WO2018218315A1 - Способ выполнения лапароскопической бариатрической операции - Google Patents
Способ выполнения лапароскопической бариатрической операции Download PDFInfo
- Publication number
- WO2018218315A1 WO2018218315A1 PCT/AZ2017/000003 AZ2017000003W WO2018218315A1 WO 2018218315 A1 WO2018218315 A1 WO 2018218315A1 AZ 2017000003 W AZ2017000003 W AZ 2017000003W WO 2018218315 A1 WO2018218315 A1 WO 2018218315A1
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- WO
- WIPO (PCT)
- Prior art keywords
- stomach
- resection
- tube
- bariatric surgery
- obesity
- Prior art date
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
Definitions
- the invention relates to bariatric surgery and can be used in the surgical treatment of patients suffering from excessive obesity.
- Obesity widespread by the end of XX! century was called by the World Health Organization a chronic non-infectious global epidemic. Over the past 30 years, the world has doubled the number of people suffering from morbid obesity. Today, despite the fact that overweight and obesity are 31% in the United States, 30% in Russia, in many developed European countries enough time and money are spent to combat this pathology (1,2).
- An increase in body weight contributes to the growth of arterial hypertension, type II diabetes mellitus, diseases of the cardiovascular system, sleep apnea, degenerative osteoarthritis, various hormonal pathologies (reproductive system disorders), gallstone disease.
- a link was found between being overweight and sudden death. In such patients, obesity reaches its most severe form, which occurs when the desired body weight is exceeded by 170%, and the ITM body mass index (BMI) is 40 kg / m 2 .
- bariatric surgical methods include gastric banding, tubular resection of the stomach, gastric bypass grafting, and biliopancreatic shunting (BPS) (8, 10, 16).
- BPS biliopancreatic shunting
- laparoscopic tubular resection of the stomach (Laparoscopic Sleeve Gastrectomy - LSG).
- a calibration tube with a diameter of 36 Fr (13 mm) is placed in the stomach, the omentum of greater curvature is dissected, the stomach is sutured by cartouches around the tube, followed by resection and removal of the remaining part of the stomach through a small puncture in the anterior abdominal wall.
- a large curvature is performed around a standard calibration tube at a distance of 4-6 cm, starting from the pyloric sphincter to the cardioesophagic zone.
- BMI is greater than 50 kg / mg , the least effective compared with gastric bypass surgery for type I diabetes, compared with other bariatric surgical procedures, weight loss stops after a certain period of time, and after a long period of time the weight rises again (6.9, fifteen).
- the objective of the invention is to provide effective and reliable disposal of patients from overweight while preventing possible complications.
- a calibration tube with a diameter of 32 Fr (11 mm) is used, and the resection is performed parallel to the cardioesophagic zone by holding the stapler line along the large curvature around the tube at a distance of 2 cm, starting from the pyloric sphincter to the fundus of the stomach, partly the antrum of the stomach is partially resected, while omentopexy of the omentum, separated from the greater curvature, is carried out longitudinally to the stapler line by plication fixation with a thread Prolite 3.0 with a needle 16 mm
- the inventive method improves the results of surgical treatment in people with excessive obesity.
- the main purpose of this flashing is to prevent twisting of the resulting narrower stomach with a diameter of 1 1 mm, as well as the simultaneous prevention of divergence of the stapler line and the strengthening of the stapler line not only with one seam, but also with an omentum.
- Figure 1 ⁇ shows the operation of LSG according to the claimed method
- Figure 4 shows mini-gastric shunting.
- a calibration tube (bougie) with a diameter of 32 Fr (11 mm) is placed through the mouth through the mouth, using a Ligasure tool or a Harmonik scalpel, the gland is dissected by dissection, the stomach three-layer sutures around the tube with subsequent resection of the stomach are sutured with cartridges with the ability to put an Endo GiA stapler 60 mm.
- the resection is carried out parallel to the cardioesophagic zone by drawing a stapler line along a large curvature at a distance of 2 cm, starting from the pyloric sphincter to the fundus of the stomach, the antrum of the stomach is partially resected.
- laparoscopic omentopexy is performed by plicating fixation of the separated omentum longitudinally to the stapler line with a shed 3.0 thread with a 16 mm needle.
- the main goal is to additionally strengthen the stapler line not only with one seam, but also with an oil seal.
- a standard tubular resection was performed (control with a standard 36 Fr bougie (13 mm) (Fig. 2). 1 cm from the cardioesophageal zone and 4-6 cm from the pyloric sphincter are resected, and in some cases, they are additionally sutured anastomotic line. The stapler line is left free, or fixing (suturing) agents are used. As a result, a stomach is formed with a diameter of 13 mm and a volume of 120-140 ml.
- Fig. 3 gastric bypass surgery according to Ru was performed (Fig. 3).
- a reservoir of about 40-60 ml is formed.
- the small intestine is sutured to the gastric reservoir in the form of a 2-3-cm anastomosis.
- the proximal part of the small intestine is sutured in the form of 70-150 cm of anastomosis on d and steel part.
- a reservoir of about 60-80 ml is formed by proximal intersection of the stomach with a stapler parallel to the lesser curvature. Then, 200-250 cm distal from the ejunal-tracy ligament, the eunal loop is lifted and sewn into the gastric reservoir as 2-3 cm of anastomosis.
- the claimed method in comparison with the standard method provides longer-term weight loss, and compared with shunting the stomach reduces the risk of vitamin deficiency and malabsorption syndrome. Along with this, this type of operation maintains normal anatomy and normal physiology and is the least risky in the prevention of complications.
- the claimed technique 32 Fr + 2 W pylor (resection of antrum) + omentopexy) can provide such patients with sufficient positive results and their least suffering from malabsorption syndrome compared with gastric bypass surgery. Along with this, this type of operation provides more opportunities to maintain normal anatomy and physiology.
- the results obtained allow us to improve the results by choosing the optimal way to perform laparoscopic bariatric surgery in people with excessive obesity, reduce the frequency of complications during and after surgery, reduce hospitalization time, simultaneously reduce the number of repeated visits, and also make it possible to determine the direction for improving the quality of life patients in the postoperative period,
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
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- Surgical Instruments (AREA)
Abstract
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Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
PCT/AZ2017/000003 WO2018218315A1 (ru) | 2017-05-31 | 2017-05-31 | Способ выполнения лапароскопической бариатрической операции |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
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PCT/AZ2017/000003 WO2018218315A1 (ru) | 2017-05-31 | 2017-05-31 | Способ выполнения лапароскопической бариатрической операции |
Publications (1)
Publication Number | Publication Date |
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WO2018218315A1 true WO2018218315A1 (ru) | 2018-12-06 |
Family
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Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
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PCT/AZ2017/000003 WO2018218315A1 (ru) | 2017-05-31 | 2017-05-31 | Способ выполнения лапароскопической бариатрической операции |
Country Status (1)
Country | Link |
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WO (1) | WO2018218315A1 (ru) |
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2017
- 2017-05-31 WO PCT/AZ2017/000003 patent/WO2018218315A1/ru active Application Filing
Non-Patent Citations (2)
Title |
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BELACHEW M. ET AL.: "Laparoscopic adjustable silicone gastric banding in the treatment of morbid obesity", SURG ENDOSC., vol. 8, 1994, pages 1354 - 1355 * |
SANTORO S. ET AL.: "Enterohormonal changes after digestive adaptation: five-year results of a surgical proposal to treat obesity and associated diseases", OBES SURG., vol. 18, 2008, pages 17 - 26, XP055554220 * |
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