SU1189433A1 - Method of placing sutures in operations on organs of gastrointestinal tract - Google Patents

Description

The invention relates to medicine, in particular to surgery "and can be applied when suturing during operations on the organs of the gastrointestinal tract. five

The purpose of the invention is to prevent the development of postoperative adhesions.

The method is as follows. ten

When suturing the front lip of the anastomosis, it starts from the angle of the wound. Each stitch of the blanket stitch starts from the mucous side, piercing it and the muscle layer at a distance of 15 0.5 cm from the edge of the wound. Then the thread is removed through the edge of the wound tangentially to the back of the peritoneum, without piercing the latter. The next stitch is applied similarly with the counter-20 of the false side of the wound. Screw the edges of the wound inside and tighten the stitches.

In this way, a smooth, well-matching tissue sealed seam is obtained.

After applying the first row of seams 25 proceed to the imposition of the second row. Departure of 1–2 mm from the anastomosis line, the needle is injected, and the shot is made slightly higher than the needle, i.e. the thread is carried out at an angle of 20-25 to the line of anastomosis. Stitch length 3-4 mm. Similarly, the thread is carried out on the other side of the anastomosis. Both ends of the thread are tied and immediately cut. When applying the next stitch, the needle is made at a distance of 3-4 mm from the previous knot, and the poke is made over the knot of the previous stitch. Thus, it turns out that after tying the thread, the knot of the previously applied seam is completely hidden in the fold formed by the next seam. Identically impose all subsequent seams. ί

Example. Patient K. was admitted 09/05/81 with a diagnosis of exacerbation of 45 duodenal ulcers. After an unsuccessful conservative treatment and an instrumental examination (x-ray, fibrogastroscopy, pH-metry), 50 patients underwent surgery (09/20/81). A gastrectomy was performed according to Billroth-P, G'ofmeister Finster with a lateral gastrojejunostomy. During the operation, the 55th keel of the stomach, the gastroenteroanastomosis was sutured by the proposed method, i.e. The first row of blanket continuous seam was superimposed through the mucous and muscular layers, and the second row of gray-serous knotted stitches was performed at an angle to the anastomosis line within 25-30 and with a step overlapping stitches. During the stitching complications and technical difficulties have arisen.

The postoperative course is smooth: the treatment was identical compared with other patients who underwent a similar operation, but only with a known method of suturing. Paresis of the intestine was resolved completely for 4 days. For 14 days. Fibrogastroduodenoscopy was performed before discharge to the patient; patency of the anastomosis is good, slightly pronounced swelling of the mucous. Clinical symptoms, talking about the pathological adhesions in the abdominal cavity, not identified. The wound healed by first intention.

The patient was discharged in good condition. At present (after 9 months), he feels well, does not note any painful phenomena on the part of the digestive organs. When X-ray examination, the stump of the stomach is somewhat stretched, the gastroenteroanastomosis is mobile, painless on palpation, and timely evacuation through the anastomosis.

The proposed method reduces the injury of the mesothelial layer of the peritoneum and avoids pronounced adhesions.

In the clinic, the proposed sutures were applied in 50 patients. All patients were discharged on time after such operations as resection of the stomach and intestines. No patient had intra- and postoperative complications.

Histological examination of the anastomosis line a day after the application of the proposed first row of stitches, compared with the known, markedly less swelling of the mesothelium, in the mesothelium itself And under it there are practically no hematomas. In the study of the second row of sutures there is a significantly smaller amount of fibrin on it compared to the known interrupted sutures.

The proposed method of imposing _shvvov possesses in comparison with izvest 1189433

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such important advantages as less invasiveness, good sealing of the serous cover and, as a result, reduced risk

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adhesions. The method is technically simple, does not require special skills and can be used in abdominal surgery.

Claims (1)

The method of stitching at surgeries of the gastrointestinal tract ^{1 of} his tract, including the imposition of a continuous blanching of the first row of stitches nodular gray-serous second row, characterized in that, in order to prevent the development of postoperative adhesions, when applying the first row of stitches, the thread is conducted from the inside outwards through the mucous and muscular layers, and when the second row of sutures is applied, the thread is conducted so that the place of injection into the intestinal wall on one side the incision is located medial to the place of the vykol, and after moving to the other wall of the intestine, the place of vcol was located lateral to the place of the vykol, with the next knot of the previous stitch being closed with each subsequent stitch, and © knitting thread, immerse it in the fold formed. 511 „1189433 1 1189433 2