SU1333310A1 - Method of anastomosing intestine - Google Patents

Abstract

The invention relates to surgery. The purpose of the invention is the reduction of postoperative complications. Cut through the intestinal walls around the circumference to the submucosal layer and form the lip of its serous and muscular layers. The lumen of the intestine at the site of dissection is pinched with a thin catgut until it is completely closed, the removed part of the intestine is cut off. Serous-muscular layers of the ends of the anastomosis sew. The method provides for wound healing under aseptic conditions. There was no narrowing of the intestinal lumen in the area of the fistula. 5 il. with oo oo oo

Description

The invention relates to medicine, in particular, to surgery, and can be used during intestinal surgery.

The aim of the invention is to reduce postoperative complications by preventing infection of the abdominal cavity and the suture area, which is achieved by forming the anastomosis in a closed way behind the outer layers, ensuring that it is self-recanalized.

Figure 1 shows the intersection of the sero-muscular sheath at the borders of the resection; Fig. 2 shows the ligation of the mucous-submucous layers with overlapping of the intestinal lumen; on fig.Z - the intersection of the intestine; Fig. 4 shows the formation of an anastomosis with a serous-muscular sheath flashing; fig.Z - the final form of the operation.

The method is carried out in the following way.

The boundaries of the resection are determined. The intestinal walls are cut along the circumference to the submucosal layer (Fig.), And the lip of the serous and muscular layers of the wall 3-4 mm wide is formed in the left parts of the intestine in a circular manner. The gut lumen at the dissection site is thinned with catgut until it is completely closed (Fig. 2). The other end of the anastomosis is treated in the same way. After that, the removed part of the intestine is cut with a scalpel directly at the ligature at a distance of 2-3 mm from it (Fig. 3) and both stumps are smeared with 5% tincture of iodine or coagulated using a diathermy apparatus. The next step is to ligate the silk ligatures of the sero-muscular layers of the anastomosis ends in one row (Figures 4 and 5). After 3-4 days from the moment of operation, the sero-muscular layer of the anastomosis grows together. Catgut ligatures covering the lumen of the anastomosis and the anterior end of the anastomosis swell during this time, partially dissolve, and the intestinal patency is restored under pressure from the anterior section of the intestine.

Example. Patient K., 49 years old, was admitted to the clinic on 28.10.83 in a planned manner. Upon admission, a complaint of fecal fistula in the left iliac region and the presence of

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Hernia bulge in the region of the midline of the abdomen of large size.

From the anamnesis: on 18.03.83, the patient was taken to the clinic of general surgery in the form of an ambulance with acute abdomen. In emergency order, it is taken to the operating room. During the operation, fecal peritonitis, necrosis of the intestinal wall in the rectosigmoid section, a seal in the area of necrosis of the type, a perforated opening of 1x1 cm in the necrosis zone were detected. The postoperative period was uneventful. 1.5 months after surgery, the patient was discharged in a satisfactory condition. Until 10/28/83, I felt quite satisfactory, I used the colostomy bag, I gained a lot of weight, I felt good. Received dp reoperation.

On admission, the patient's condition is satisfactory, the abdomen is large due to hernial protrusion, which is more pronounced when the patient is in an upright position. In the left iliac region, an unnatural anus with a calophorium is detected; there is no edema, there is no hyperemia in the region of the excreted intestine, the mucous is shiny pink, the function of the unnatural anus is normal. Hernial proliferation about 30x40 cm. There is a postoperative scar along the midline of the abdomen from

xiphoid process to the pubic joint.

Diagnosis: unnatural anus, condition after resection of sigmoid colon, mechanical intestinal obstruction, fecal peritonitis, postoperative ventral hernia.

22.11,83 operation: second stage of Hartmann's operation. The imposition of colonic anastomosis proposed method

The operative field is processed according to G Grossikha, the lower median laparotomy, excision of the unnatural anus from the anterior abdominal wall, bringing it into the abdominal cavity to the place of anastomosis with

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direct gut. Extracted from adhesions distal segment of the sigmoid colon. The proximal and distal ends of the intestine are treated as follows: a 0.25% solution of novocaine (about 30 ml) is circularly injected under the sero-muscular layer, the intestinal wall is dissected transversely to the submucous layer also circularly, from the sero-muscular the intestinal wall is released both at the central and peripheral ends of the future anastomosis over 2 cm, the lumen of each end of the intestine is tightly closed in this place with catgut ligatures, and the free fins are cut off at the very ligatures, the mucous submucosal stump The layers in the adductor end and in the end are smeared with iodine and coagulated by the diathermy device. The ends of the intestine are drawn together, one row of sero-muscular sutures is applied, there is no lumen in the anastomosis. The wound is sutured in layers, aseptic dressing. The postoperative period was uneventful, the gases began to withdraw on the third day of the operation. The wound healed by primary tension.

The method was developed in the experiment and passed successful clinical trials.

During the tests, radiological, clinical and bacteriological methods were used. In order to objectively confirm the asepticity of the proposed technique, after surgery, the fistula was washed from the anastomosis from the abdominal cavity, as well as from the instrument and suture material. At the X-ray method of examination, after 15 days and one year after the operation, the passage of bari in the area of the fistula, its width and function of the intestine was observed. During clinical observation, the 5H) Nimi paid attention to their general condition in the postoperative period, the presence of peritoneal

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the time of onset of gas discharge.

Test results: for the first 2-3 days after surgery, the anastomosis is closed, which allows the intestinal wound to heal under aseptic conditions. On the third day after the operation, after the spontaneous opening of the projection 10 of the anastomosis in patients, the gases begin to escape through the venting tube, the free end of which was dipped into a vessel with water.

Crops made from swabs, taken during the operation according to the proposed method, gave rise to microflora, whereas with traditional anastomosis methods, the crops made in 8 patients gave an increase in colonies of intestinal 20 rods.

With the X-ray method of examination after 15 days and one year after the operation, the patient operated on with the proposed method did not have 25 narrowing of the intestinal lumen in the area of the fistula, there were no complications in the postoperative period. The patient is under the supervision of 1-2 years. During this period, 30 complications were not observed

The method is recommended for practical use.

Claims (1)

Invention Formula The method of intestinal anastomosis, including the intersection of the intestine at the borders of the resection and the stitching of the seropathies A suture, characterized in that, in order to reduce postoperative complications by preventing infection of the abdominal cavity and suture area, the sero-mucosa of the intestine is previously dissected at the borders of the resection, the mucous-submucous layers of absorbable ligature are stitched, after which the intestine is crossed and the sero-mucosa is crossed. Minor case of its ends. Fi8.1 Cpue.2 Fiyo.Z FIG. 4 Editor A.Mahovska Compiled by T. Shakhmatova Tehred M. Khodanych Order 3859/4 Circulation 594 Subscription VNIIPI USSR State Committee for inventions and discoveries 113035, Moscow, Zh-35, Raushsk nabo, d.4 / 5 Production and printing company, GoUzhgorod, Projecto St., 4 (Par 5 Corrector G, Reshetnik