UA123255C2 - METHOD OF COLOSTOMA FORMATION - Google Patents

Abstract

The invention relates to surgery and coloproctology and can be used in performing surgery on the colon and rectum in cases that require the formation of permanent, temporary or preventive colostomy for pathology of the colon, which forms a colostomy, including dissection of the aponeurosis, where the abdominal wall in the left mesogastric region of the intestine is fixed only to the aponeurosis with 3-4 nodal sutures and to the skin with a continuous suture made of biodestructive suture material, capturing the skin and intestinal wall.

Description

The invention belongs to medicine, namely to surgery and coloproctology, and can be used in performing surgical interventions on the colon and rectum in cases that require the formation of a permanent, temporary or preventive colostomy due to the pathology of the large intestine.

The method of forming a colostomy is the closest to the one proposed, in which an oval window is cut out to the aponeurosis of the oblique muscle of the abdomen in the left pubic region in the projection of the proximal stump of the sigmoid colon. The muscle-aponeurotic wall is dissected in a cruciform manner.

The peritoneum is taken with Mykulich clamps. The peritoneum is fixed to the skin with sutures of the muscle-aponeurotic wall with a gap of 1.0 cm. The ligatures are not cut, holding them on separate Billroth clamps. Through the formed hole in the left pubic region, the proximal stump of the colon is brought out. Later, with a barbed needle and previous threads (which are not cut), the intestine is fixed to the peritoneum, picking up the serous-muscular layer of the intestinal wall. Knotted sutures are placed thinly on the skin, after which the stoma can be opened and its edges can be fixed with through sutures through the entire thickness of the wall to the skin in a circle (L.Ya. Kovalchuk,

AND I. Dzyubanovsky. Atlas of operative interventions on organs of the gastrointestinal tract and anterior abdominal wall: Monograph. - Ternopil: Ukrmedknyga, 2004. - P. 182-184).

The disadvantage of this method is that, firstly, the muscle-aponeurotic wall is dissected in a cruciform manner, which is quite traumatic for the muscles of the abdominal wall. Secondly: the peritoneum is fixed to the skin with the musculo-aponeurotic wall caught in the sutures with a gap of 1.0 cm, which is also a big drawback, since this technique deliberately leads to the formation of a funnel-shaped paracolostomy retraction of the soft tissues of the anterior abdominal wall, which, in turn, significantly complicates colostomy care (hygiene, calorimeter fixation). Thirdly: knotted sutures are applied, which fix the wall of the intestine to the skin.

The invention is based on the task of creating a perfect method of forming a colostomy.

The task is solved by the method of forming a colostomy (single-stem, double-stem), which is formed in the left mesogastric region, is fixed only to the aponeurosis with 3-4 knotted sutures and to the skin with the help of a continuous wrapping suture made of biodegradable suture material, capturing the skin and the intestinal wall.

The method is carried out as follows. After mobilization of certain sections of the colon or

From the rectum (for its removal), their resection, the formation of one or another anastomosis with the subsequent formation of a preventive colostomy, a channel is formed in the anterior abdominal wall at the level of the left mesohypogastrium. To do this, the skin is grasped with an Alice clamp, around which the skin and subcutaneous fat tissue are cut circularly (with a diameter of 2-2.5 cm) using an electrosurgical knife to the aponeurosis of the external oblique muscle of the abdomen. The aponeurosis of the external oblique muscle of the abdomen is dissected in a cruciform manner. At the edge of the dissected aponeurosis, 4 sutures (evenly along the perimeter) of 3/0 biodestructive suture material are applied, which are not tied, but taken on holders. The muscles of the anterior abdominal wall are stretched with clamps

Billroth is captured early by Farabef's expanders. Transverse fascia, pre-peritoneal tissue and parietal peritoneum are dissected with an electrosurgical scalpel, grasped with Farabef's wound dilators and spread in order to form a channel in the anterior abdominal wall (diameter 3.5-4 cm) into which two fingers of the surgeon could freely pass.

From the side of the surgical wound, a clamp is inserted into the formed channel of the anterior abdominal wall

The bile ducts capture the conductors, which fix the loop of the colon (sigmoid, transverse colon) and lead to the anterior abdominal wall. Next, the removed loop of the colon is fixed to the aponeurosis of the external oblique muscle of the abdomen with the help of previously applied 4 stitches. The removed loop of intestine is dissected along the iepia of IPreg. At the end of this stage, the colostomy is fixed at the skin level. At one of the edges of the colostomy, a nodal suture is applied using a 3/0 biodestructive material with an atraumatic needle. Next, with the same thread, the wrapping suture is continued around the perimeter of the colostomy, fixing the skin and the wall of the intestine. After completing the application of the wrapping seam, it is tied with the ligature that was left after the application of the first nodal seam.

An example of clinical application of the method. Patient A., 60 years old. Diagnosis: cancer of the middle ampullary part of the rectum of HER st... kl.gr.

Operation: ultra-low intra-abdominal resection of the rectum with the formation of an "end-to-end" circumrectal anastomosis using a circular suturing device and preventive transversostomy.

A lower and middle laparotomy was performed. The inferior mesenteric artery near the mouth of the aorta and the inferior mesenteric vein near the lower edge of the pancreas were ligated and transected. The rectum with the tumor was mobilized with the mesorectum to the pelvic floor and transected 14 cm above the tumor, 1.5 cm below the tumor and removed. In the proximal stump of the colon, the head of the stapler is fixed with a purse-string suture. A stapler is inserted transanally, which is also fixed with a pocket suture. An anastomosis is formed. The stapler was not removed from the rectum, but the anastomosis was fixed with it. The transverse colon was mobilized, under which the PVC conductor was placed. A channel is formed in the anterior abdominal wall at the level of the left mesogastric area. The skin is grasped with an Alice clamp, around which the skin and subcutaneous fat tissue are cut circularly (with a diameter of 2-2.5 cm) using an electrosurgical knife to the aponeurosis of the external oblique muscle of the abdomen. The aponeurosis of the external oblique muscle of the abdomen is dissected in a cruciform manner. On the edge of the dissected aponeurosis, 4 sutures (evenly along the perimeter) of 3/0 biodegradable suture material are applied, which are taken on the holder. The muscles of the anterior abdominal wall are dilated early by Farabef's extensors. Transverse fascia, preperitoneal tissue, and parietal peritoneum were dissected using an electrosurgical scalpel. A clamp is inserted into the formed channel from the side of the surgical wound

The bile ducts are captured and captured by the PVC conductors, which fix the loop of the transverse colon and lead to the anterior abdominal wall. The removed loop of the colon is fixed to the aponeurosis of the external oblique muscle of the abdomen with the help of previously applied 4 sutures.

The removed loop of the intestine is dissected along the hepia of Irega. On the medial edge of the colostomy, a nodal suture was applied using a 3/0 biodegradable material with an atraumatic needle. The same thread is used to continue applying the wrapping suture around the perimeter of the colostomy, fixing the skin and the wall of the intestine. After completing the application of the wrapping seam, it is tied with the ligature that was left after the application of the first nodal seam.

The postoperative period was uneventful. The patient was discharged from the hospital in a satisfactory condition on the 7th day of the postoperative period. Preventive transversostomy is functioning.

Thus, the main distinguishing feature of the method compared to other methods is its simplicity, speed of execution, minimal trauma, and reliability, which significantly improves the results of surgical treatment and rehabilitation of patients who undergo preventive and final colostomy placement.

Claims (1)

FORMULA OF THE INVENTION Zo The method of forming a colostomy, which includes the dissection of the aponeurosis, which is characterized by the fact that the intestine removed to the anterior abdominal wall in the left mesogastric area is fixed only to the aponeurosis with 3-4 knotted sutures and to the skin with the help of a continuous wrapping suture made of biodestructive suture material, capturing skin and intestinal wall.