UA142292U - METHOD OF CREATING THAST-COLON ANESTHOMOSIS - Google Patents

Abstract

A method of creating a colon-colon anastomosis, which performs resection of the affected area of the colon, intussusception of the proximal part of the colon in the distal part with an anastomosis "end to end". A purse string suture is applied to the proximal end of the colon, held under tension, and a needle with two ends of ligatures from the purse string suture is passed through the middle of the tenia libera at a distance of 5-7 cm from the free end of the distal part of the colon. The end-to-end anastomosis is fixed by one row of nodal sutures with nodules to the middle of the suture line with atraumatic monofilament thread 4/0 or 5/0 with capture only of the serous-muscular layer of the afferent and excretory parts of the intestine. in duplicate in the form of a coupling.

Description

The utility model belongs to the field of medicine, namely gastric and intestinal surgery, and can be used in the formation of colonic anastomosis.

The incidence of colon cancer in Ukraine is constantly increasing and has taken the third place in the structure of oncological diseases (Y.S. Bereznytskyi, A.V. Gaponov, V.M. Turchyn.

Rationale for performing primary and restorative surgical interventions for obstructive colon obstruction //Ukrainian Journal of Ukraine, 2009. -Me 5. -S. 11-13; OHM.

Lishchyshyn, O.M. Zhurbenko. Colorectal cancer: the state of medical care for patients in Ukraine and peculiarities of mortality / Oncology, 2008. - Mo 1. - P. 101.

Every year, 5-18 people per 100,000 people fall ill in the world. Mortality in this localization of cancer remains high and shows no downward trend. At the same time, failure of anastomoses in colon surgery is one of the causes of death.

There is a known method of creating a large-colonic anastomosis, which consists in invagination of the proximal part of the large intestine into its distal part with an end-to-end anastomosis (Littmann I. Operative surgery - Academy of Sciences of Hungary, Budapest, 1985).

The disadvantage of this method is the high probability of infection of the abdominal cavity due to the fact that both parts of the colon are open.

There is a known method of creating a large-colonic anastomosis, which consists in invagination of the proximal part of the large intestine into its distal part with the formation of an end-to-end anastomosis with the help of a double-row suture, and before intussusception, a pocket suture is applied to the proximal part, which is removed after the anastomosis is applied (SH 31397|.

A significant disadvantage of the known solution is the risk of anastomosis failure due to infection of the anastomotic zone and increased intra-intestinal pressure in the postoperative period.

The task of a useful model is to improve the method of creating a large-colonic anastomosis by applying surgical measures and actions related to the anatomical features of the large intestine, as a result of which the infection of the abdominal cavity is maximally reduced, which favorably affects the safety of surgical intervention.

The task is solved by the fact that in the method of creating a large-colonic anastomosis, according to a useful model, resection of the affected part of the large intestine is performed,

For intussusception of the proximal part of the large intestine into its distal part with an end-to-end anastomosis, at the same time, a pouch suture is placed on the proximal end of the colon, it is held under tension, and at the same time a needle with two ends of the ligatures from the pouch suture is passed through the middle of the iepia of Irega at a distance 5-7 cm from the free end of the distal part of the colon, while the "end-to-end" anastomosis is fixed with one row of nodular sutures with nodules to the middle of the suture line with an atraumatic monofilament thread 4/0 or 5/0 with capture of only the seromuscular layer adductor and abductor parts of the intestine, while the anastomosis zone of the abductor intestine is duplicated in the form of a clutch along the circumference.

The authors of this useful model proved that the means and actions aimed at obtaining end-to-end anastomosis of the proximal and distal parts of the large intestine ensure the prevention of contamination of intestinal microflora at the anastomosis seams.

To prevent contamination of the intestinal microflora in the anastomotic sutures, when fixing one row of nodular sutures with nodules to the middle of the suture line with an atraumatic 4/0 or 5/0 monofilament thread, it is suggested to carry out the indicated operation with capture of only the serous-muscular layer of the adductor and abductor parts of the intestine, avoiding at the same time, it is caught in the seam of the mucous membrane.

In addition, it should be noted that the useful model envisages that the area around the anastomosis of the diverticula is duplicated, which, in the form of a clutch, creates ideal opportunities for a sero-muscular nodal suture capable of withstanding an increase in intra-intestinal pressure up to 16 mm Hg. Art. (normally 2-3 mm Hg).

The proposed solution is confirmed by an example of a specific implementation.

Example.

Patient M., 72 years old, diagnosed with cancer of the sigmoid colon. According to the claimed method, the patient underwent surgical intervention - resection of the sigmoid colon with colon-colon anastomosis. After the resection, a pouch suture was placed on the proximal end of the colon at a distance of 2-3 mm from its edge, after which this part of the colon was held under tension and invaginated into its distal part, while a needle with two ends of ligatures from the pouch suture was passed through the middle of the iepia IPerega at a distance of 5-7 cm from the free end of the distal part of the large intestine. The end-to-end anastomosis was fixed with one row of knotted seromuscular sutures with an atraumatic 4/0 or 5/0 monofilament thread, with capture of only the seromuscular layer of the adductor and abductor parts of the intestine, avoiding capture in the mucosal suture, then one the end of the ligature from the pouch seam above the intestine was cut, and the other was pulled out.

The condition of the patient after the operation is without complications. Peristalsis resumed on the second day.

Thus, the proposed useful model indicates the maximum reduction of infection of the abdominal cavity with the simultaneous ability to withstand an increase in intra-intestinal pressure.

The specified advantages of the proposed solution ensure the safety of surgical intervention.

Claims (1)

USEFUL MODEL FORMULA The method of creating a large-colonic anastomosis, in which resection of the affected part of the large intestine is performed, intussusception of the proximal part of the large intestine into its distal part with an end-to-end anastomosis, while a pocket suture is applied to the proximal end of the large intestine, it is held under tension and at the same time a needle with two ends of ligatures from the purse-string suture is passed through the middle of the Prega ileum at a distance of 5-7 cm from the free end of the distal part of the colon, while the end-to-end anastomosis is fixed with one row of knotted sutures with knots to the middle of the suture line with an atraumatic monofilament thread 4 /0 or 5/0 with capture of only the seromuscular layer of the adductor and diverticula parts of the intestine, while the anastomosis zone of the diverticulum is duplicated in the form of a clutch along the circumference.