UA58711A - Technique for generating anastomosis upon resecting rectum - Google Patents

Abstract

The technique for generating the anastomosis upon resecting the rectum comprises demucosation of the rectum above the pectineal line while the other divisions of the large bowel are descended through the lumen of the rectal stump. The end division of the graft devoid of serosa is descended into the demucosed rectal stump followed by fixation of the mucosal–submucosal flap by the separate sutures along the pectineal line.

Description

Description of the invention

The invention belongs to medicine, namely to abdominal surgery and proctology, and can be used 2 in operations on the colon and, in particular, to restore intestinal continuity after rectal resection.

The method |1| is known rectal demucosation, in which a probe equipped with an inflatable cuff is inserted into the rectum, and the cuff is placed at the estimated level of the beginning of the intestinal wall delamination. At the same level on the outside of the intestine and around it, a detachable ring is installed, on the inner surface of which surgical glue is applied, the cuff of the probe is inflated, ensuring that the intestinal wall is pressed against the ring while the serous membrane is glued to it, then the probe is pulled out and, holding the intestinal wall by ring, the mucosa-submucosa layer is peeled off from the serous-muscular layer. However, when removing the separation ring, there is a risk of damage to the intestinal wall.

There is a known method |2) of treating diffuse polyposis of the large intestine, in which an anastomosis is imposed between the sutured descending colon and the free edge of the demucosated rectum, followed by the opening of the intestinal lumen 79 and the inclusion of the intestinal contents of the demucosated ampoule of the rectum into the passage, but the intestinal contents enter the demucosated areas intestines can contribute to the development of septic complications.

There is a known method of forming a colorectal anastomosis, in which the rectum is mobilized to the level of 4-5 cm above the edge of the anus, the muscular layer of the intestine is crossed at this level and the mucous membrane is mobilized in the distal direction for 4-5 cm. The muscle ring formed is taken for temporary sutures around the entire circumference of the intestine. The isolated mucous membrane is sutured with a UDO device and cut off. A healthy section of the large intestine is brought down to the perineum through the remainder of the ampulla of the rectum. With the help of previously applied sutures, the muscular layer of the ampulla of the rectum is sewn together with the serous-muscular layer of the descending intestine.

The disadvantage of this method is the difficulties that arise during the release of the mucous membrane, especially in patients with a deep and narrow pelvis.

The method |4| is known performance of an abdominal-anal resection of the rectum, during which "demucosation of the anus is carried out from the side of the perineum". On the remaining viable part of the graft, which is brought out below the anastomotic-cutaneous line, the largest omentum process is selected and bluntly and sharply separated at the base from the serous membrane with the help of a clamp, two feeding legs are formed in it in the form of a bridge in the proximal-distal direction. Between the feeding legs and under them in the tunnel formed, the serous, muscular membrane and submucosa are dissected, the incision is continued circularly along the circular wall of the intestine. The circular defect formed in the wall of the descending intestine is bluntly expanded. A section of the intestine with a separated mucous membrane is inserted into the anus in place of the rectal mucosa removed during demucosation. with

The method |5| is known formation of a seamless anastomosis during resection of the rectum, in which before

With demucosation, the rectum is turned to the perineum, demucosation of the rectum is performed above the comb line by at least 1.5 cm in a section 1.5-2.0 cm long, after which the rectum is resected along the upper edge of the demucosated area and its stump is screwed into initial position. The other sections of the colon are pulled through the lumen of the remaining stump of the rectum to the required level and the "descended colon" is cut off at a distance of 5-7 cm from the edge of the anus. After approximately three weeks, the excess of the descending intestine is cut off. c However, to perform this technique, it is necessary to mobilize the rectum to the anal canal, which

With" is not necessary in all cases.

The invention is based on the task of improving the method of restoring intestinal continuity, which reduces the risk of postoperative complications associated with failure of the colorectal anastomosis. i-th The task is solved by the fact that in the method of forming an anastomosis during rectal resection, which

Ge | includes demucosation of the rectum above the comb line, lowering of other sections of the large intestine through the lumen of the left rectal stump, according to the invention, the de-serosed end section of the transplant 7 is lowered into the demucosated by hydropreparation of the rectal stump, with subsequent fixation - 20 mucosa-submucosal flap with separate sutures on comb line levels.

The method is carried out as follows: mobilization and resection of the areas necessary for the removal of the colon and rectum are carried out, demucosation of the stump of the rectum above the comb line is carried out using hydropreparation using a 0.595 solution of novocaine, the terminal section of the graft, which has been deserosated in advance for 5-bsm, is brought down through the lumen of the left stumps of the rectum and fix the mucosa-submucosa 29 flap in a circle with separate sutures at the level of the comb line in. Example. Patient B. entered the clinic with complaints of unstable defecation, profuse bloody discharge during defecation, pain in the lower parts and periodic bloating, progressive weight loss. During rectoromanoscopy, a tumor-like formation, crimson in color, saucer-shaped, up to bcm in diameter, 7 cm from the anal edge along the posterior semicircle. After preoperative preparation and a course of 60 non-adjuvant chemotherapy, the patient was operated on. No metastases were found during laparotomy. During the revision of the organs of the abdominal cavity, no distant metastases were found. A tumor of the middle ampullary section of the rectum up to 7 cm in length reaches the upper ampullary section. The intestine with the tumor was mobilized with ligation of the rectal and sigmoid arteries. On the border of mobilization, a section of the intestine was made within the limits of healthy tissues. From the side of the perineum, demucosation of the stump of the rectum, above the comb line, was performed using hydropreparation using 0.595 novocaine solution. Pre-deserous course

The 5-bsm terminal section of the transplant is brought down through the lumen of the rectal stump with separate catgut sutures, the mucosa-submucosa flap is fixed in a circle at the level of the comb line. The seamless anastomosis zone is drained through an incision in the perineum. The abdominal cavity was drained through the lower corner of the wound with 2 drains, sewn up in layers. The postoperative period was uneventful. The patient was discharged in satisfactory condition.

He was examined after a year, the condition is satisfactory, the tone of the sphincter and volitional effort are preserved, the bowel movements are 1-2 times a day, formalized, there are no signs of recurrence of the disease.

Advantages of the claimed method. Technical simplicity of execution without the use of special expensive equipment and equipment. The proposed method makes it possible to maximally provide surgical intervention for 7/o due to the use of technical methods developed by the authors, reduce the possibility of developing postoperative complications, reduce the stages of operations, which leads to a reduction in the patient's stay in the hospital and a reduction in treatment costs.

References: 1. Popov S.A. Method of rectal demucosation /AS 1701291 Ab1B 17/00 dated 12.30.91 Bull. Mo 48. 2. Nikityn A.M., Mykhaylants G.S., Baranov O.N., Yakushin A.V. Method of treatment of diffuse polyposis of the large intestine /AS 1461421 AbЭ1В 17/00 dated 28.02.89 Bull. Mo 8. 3. Shchytinin V.E., Sherdys F.K. The method of forming a colorectal anastomosis /AS 1703076 Ab1B 17/11 dated 07.01.92 Bull. Mo 1. 4. Bondar G.V., Basheev V.Kh., Zolotukhin S.Z., Borota A.V., Psaras G.G. Abdominal resection with 2o remucosation of the anus in the treatment of cancer of the mid-ampullary section of the rectum / /Clinical surgery. -1996. - Mo 4. - P. 8-10. 5. Fedorov V.D., Nikityn A.M., Protasevich A.A., Mykhaylants G.S. The method of forming a seamless anastomosis during rectal resection /AS 594970 Ab1817/00 dated 28.02.78 Bull. Mo 8.

Claims (1)

29 Formula of the invention "Method of formation of an anastomosis during rectal resection, which includes demucosation of the rectum above the crestal line, lowering of other sections of the colon through the lumen of the remaining stump of the rectum, "- which differs in that the de-serosed terminal section of the transplant is lowered into the demucosated by hydropreparation stump of the rectum with subsequent fixation of the mucosa-submucosal flap with separate sutures "- at the level of the comb line. chn Official Bulletin "Industrial Property". Book 1 "Inventions, useful models, topographies of integrated 99 microcircuits", 2003, M 8, 15.08.2003. State Department of Intellectual Property of the Ministry of Education and Science of Ukraine. - with . and? 1 (ee) - I - 50 - 60 b5