SU1155255A1 - Method of treatment of anorectal atresia - Google Patents

Abstract

METHOD OF TREATMENT OF ANO-RECTAL ATRESIA, including mobilization of the colon, formation of a sero-muscular sheath from its distal section, formation of a tunnel in the atresia zone, reduction of the colon through the case and tunnel, fixation of the intestine to the case at the level of the transitional peritoneal fold, clipping an excess of intestine with the formation of the anus, the imposition of skin-mucous sutures, characterized in that, in order to improve the function of holding and prevent the formation of hematomas, the sero-muscular sheath is invaginated, and Lead down its intestine addition-. it is fixedly secured to the case at the level of the external floor. sd ate 1 s sd

Description

The invention relates to the field of medicine, in particular, to surgery, protology, and can be used in the surgical treatment of high anorectal atresia. The aim of the invention is to improve the function of holding and preventing the formation of hematomas. The drawing shows the implementation scheme of the proposed method, where the following notation is used: mobilized thick intestine 1; serous-muscular (demucosized) case p 2; external sphincter of the back passage; the free-hanging cult of the 4th diluted colon; transition fold 5 peritoneum; interrupted sutures 6 connecting the serous membrane of the descending colon and invaginated sero-muscular sheath; interrupted sutures 7 fixing the intestine to the case at the level of the external sphicter. The method is carried out as follows. The abdominal cavity is opened with one of the accesses for operations on the colon and rectum. Taking into account the level of resection and the required length for perineal mobilization, the colon is mobilized 1. The distal colon is removed, leaving the sero-muscular (demucosated) case 2. The perineal skin is cut in the projection of the external sphincter of the anus 3, forms a tunnel in the pelvic bottom. The upper edge of the sero-muscular sheath 2 is invaginated through the tunnel in the pelvic floor to the level of the external sphincter of the anus 3. Through the invaginated sero-muscular sheath 2 the mobilized colon 1 is released, the distal segment of the retracted colon is resected on the perineum, leaving it free hanging 4 4–5 cm long stump 4. At the level of the transitional fold of peritoneum 5, the serous membranes of the invaginated sero-muscular sheath 1 and the reduced large intestine are stitched with interrupted sutures 6. Additionally fix the intestine to the body Ru 2 at the level of the outer pulp. An anus is formed by superimposing mucous-skin seams after cutting off the free-hanging stump of the retracted colon. Example Svetlana B., 7 years and 5 months old, was hospitalized in the surgical department with a diagnosis of atresis of the anal canal and rectum, rectal vaginal fistula. On admission she complained of constipation, fecal incontinence and gas. Lacking in physical development, weight 27 kg. The abdomen is enlarged, palpable dilated filled with dense fecal sigmoid colon. The anal orifice is absent, the symptom of the cough impulse is negative, the anal reflex is mild. External genitals are developed correctly. Along the back of the vagina, at a height of 3 cm, there is a fistula opening with a diameter of up to 1 cm, through which feces are constantly excreted. On the fistulo-epidermis, the bottom of the atreated rectum is defined above the pubococygeal line, the distal parts of the large intestine are dilated, the gaustra is absent, the recto-vaginal fistula is short. In general clinical and biochemical studies there are no deviations from the age norm1. After conducting pre-operative preparation aimed at the reorganization of the large intestine, under endotracheal anesthesia, an operation was performed; middle laparotomy. An examination of the abdominal organs was found: the sigmoid colon was extended, expanded, its diameter was up to 6 cm, the wall was hypertrophied, sclerosed. The level of colon resection was determined and its left half was mobilized. Upward is 6 cm from the level of the transitional fold of the peritoneum, the sero-muscular layer of the sigmoid colon is circularly dissected and the removal of the distal part of the large intestine to the rectal-vaginal fistula is performed. The mucous membrane of the fistula is transferred and intersected between the ligatures. The bottom of the educated demucotic serous-muscular sheath is widely dissected. In the projection of the external sphincter of the anus, a perineal skin incision is made and a tunnel is formed in the pelvic floor, which communicates with the lumen of the sero-muscular sheath. The upper edge of the sero-muscular sheath is invaginated through the formed tunnel in the pelvic floor to the level of the external sphincter of the anus. Through the invaginated serous-muscular sheath, the mobilized colon is relegated to the perineum and fixed to it at the level of the outer pulp. The wall of the retracted colon is hemmed with interrupted sutures to the edges of the perineal skin incision. A 20 cm resection of the pathologically modified distal colon, which was removed, was made so that the cult was left hanging loosely on the perineum with a length of 5 cm. From the side of the cavity, at the level of the transient fold, the peritoneum was stitched together with interrupted sutures; the case. The wound of the anterior abdominal wall is sutured in layers tightly. After splicing the wall of the lowered thick grape with the skin of the perineum, the anus is formed by overlaying

mucocutaneous seams after cutting off the stump of the reduced large intestine that hangs freely on the perineum.

The postoperative course is smooth. The wound of the abdominal wall healed by primary tension. Independent chair through the formed anus for wils on the 3rd day.

At the time of discharge, the patient's condition was satisfactory, there were no complaints. The anal orifice was closed, there were no inflammatory changes in the skin around it. Oshush.ala urges to the bottom, the chair is self-contained 4-5 times a day. Discharged for outpatient treatment. Appointed: exercise therapy for perineal muscles, diet.

The patient was examined 2 months after discharge: the girl's condition was satisfactory, showed no complaints, the stool was independent 2-3 times a day, the solid stool retained well, the liquid stool and gases did not hold enough. The stomach is not swollen, symmetrical, soft, painless. The anal opening is formed correctly, it is closed, there are no Cicatricial deformities. In the digital examination of the rectum, the sphincter tone is pronounced, and the will is felt. Sphincterometry: tone 30 mmHg. v .; with an active voltage of 50 mm Hg. Art. A repeated course of stimulation of the muscles of the perineum is recommended.

Re-examined after 7 months. after surgery: no complaints, stool is independent 1-2 times a day, feces and gases are retained both during the day and at night. In the digital examination of the rectum, no narrowing or deformation was detected. Sphincterometry: tone 30 mmHg. v .; active voltage is 65 mmHg. Art. Almost healthy.

The method is recommended in clinical practice.

Claims (1)

METHOD FOR TREATING ANO-RECTAL ATRESIA, including mobilization of the colon, formation of a serous-muscular case from its distal section, formation of a tunnel in the atresia zone, reduction of the colon through the case and tunnel, fixation of the intestine to the case at the level of the transitional fold of the peritoneum, excision of excess intestine the formation of the anus by applying mucocutaneous sutures, characterized in that, in order to improve the holding function and prevent the formation of a hematoma, a serous-muscular case is invaginated into the tunnel, and after SIC gut it by the additional fixed to the case at the level of the external field. SU, 1155255