SU1281254A1 - Method of treatment of reflux-esophagitis - Google Patents

Abstract

This invention relates to medicine, namely abdominal surgery. The purpose of the invention is to prevent the recurrence of reflux esophagitis and preserve the physiological reflux by creating an anti-reflux valve in the fundus of the stomach. For this purpose, median laparotomy is performed, the coronary ligament of the liver is crossed. Then the stomach is mobilized along the greater curvature, crossing the gastrophrenic ligament from the esophagus 1 before the splenic branches begin to spread. Then proceed to the plastic. A suture is placed on the back wall 2 of the stomach at the same distance from the lesser curvature 3 and from the esophagofundal fold 4. Next, the thread with the needle is transferred through the bottom of the stomach 5 and the anterior wall 6 is taken into the suture at the same distance from the small curvature 3 and from the bottom . The resulting folds are tightened with an anchor suture 7 with immersion inside the esophagofundal junction in the area of the His angle. The next two stitches are placed in the same sequence, each 1-1.5 cm distal from the previous one at the same distance from the minor curvature. The criterion of usefulness of the resulting valve is full coverage with the laying of the rubber probe 8 inserted into the stomach. The postoperative wound is closed in the usual way. 1 il. i W

Description

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This invention relates to medicine, specifically to abdominal surgery.

The aim of the invention is to prevent the recurrence of reflux esophagitis and the preservation of physiological reflux, which is achieved by creating an anti-reflux valve in the fundus of the stomach.

The drawing shows the imposition of the first knotted suture on the fundus of the stomach.

The method is carried out as follows.

After opening the abdominal cavity (median laparotomy or thoracotomy), the coronary ligament of the liver is crossed. The next stage of the operation is mobilization of the stomach along the greater curvature for 8–10 cm from the esophagofundal junction, which is achieved by intersecting the gastro-diaphragmatic ligament from the esophagus 1 before the splenic splenic branches sprout. At the end of these stages, proceed directly to the plastic in a new way. The first wall of the future fold takes the back wall 2 of the stomach at the same distance from the lesser curvature 3 and from the esophagofundal fold 4. After that, the thread with the needle is transferred through the bottom of the stomach and the seam takes the front wall 6 at the same distance from the small curvature and from bottom. The resulting folds are tightened with an anchor suture 7, while immersing the esophagofundal junction in the area of the His angle. The next two stitches are placed in the same sequence, each 1-1.5 cm distal from the previous one at the same distance from the minor curvature. The criterion of usefulness of the resulting valve is tight coverage with a clutch of rubber probe 8 inserted into the stomach. At this stage, the anti reflux surgery can be considered complete. The question of combining the proposed method with additional manipulations (pinching the legs of the diaphragm, fundodiaphragopexy, etc.) is solved by the indications in each particular case. Postoperative wound is closed in the usual way.

Being technically simpler, the proposed method is quick

intervention creates a new type of antireflux valve mechanism.

Example. Patient S., 36 years old. Diagnosis: large sliding hernia of the esophageal orifice of the diaphragm, ulcerative reflux esophagitis. Performed operations: laparotomy in the tenth intercostal space, suturing of the diaphragm legs, plastic using the proposed method. The postoperative course is smooth, the feeding of the patient is started on the second day, the belching is preserved, the healing is by primary tension. The patient was discharged on the twelfth day after surgery. Signs of dysphagia and reflux of gastric contents in the early postoperative period, four months and three years after the operation were not detected during X-ray and endoscopic control. The patient began work two months after surgery.

The proposed method of surgical treatment of reflux esophagitis with hernias of the esophageal orifice of the diaphragm accelerates the process of treating the disease, provides a good antireflux effect and does not cause patients with dysphagia in the postoperative period. In addition, it can be applied both in a standalone form without additional manipulations, and in combination with operations such as crucophagi, fundodiaphragmopexy, vagotomy and pyloroplasty, taking into account specific clinical cases of the disease.

Claims (1)

Invention Formula A method of treating reflux esophagitis, including mobilization of the stomach with the intersection of the ligament apparatus and the creation of an antireflux valve, characterized in that, in order to prevent recurrence of the disease and preserve physiological reflux, during mobilization they cross the left coronary and gastrointestinal diaphragmatic section, the valve is made by lateral immersion of the cardia in the stomach with sutures, engaging the front and rear walls of the cardia.