SU1286178A1 - Method of forming colorectal anastomosis - Google Patents

Abstract

This invention relates to the field of medicine, namely to surgery and proctology. The purpose of the invention is to reduce the treatment time and improve the function of holding the pulp of the anus. After the midline laparotomy, the distal sigmoid colon and rectum are mobilized. The enlarged intestine is removed. The stump of my intestine is sutured. An incision is made along the posterior semicircle of the anal canal. The rear wall of the rectum is mobilized and retracted upwards. An incision is made in the posterior rectum from the side of the perineal wound. The distal segment of the mobilized colon is stirred into the perineal wound. With the clamping device, the distal segment of the colon is drawn into the lumen of the rectum. A mucous-mucous row of sutures of the anastomosis is placed around the entire circumference, so as to mix the mucosa of the rectum and the retracted colon. On the wound side in the perineal region, an additional serous-muscular series of sutures of the anastomosis is placed. Under the reduced colon, the proxy is proximal. The muscles that lift the anus are stitched together more closely than the formed junction, forming a rectal angle. i (/)

Description

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The invention relates to medicine, namely to surgery and proctology, and can be used in an operation with the subsequent formation of a colorectal anastomosis.

The purpose of the invention is to reduce the time of treatment and improve the function of holding the pulp of the anus, which is achieved by performing the operation simultaneously, the anastomosis is formed from the perineal access, while the mucous-mucous sutures are imposed from the lumen of the right dimple, and from an additional incision behind the straight line, forming a colorectal angle.

The method is carried out as follows.

Median laparotomy is performed. The distal part of the sigmoid pestle and the right pike are mobilized to the level of 7-8 cm from the outer edge of the anus. The mobilized, trimmed dehis is crossed and removed. The stump of my rectum is sutured with three-sided grooves. From the side of the perineum, a skin incision of 7–8 cm in length is made, indented 3 cm from the skin-mucous edge, along the posterior semicircle of the anal canal. Acutely mobilize the posterior posterior wall of the posterior to the proximal end of its stump. The mobilized straight bite is retracted upwards. An incision is made in the posterior posterior wall of the rectum from the side of the perineal wound 1.5 cm above the sphincter. The distal segment of the mobilized colon is moved to the wound of the perineum. A clamp is inserted into the lumen of the rectum, which is guided through an incision in the posterior wall of the rectum, and with its help, the reduced distal segment of the colon is drawn into the rectal lumen. A mucous-mucous row of sutures of the anastomosis is placed along the entire circumference, combining the mucous membrane of the rectum and the reduced colon. From the side of the wound in the perineal region, an additional second row of sutures of the anastomosis is placed — sero-muscular. Under the retracted colon, proximally formed cone-joint, muscles that lift the anus are formed, forming a right angle &

Example. Patient T., 22 years old, was admitted to the hospital with a diagnosis of congenital insufficiency of the anal sphincter of the III degree, obstructive megacolon (megarectum and megasigma), condition after the operation for atresia of the anal canal. An objective examination revealed a sharp expansion of the rectum and sigmoid colon to 18–20 cm in diameter, the function of the rectal sphincter was sharply reduced: the patient did not hold intestinal contents. The patient underwent surgery: under general anesthesia, a midline laparotomy was performed. Mobilized sigmoid and pr ma

fang to the level of 7 cm from the outer edge of the anus. Enlarged sections of the colon are crossed and removed. The cult of my throat sutured three-sided seams.

From the side of the perineum, indent 3 cm from the skin-mucous edge, a skin incision of 7 cm in length is made along the posterior semicircle of the anal canal. In an acute manner, the posterior wall of the rectum is mobilized to the proximal end of the stump and moved upwards. An incision is made in the posterior rectal wall from the perineum 1.5 cm above the sphincter. The distal segment of the mobilized colon is moved to the perineal wound. Into the lumen

a rectum was inserted into the clamp, passed through a wound in the back wall of the rectum. With the help of a clamp, the distal collar of the colon is captured and retracted into the lumen of the rectum. From the side of the lumen of my intestine mucous-mucous is superimposed

0 p d suture anastomosis. On the wound side in the perineal region, an additional second row of seams of the anastomosis is placed — the gray-muscular. The muscles that raise the anus are tightened to the anastomosis area and are stitched under the reduced intestine more fistula, with a colorectal angle formed. Laparotomic and pro-inter-wounds are sutured tightly.

The proposed method performed operations in 12 patients with various forms of obstructive megacolon in combination with insufficiency of the anal sphincter. Patients were examined at 6, 9 and 12 months. and 1.5 years after surgery. Not a single patient has a recurrence of megacolon, the function of the locking apparatus is direct

 the intestines are good: in all patients, daily self-stool is present, intestinal contents are fully retained.

The operation is performed simultaneously, which reduces the treatment time.

0 The formation of a colorectal anastomosis, an end to the side with the imposition of additional seromal sutures from the perineal access increases the reliability of the anastomosis itself, avoids long-term dilation of the anal sphincter

 excess intestine in the form of a temporary perineal colostomy and, thus, does not reduce the obturator function of the sphincter. Formation of the colorectal angle by suturing the muscles that raise the anus under the reduced colon

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proximal to the superimposed fistula, improves the functions of the locking apparatus of the rectum and allows for good functional results.

Claims (1)

Invention Formula A method of forming colorectal anastomosis involving resection of a thick 3 12861784 the intestines, the formation of the stump of the rectum, the lumen of the rectum, and the sero-imposition of the end of the fistula, the muscle-sutures are distinguished from the additional fact that, in order to reduce the incision of the perineum behind the treatment of the intestine, after which they form the colorecny lobe of the anus, the operation is vy-, thal angle, stitching the muscles, raising at one time, when anas-anus is applied under the colon of the proxytomosis, the intestinal mucosa is stitched from the mouth more closely.