the intestine in the area of suture failure through a laparostomy cone, without relaparotomy. In addition, the opportunity was created to visually observe the course of the inflammatory process in the abdomen, the effectiveness of the functioning of the drainage and the regeneration of the wound of the intestinal wall. The hospital stay of patients was reduced by an average of 2 weeks. A fatal outcome was observed in only one patient who was late diagnosed with anastomotic suture failure and developed diffuse peritonitis.

For a better understanding, the device is schematically shown in Fig. 1., Where 1 is a bioinert polyethylene truncated cone, 2 is a circular drainage tube, 3 is a double-lumen drainage, 4 is an anastomosis in the intestine, 5 is a stale base.

The device is used as follows. An unloading colostomy is applied, then an oblique incision is made 8 cm long of the anterior abdominal wall in the left iliac region in the projection of the anastomosis. The abdominal wall is opened in layers. A bioinert polyethylene truncated cone (1) is installed in the wound and abdominal cavity. The cone wall thickness (1) is 1.5 mm. The height of the cone (1) is calculated depending on the thickness of the abdominal wall and the size of the abdomen, and it can vary from 8 to 15 cm. Its upper edge is hemmed around the entire circumference of the skin with 4-6 interrupted sutures. The lower zauovanny base (5) of the cone (1) is set strictly in the region of the anastomosis and is fixed with 1-2 sutures to the parietal peritoneum of the left iliac region. Before introducing the cone (1) into the wound, on the outer surface of the cone (1), single-lumen drainage tubes (2) with a diameter of 0.5 cm are fixed around the circular-peritoneal tissue level around. The wall thickness of the tubes is - 1 mm and has perforated holes along the entire length. Through separate skin incisions, the ends of the circular drainage tubes are brought out (2). A double-lumen drainage (3) with a diameter of 1.0-1.2 cm is inserted into the lumen of the cone and placed above the anastomosis in the intestine (4). The lumen of the cone (1) was loosely filled with a gauze swab with an antiseptic to prevent intestinal eventuation. All drains are connected to an aspirator and periodically washed with an antiseptic. When dressings carry out visual monitoring of the healing process of the wound of the intestinal wall, the course of peritonitis and the full removal of pus and solid stool fragments, as well as the possibility of the formation of paracolostomy abscesses in the abdominal cavity. In the cases of their formation, they can be emptied through the laparostomy, and the cavities can be drained with additional tubes that lead out through the laparostomy cone (1). When cleaning the wound of the intestine (4), it can be sutured through the cone (1). After removal of the cone (1), the abdominal wall wound is sutured with rare sutures up to 2 lumen drainage (3) left in the abdominal cavity. It is removed gradually in the last turn. The discharge colostomy is closed according to the generally accepted method, and there is no need to perform an operation to close the wound in the area of the anastomosis, its resection or plastic surgery for stenosis.

Example. Patient M., 42 years old, was admitted to the colopractology department of KKB on April 2, 2006. The examination was diagnosed with cancer of the rectosegmoid division. A week later, the patient was operated on. An anterior resection of the rectum was performed, difficulties were noted during the imposition of a low colorectal anastomosis. On the 5th day after the operation, anastomosis failure and peritonitis were diagnosed. With relaparotomy, the diagnosis is confirmed. Insolvency was located on the front wall of the intestine (2 sutures split), diffuse peritonitis was noted. It was not possible to withdraw the intestine with anastomosis to the anterior abdominal wall. An unloading transversostomy is imposed. Then, an oblique incision was made in the left inguinal-iliac region 8 cm long over the projection of the colorectal anastomosis. The abdominal cavity was opened in layers. Liquid and semi-formed fecal contents were released through a hole in the anastomosis insolvency area with a diameter of about 2 cm, in addition, an accumulation of fetid pus was observed around the anastomosis and between adjacent loops of the small intestine, with individual fragments of formed feces. The washing of the contents of the colon between the discharge colostomy and the anastomosis and thorough sanitation of the abdominal cavity were performed. The proposed bioinert polyethylene cone is introduced into the wound of the abdominal wall, equipped with single-lumen drainage tubes on the outer surface of the cone at the level of the preperitoneal tissue circularly. The cone is mounted above the hole in the gut. In the abdominal cavity, the lower edge of the cone is hemmed with 2 nodal sutures to the parietal peritoneum of the iliac fossa, the upper edge of the cone is attached to the skin with 4 nodal sutures, the ends of the circular drainage tubes from opposite sides of the cone are brought out through separate skin incisions. A double-lumen drainage with a diameter of a thick tube of 1.0 cm, which is installed above the perforated opening of the intestine, is introduced into the lumen of the cone. The lumen of the cone was loosely swabbed with large swabs with an antiseptic. All drains are connected to an aspirator and periodically washed with antiseptics. When dressings were carried out, visual monitoring of the course of the purulent process in the abdominal cavity and wound healing in the area of anastomotic insolvency was performed. Pus was constantly removed through the drains, and solid stool fragments were removed mechanically through dressings through the cone lumen. At the end of the first week, two paracolostomy abscesses nevertheless formed, in close proximity to the anastomosis, which were emptied through the cone and drained by an additional 2 luminal tubes discharged through the cone. These drains were removed after 8 days. 2 weeks after the first operation, when it was found that the intestinal wound in the anastomosis area was cleansed of pus and the regenerative process began, it was sutured with 2-row interrupted sutures using precision technology. The cone was in the anterior abdominal wall for 3 weeks, after which it was removed and the wound was sutured with rare sutures up to 2 lumenal drainage, which was initially brought to the anastomosis. This drainage was gradually tightened and removed last. The wound in the left iliac - inguinal region healed by the type of primary tension. The unloading colostomy was closed according to standard methods. It was not required to perform any operation in the area of the anastomosis, since its patency was good, which is confirmed by contrast irrigography and colonoscopy. The patient was discharged in good condition 2 weeks after the last operation.

Claims (1)

A device for draining the wounds of the abdominal cavity and abdominal wall, containing drainage tubes, characterized in that the device of bioinert material has the shape of a truncated hollow cone with base diameters of 5-6 cm and 7-8 cm, two perforated drainage tubes adjacent to the outer surface of the cone and leading outgoing ends in opposite directions, the ends of the tubes being located above the larger base of the cone by 8-15 cm, and the edge of the lower base is stale.