UA118582U - METHOD OF FORMATION OF NECK ANTYREFLUX ANASTOMOSIS - Google Patents

Abstract

A method of forming a cervical antireflux anastomosis involves forming the free end of the esophageal tube, removing it as a stoma on the neck, and performing esophagoplasty at the same time as forming a stoma on the neck by imposing an anastomosis between the esophagus and the end-to-side interposition. When forming the esophagus stump, the latter intersect so that the plane of the section was at an angle of 40-50 ° to the longitudinal axis of the stump, in the formation of an anastomosis, the first row of sutures is applied between the end of the esophagus stump and the side of the gastric internat, then run a nasogastric probe through the lumen of the lumen , submerge the end of the stump into the lumen of the interliner so as to form an inclined cylinder with a plane of the base at an angle of 40-50 ° to the longitudinal axis of the stump, the second row of seams is applied between the interliner and the esophagus on a routine probe so that the end of the stump into the lumen interponatu twisted to form a distal end of antireflux valve, and the valve is placed on the side opposite to the gastrostomy neck.

Description

A useful model belongs to surgical gastroenterology and can be used to prevent postoperative complications of esophagoplasty.

The method of forming a cervical anastomosis is known according to the patent Mo 92357 Sh (SHA, application 03/21/2014, published 08/11/2014, Method of one-time esophagogastroplasty). It includes a single-stage esophagogastroplasty with the formation of an end-to-side esophagogastroanastomosis.

The method allows one-time esophagogastroplasty, but does not prevent gastroesophageal reflux. As a result, over time, an inflammatory process develops in the esophageal stump, erosions and possible stenosis of the anastomosis occur.

The closest to a useful model is the method of forming a cervical anastomosis according to patent No. 106908 SHO (OA, application 11/18/2015, published 05/10/2016, Method of prevention of postoperative complications of esophagoplasty). It includes the formation of the free end of the esophageal tube, its removal as a stoma on the neck, as well as the performance of esophagoplasty simultaneously with the formation of the stoma on the neck by imposing an anastomosis between the esophagus and the interponat in the "end-to-side" type, while the free end of the esophageal tube is chosen proximal part of the interponate above the level of the anastomosis, additionally, a probe is introduced into the lumen of the interponate beyond the latter and fixed to the skin of the neck.

The method is intended for the prevention of postoperative complications of esophagoplasty by forming a stoma on the neck, but it does not prevent the reflux of the contents of the interponate into the esophagus.

The basis of a useful model is the task of creating a method that prevents the occurrence of gastroesophageal reflux by surgically forming an antireflux esophagogastroanastomosis.

The task is solved by the fact that in the method of forming a cervical antireflux anastomosis, which includes the formation of the free end of the esophageal tube, its removal as a stoma on the neck, as well as the performance of esophagoplasty simultaneously with the formation of a stoma on the neck by imposing an anastomosis between the esophagus and the interponate in the "end- to the side", according to a useful model, when forming a stump of the esophagus, the latter is crossed in such a way that the cross-sectional plane is at an angle of 40-507 to the longitudinal axis of the stump, when forming

From the anastomosis, the first row of sutures is placed between the end of the esophageal stump and the side of the gastric interponate, then a nasogastric probe is inserted through the lumen of the interponate into the gastric reservoir, the end of the stump is immersed in the lumen of the interponate in such a way that an inclined cylinder is formed with the plane of the base at an angle of 40-507 to the longitudinal axis stumps, the second row of sutures is applied between the interponate and the esophagus on the inserted probe in such a way that the end of the stump turns inside the lumen of the interponate with the formation of an antireflux valve from its distal end, while the valve is placed on the side opposite to the gastrostomy on the neck.

Crossing the esophagus at an angle of 40-507 to the longitudinal axis of the stump allows you to provide an "excess" of the esophageal stump, which can function as an antireflux valve when immersed in the lumen of the interponate. The selected value of the cross section angle ensures the maximum possible size of the indicated valve.

The location of the valve on the side opposite to the gastrostomy on the neck makes it possible to prevent the throwing of the contents of the interponate due to the fact that during retrograde advancement of the specified contents under its pressure, the valve closes the lumen of the esophageal stump.

The method of applying the anastomosis between the esophageal stump and the gastric interponate allows to ensure the strength of the valve both due to strong (double rows) seams and its thickness (combination of the thickness of the tissues of the esophageal wall and interponate).

The method is illustrated by drawings showing:

Fig. 1 - a method, a general view of the upper parts of the gastrointestinal tract after the completion of the operation;

Fig. 2 - the same, the moment of immersion of the stump of the esophagus into the lumen of the interponate;

Fig. C - the moment after the operation, the appearance of the valve at the time of its closure under the influence of retrograde movement of the contents of the interponate.

On the drawings, the following designations of the esophageal stump 1, gastric interponate 2, stoma Z on the neck, newly formed valve 4, gastric reservoir 5, nasogastric probe 6, probe 7 for feeding the patient are adopted.

A detailed description of the method is given on the example of its implementation in the clinic.

A clinical example.

Patient Sh., 59 years old, was admitted to the clinic of the "V.T. Zaitsev National University of Medical Sciences" with a diagnosis of prolonged post-burn cicatricial stricture of the esophagus.

During the surgical intervention, the small curvature of the stomach was partially treated with clipping of the left gastric artery, and an isoperistaltic tube of an arcuate shape was formed along the large curvature of the stomach and a reservoir from the part of the stomach adjacent to the small curvature. This was done using a linear suture machine followed by a second row of sutures. The diameter of the isoperistal tube was 4 cm (corresponding to the diameter of the esophagus), the length was 27 cm.

Distal resection of the esophagus (the part of the esophagus affected by the post-burn extended stricture) was performed via a transhiatal approach. An anastomosis of the esophageal stump with an "end-to-side" interponate was performed with the formation of an antireflux valve and the removal of a gastrostomy to the neck according to the method described above.

The postoperative period passed without complications, the patient was discharged with an increase in weight of 2.8 kg on the 15th day after the operation. After 3 months, the weight increased by another 10 kg, and after six months, the patient regained his weight by 100 95.

Thus, performing the method according to a useful model allows preventing the occurrence of gastroesophageal reflux and all the complications that arise from it after esophagoplasty.

Claims (1)

USEFUL MODEL FORMULA The method of forming a cervical antireflux anastomosis, which includes the formation of the free end of the esophageal tube, its removal as a stoma on the neck, as well as the performance of esophagoplasty simultaneously with the formation of a stoma on the neck by imposing an anastomosis between the esophagus and the interponate in the "end-to-side" type differs in that when forming the esophageal stump, the latter is crossed in such a way that the cross-sectional plane is at an angle of 40-50° to the longitudinal axis of the stump, when forming the anastomosis, the first row of sutures is placed between the end of the esophageal stump and the side of the gastric interponate, then a nasogastric probe is inserted through the lumen of the interponate into the stomach tank, the end of the stump is immersed in the lumen of the interponate in such a way that an inclined cylinder is formed with the plane of the base at an angle of 40-50" to the longitudinal axis of the stump, the second row of sutures is placed between the interponate and the esophagus on the inserted probe in such a way that the end of the stump turns inward the lumen of the interponate with Zo is formed yum from its distal end of the antireflux valve, and the valve is placed on the side opposite to the gastrostomy on the neck. oh I ,. VSH 2 K-i h i rai 5 i y I sche y r SCHE du 5 i SCHE Se 5 ko MIK KOH :. i i KKZ KOH I Kon E VC: ha : I ; sh- WHAT! Same VE ON i zr B x x KE o Y po. I "horn.