UA19738U - Method for sewing bed of gall bladder after cholecystectomy - Google Patents

Abstract

The method for sewing the bed of the gall bladder after cholecystectomy comprises applying uninterrupted blanket catgut suture, ligating the bed in its proximal division, separating the bed into two parts, placing a part of ligature along the bed, sewing the bed, tightening the ligature, crimping the sewed bed, and tying up the ligature.

Description

Description of the invention

The useful model refers to the field of medicine, namely to surgery and can be used in 2 surgical treatment of gallstone disease and its complications.

There is a known method of suturing the bed of the gallbladder after cholecystectomy, which includes stitching the bed with a continuous suture |1). This method of suturing the bed of the gallbladder is close to us in terms of technical essence and was chosen as a prototype.

The prototype method is performed by stitching the bed of the gallbladder with a continuous catgut suture 70 starting from the stump of the cystic duct in the distal direction. The disadvantage of the prototype method is that it performs the hemostatic and biliary-stopping function only if the serous membrane (Gleason's capsule) is left along the edge of the gallbladder bed after its removal, that is, only in the presence of chronic calculous cholecystitis. In the case when cholecystectomy is performed due to acute destructive cholecystitis, and even more so in the presence of mechanical jaundice with increased bleeding 72 of the liver parenchyma, this method of suturing the bed cannot provide sufficient hemostasis, leakage of bile into the abdominal cavity. The consequence of such complications are intra-abdominal bleeding, biliary peritonitis, which in most cases require relaparotomy in the early postoperative period. In elderly patients, especially against the background of mechanical jaundice, relaparotomy can lead to the development of hepatargia and a fatal outcome.

The basis of a useful model is the task of improving suturing of the gallbladder bed after cholecystectomy, including in cases of acute destructive cholecystitis, mechanical jaundice, when tissue bleeding, including liver is too high. The main goal is reliable hemostasis, as well as the prevention of the outflow of bile from the bed, that is, the exclusion of the development of intra-abdominal bleeding and biliary peritonitis.

The task is solved by the fact that in the method of suturing the bed of the gallbladder after cholecystectomy, 22 which includes stitching the bed with a continuous wrapping catgut suture, according to a useful model, the bed is sewn in the proximal part with a ligature, it is divided into two equal parts, one part is placed along the bed, with the second part, the bed is sewn up in the distal direction so that the free ligature is in the lumen of the wrapping seam, the ligatures are tightened, the sewn bed is crimped, and the ligatures are tied.

The claimed method is explained by drawings: so

Fig. 1. Stitching of the gallbladder bed in the proximal part. co

Fig. 2. Suturing the bed in the distal direction.

The method is performed as follows: after ligation of the cystic duct and artery, the gallbladder is removed. in

With a long catgut ligature with a round needle, the bed is stitched in its proximal part, close to the stump of the cystic duct from Fu, and the ligature is divided into 2 equal parts. At the end of its free part, a 3 o clamp is applied and placed along the bed of the gallbladder. With the second part of the ligature with a needle, the bed is sewn up in the distal direction with a continuous wrapping suture in such a way that the free ligature is in the lumen of the wrapping suture. After stitching is finished in the distal part of the gallbladder, both ends of the two ligatures are tightened. At the same time, the superimposed seam corrugates the bed, the ends of the ligatures are tied. The operation ends with drainage of the abdominal cavity and suturing of the surgical wound. WITH

In the clinic of surgical diseases of stomata. Faculty of Donetsk State Medical University named after M. Gorky on the basis of the Central Medical Center, 34 patients were operated on according to the stated method, including in 12 cases with acute

From" destructive cholecystitis, choledocholithiasis, mechanical jaundice. No postoperative complications were found in patients operated on according to the stated method.

Example 1. Patient K., 67 years old (medical history Mo719) was hospitalized in the clinic of surgical diseases 49 stomata. of the faculty of the Central Medical University of Donetsk, 7.03.0br. 48 hours after the onset of the disease with a diagnosis of: - chronic calculous cholecystitis, choledocholithiasis, mechanical jaundice. 10.03.0br. surgery performed: (se) cholecystectomy, choledocholithotomy, drainage of the common bile duct according to Halsted-Pikovsky. During the operation, increased bleeding of the tissues, in particular the liver, was observed as a result of hyperbilirubinemia. and After removal of the gallbladder, its bed is sutured according to the stated method. Postoperative period - without so 20 complications. Dressings made on the day of the operation, as well as in the following days (the first 4 days), noted the wetting of the dressings with serous secretions. There were no signs of bleeding and seepage of bile through the drains. so The wound healed with primary tension. The patient was discharged on the 10th day after the operation in a satisfactory condition.

Example 2. Patient K., 37 years old (medical history Mo1542) was hospitalized in the clinic for surgical stomatal diseases. of the faculty of TsMKLMe1, Donetsk, 12/24/05 9 hours after the onset of the disease with the diagnosis: 29 acute calculous cholecystitis. After the examination and confirmation of the diagnosis on 12.27.05. the operation was performed: with cholecystectomy, drainage of the abdominal cavity. The presence of acute phlegmonous calculous cholecystitis was established at the operation. After removal of the gallbladder, its bed was sutured according to the stated method.

Postoperative period - without complications. Dressings were made on the day of the operation, as well as on the following days. Signs of bleeding and leakage of bile through the drains were not detected. The wound healed with primary tension. The patient was discharged on the 12th day after the operation in a satisfactory condition.

Example 3. Patient R., 72 years old (medical history Mo1325) was hospitalized in the clinic for surgical stomatal diseases. of the faculty of TsMKLMeO1, Donetsk 3.05.0br. 12 hours after the onset of the disease with a diagnosis of acute calculous cholecystitis. After examination and preoperative preparation 5.05.0br. surgery performed: cholecystectomy, drainage of the abdominal cavity. After the removal of the gallbladder, its bed was sutured according to the stated method. Postoperative period - without complications. Dressings were made on the day of the operation, as well as in the following 4 days, it was noted that the dressings were soaked with serous secretions. There were no signs of bleeding and seepage of bile through the drains. The wound healed with primary tension. The patient was discharged on the 10th day after the operation in a satisfactory condition.

Thus, the method of suturing the gallbladder bed after cholecystectomy, developed by us, allows to avoid such postoperative complications as intra-abdominal bleeding, biliary peritonitis and, accordingly, relaparotomy in the early postoperative period and, thus, to improve the results of surgical treatment of patients with gallstone disease, and their complications.

Sources of information taken into account. 70 1. Shalimov A.A. Surgery of the liver and bile ducts. - Kyiv, 1975. - p. 88. 2. Mschenko I.N. Operations on the biliary tract and liver. - Kyiv, "Health", 1966. - pp. 114-115.

Claims (1)

The formula of the invention , , , and Method of suturing the bed of the gallbladder after cholecystectomy, which includes suturing the bed with a continuous wrapping catgut suture, which differs in that the bed is stitched in the proximal part with a ligature, it is divided into two equal parts, one part is placed along the bed, the other part sew the bed in the distal direction so that the free ligature is in the lumen of the wrapping seam, tighten the ligatures, crimp the sewn bed, tie the ligatures. that 2 (ee) (ze) in (o) yo - and? - se) -i (95) IR e) 60 b5