UA139304U - METHOD OF PERFORMANCE OF INVAGINARY GASTROINTESTINAL GASTROINTESTINAL ANASTOMOSIS - Google Patents

Abstract

The method of forming an intussusception esophagogastric anastomosis includes the formation of "ribs" of the anastomosis, the formation of a second row of sutures on the anterior wall of the anastomosis, which invaginates the stump of the esophagus into the stomach. The "ribs" of the anastomosis are formed for 4-5 cm, for which impose 3 serous-muscular sutures on both sides, and on the posterior lip of the anastomosis from the lumen impose two sutures-holders at a distance of 1.0-1.5 cm from each other, then, pulling the sutures-holders and between them, stitch and cut with a linear suturing-cutting apparatus for 30 mm deep into the wall of the stomach and esophagus, and the inner row of sutures of the anterior lip of the anastomosis perform two threads facing each other Schmiden sutures .

Description

A useful model belongs to medicine, namely to surgery, and can be used in resections of the esophagus with plastic gastric graft.

A known method of forming an invaginal esophageal-gastric anastomosis includes the formation of "ribs" of the anastomosis over a length of 2.5-3 cm, the imposition of nodal sutures on the inner row of the front and back walls of the anastomosis, and the formation of a second row of sutures on the front wall of the anastomosis, which invaginates the esophageal stump into the stomach Y.M. Shoikhet, A.F. Lazarev, S.D. Fokeev,

E.S. Fokeeva Bulletin of the Russian National Center for Advanced Studies named after M.M. Blokhina RAMS, vol. 17, Mo. 1, 2006, art. 43-47).

The disadvantage of the known method is a large number of postoperative complications in the form of the possibility of the development of a cicatricial stricture of the invaginal esophageal-gastric anastomosis, due to the narrowing of the anastomotic lumen, as well as a high probability of infection of the anastomotic area, which is most often associated with prolonged manipulations during the formation of the anastomotic walls by hand and single sutures .

The basis of a useful model is the task of developing such a method of forming invaginal esophageal-gastric anastomosis, which, due to the formation of longer "ribs" of the anastomosis and a larger diameter of the lumen, would ensure a decrease in the number of postoperative complications.

The task is solved by the fact that in the method of forming an invaginal esophageal-gastric anastomosis, which includes the formation of "ribs" of the anastomosis, the formation of a second row of sutures on the front wall of the anastomosis, which invaginates the stump of the esophagus into the stomach, according to a useful model, the "ribs" of the anastomosis are formed on for 4-5 cm, for which seromuscular sutures are applied on both sides, and two holding sutures are applied to the back lip of the anastomosis from the lumen at a distance of 1.0-1.5 cm from each other, after which, pulling the retaining sutures and between them, stitch and cut with a linear suture-cutting device 30 mm deep into the wall of the stomach and esophagus, and the inner row of sutures of the anterior lip of the anastomosis is performed with two threads facing each other with Schmiden sutures.

Forming the "ribs" of the anastomosis over a length of 4-5 cm on both sides, placing two holding sutures from the lumen on the back lip at a distance of 1.0-1.5 cm from each other, sewing with a cut between them with a sewing-cutting device along the length 30 mm deep and forming the inner row of sutures of the anterior lip of the anastomosis with two threads facing each other with Schmiden sutures

Zo provides a reduction in the number of postoperative complications in the form of stricture of the invaginal esophageal-gastric anastomosis because the "ribs" are larger, which ensures greater rigidity of the anastomosis. And thanks to the depth of the suture, 30 mm deep, the lumen of the anastomosis has a larger diameter.

All numerical values indicated in the formula of the useful model are selected on the basis of clinical studies of 8 patients.

The method is carried out as follows. 5 trocars for a laparoscope and laparoscopic manipulators are inserted into the abdominal cavity, the stomach is mobilized and an isoperistaltic stem up to 4 cm wide is formed from it, which is supplied with blood by the right gastric, gastro-omentum and intramural vessels. Its proximal part along the great curvature for 3-4 cm from the edge does not have an omentum. The formed transplant is carried out into the pleural cavity through the esophageal opening of the diaphragm. A feeding microjejunostomy is formed and trocar wounds are sutured. After thoracotomy, the esophagus is isolated and resected.

The gastric graft is placed in the bed of the esophagus. Over a period of 4-5 cm, serous-muscular sutures are applied from both sides on the lateral surfaces of the back wall of the esophagus and the gastric graft with kapron thread, directed to their edges, forming the "ribs" of the anastomosis.

The formed sutures are tied so that the esophageal stump and the gastric graft are adjacent to each other for 4-5 cm along the back walls. The surplus of the proximal part of the gastric graft is cut off at the level of the lumen of the esophageal stump. Through all the layers of the back lip of the anastomosis, two kapron holding sutures are placed from the lumen at a distance of 1.0-1.5 cm from each other, after which, pulling up the holding sutures, a linear suturing-cutting device is introduced to the back lip 30 mm deep and stitched and cut, forming the back inner row of seams. The first row of the front lip is sewn through all layers with two threads of ROB 4-0 facing each other with Schmiden sutures. The next row of sutures on the front wall of the anastomosis invaginates the esophageal stump into the gastric stem, starting from the left edge of the anastomosis, performing needle injections at a distance of 2-2.5 cm from the inner row with the capture of the seromuscular layer. 4-5 such sutures are applied, as a result of which the esophagus invaginates into the formed gastric graft, to a depth of 4-5 cm without the formation of tension of external sutures. The operation ends with the installation of pleural drains, suturing of wounds and application of aseptic bandages. 60 Example Mo 1

Patient D., born in 1959, medical history No. 006243, 2018, hospitalized in the Department of Surgery of the Esophagus, Stomach and Intestines of NIHT AMNU with a diagnosis: Ca n/3 of the esophagus RTZMZMO,

YMa st., II cl. gr., state after non-adjuvant CRT. The patient was examined at the pre-hospital stage (clinical examination, laboratory tests, FEGDS, computed tomography of the OC and OCP).

On October 25, 2018, the patient underwent surgery: hybrid Lewis operation, microjejunostomy.

Trocars would be inserted into the abdominal cavity. During the revision in the abdominal cavity in the area of the cardia, there are enlarged lymph nodes Mo 1, 2, 3, 7 and 9 up to 1.5 cm in diameter, dense, spherical. No other pathology was found. The stomach is mobilized with the Nagptopis ACE apparatus, starting from the level of 3 cm above the portal vein to n/3 of the thoracic part of the esophagus. At the level of the thoracic part of the esophagus, post-radiation changes, rough adhesions are noted. The left gastric artery and vein were isolated, and the separately clipped Net-o-Ios were transected. Lymphodisection in volume D2. A gastric graft was formed intracorporeally with the EpdospiA b60OB device on the right gastric and gastro-omentum vessels - it is viable, the pulsation of the peripheral vessels is visualized. A food microjejunostomy was formed 30 cm from the ligament of Treitz. Hemostasis is stable. Polychlorvinyl drainage of 6 mm into the abdominal cavity subdiaphragmatically on the left. The wounds are sewn up. Aseptic bandages.

After laying the patient on the left side, a thoracotomy was performed in the 5th intercostal space. Dissected lower pulmonary ligament, mediastinal pleura. During the revision, the wall of the esophagus at the level of the lower third is thickened, there are enlarged paraesophageal, paratracheal, bifurcation, paraaortic lymph nodes. Lymphodisection 52. Along the thoracic duct at the level of the lower third of the esophagus, a changed lymph node measuring 1.0 cm in diameter, spherical, dense, whitish in color was visualized - a section of the thoracic duct with a lymph node for 5-6 cm was resected, proximally and distally clipped. M.agudo5 clipped pet-o-Ios, crossed. The thoracic part of the esophagus was mobilized 6 cm above the palpable tumor and cut off 3 cm from the tumor. The stomach is transferred to the pleural cavity through the esophageal opening of the diaphragm. The transplant was cut off from the bottom of the stomach with the Mipi5 1000 device. The device suture was peritonized along the course of the gastric transplant with a ROB II 4-0 thread. For 4 cm on the side surfaces of the esophagus and gastric graft, serous-muscular sutures are applied on both sides, the sutures are tied. From the lumen of the anastomosis, 2 holding sutures are placed on the back lip at a distance of 1.5 cm from each other through all layers. By applying traction to the holding sutures on the back lip

From the anastomosis between the seams, a linear stitching and cutting apparatus EpaospiA 45r with a depth of the staple bend of 3.5 mm was introduced, the back lip of the anastomosis was stitched and cut to a depth of 30 mm. The front lip of the anastomosis is formed in two rows - the first row is made with ROB 4-0 Schmiden sutures, the second row is formed by 5 seromuscular nodal sutures that invaginate the esophageal stump into the lumen of the gastric graft to a depth of 4 cm. Two drains are installed in the pleural cavity. The wound is sutured. The postoperative period was uneventful. The patient was discharged on the 17th day after the operation in a satisfactory condition. At the follow-up examination three months later, no evidence of esophageal stricture was found.

According to the proposed method, 8 patients with esophageal diseases of various localizations were operated on. There were no complications in the form of cicatricial stricture of invaginal esophageal-gastric anastomosis. In a group of 8 patients, an analog method was used, after using which complications were noted in 2 patients in the form of stricture of the anastomosis.

Thus, the proposed method allows to reduce the number of postoperative complications in the form of scar stricture of invaginal esophageal-gastric anastomosis.

Claims (1)

USEFUL MODEL FORMULA The method of forming an invaginal esophageal-gastric anastomosis, which includes the formation of "ribs" of the anastomosis, the formation of a second row of sutures on the front wall of the anastomosis, which invaginates the stump of the esophagus into the stomach, which differs in that the "ribs" of the anastomosis are formed along 4-5 cm, for which serous-muscular sutures are applied on both sides, and two retaining sutures are applied to the back lip of the anastomosis from the lumen at a distance of 1.0-1.5 cm from each other, after which, pulling the sutures holders and between them, stitched and cut with a linear suturing-cutting device for 30 mm deep into the wall of the stomach and esophagus, and the inner row of seams of the front lip of the anastomosis is performed with two threads facing each other with Schmiden sutures.