RU2018266C1 - Method of surgical treatment of double-trunk intestinal fistulas - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: lateral part of anastomosis is formed by magnetic compression. The stoma distal part is resected together with a portion of the magnetic compression anastomosis, preserving its patency. Double-row intestinal stitch is put in on the anastomosis terminal part. EFFECT: higher functional and anatomical competence pf interintestinal anastomosis and lower rate of surgical intervention traumatism. 5 dwg

Description

 The invention relates to medicine, namely to pediatric abdominal surgery.

 A known method of creating an end-lateral inter-intestinal anastomosis according to Lukyanenko and Matyashin. The essence of the method lies in the fact that anastomosed loops of intestines are sewn together in the form of a double-barreled shotgun, and then they are longitudinally cut along the lateral surface. After this, the anastomosed intestinal loops are stitched together with the lateral and terminal parts of the double-row suture [1].

 The disadvantage of this method is that due to the application of additional lateral incisions on the walls of the anastomosed loops of the intestines, an increase in the line of the inter-intestinal anastomosis, its reliability is reduced, and the invasiveness of surgical intervention is increased.

 A known method for the surgical treatment of double-barreled intestinal fistulas, including the introduction of magnets in the lead and outlet loop of the intestine carrying the fistula, and subsequent suturing of the stoma after the formation of the anastomosis.

 Closing the actual fistulous opening in the known method is performed by traditional methods — the fistula is sutured or the loop carrying it is resected, with the formation of stumps, which does not always ensure functional and anatomical consistency in the restoration of intestinal continuity.

 The aim of the invention is to remedy these disadvantages, namely the provision of anatomical and functional viability.

 In FIG. 1 shows the introduction of magnets into the lumen of the adducting and abducting loops of the intestine; figure 2 is a view of the forming anastomosis from the inside; figure 3 - location of the resection line; figure 4 - suturing of a bowel defect; figure 5 is the final view of the operation.

 The method is as follows.

 Into the formed double intestinal stoma, magnetic plates in the silicone sheath are introduced into the lead 1 and lead 2 loops and fixed on the common wall of the intestinal stoma (Fig. 1). As a result of magnetic compression for 4-6 days, a lateral magnetic compression anastomosis 4 is created, which allows the disabled section of the intestine to start functioning (figure 2).

 Then, after 3-4 weeks, surgery is performed aimed at closing the double intestinal stoma and anastomosing the adducting and diverting intestinal loops. Two bordering incisions excise the external opening of the double intestinal stoma, the skin edges above it are sutured. Gradually, in an acute way, the stoma is isolated from the tissues of the anterior abdominal wall, the abdominal cavity is opened.

 After determining the exact localization of the lateral magneto-compression anastomosis with a Scalpel-1 laser beam, resection 5 of the distal stoma is performed together with a portion of the magnetic compression anastomosis. The saved part of the anastomosis is a normal intestinal wall, which is at least half the line of the future end-lateral anastomosis along the length (Fig. 3).

 Then, an atraumatic needle imposes a first row of continuous catgut suture 6 and a second row of individual nodular silk sutures on the terminal anastomosis (Fig. 4). Control the patency and tightness of the formed end-lateral inter-intestinal anastomosis (figure 5).

 PRI me R 1. The method was successfully used in patient S., 6 months old, admitted to the clinic for sanitation with a diagnosis of ileo-colon invagination of the intestine, cystic ileum doubled, ileum necrosis, diffuse peritonitis. Produced median laparotomy, resection of the ileocecal angle and ileum, formed ileocolostomy according to Mikulich. 11 days after the operation, a lateral magnetic compression anastomosis was created in the ileocolostomy. After 3 weeks, the ileocolostomy was closed with the creation of an intraperitoneal end-lateral inter-intestinal anastomosis. The external opening of the ileocolostomy is excised with two bordering incisions, the skin edges are sutured over the stoma. In stages, the intestinal stoma was isolated from the soft tissues of the anterior abdominal wall in an acute way, and the abdominal cavity was opened. The exact localization of the magnetic compression anastomosis was determined by palpation, a laser beam resected the distal stoma along with the distal part of the magnetic compression anastomosis, preserving its proximal part. When revising the stored proximal part of the anastomosis, it was revealed that it represents the usual wall of the intestine and is at least half the line of the future anastomosis. An atraumatic needle placed the first row of a continuous catgut suture, then the second row of individual nodular silk sutures on the end part of the created intestinal anastomosis. After suturing, the anastomosis is passable and leakproof. Control of hemostasis. Layered seams on the wound of the anterior abdominal wall. The postoperative period without complications.

The method was applied in patients aged 6 months to 9 years, operated on initially with the following diagnoses:
Iliac-colon invagination of the intestine, ileum necrosis.

 Suppurative cystic doubling of the terminal ileum.

 Gangrenous-perforated appendicitis, local delimited peritonitis.

 In all cases of the operation in this way, a full anatomical and functional result was obtained, clinically and radiologically confirmed.

The method allowed:
a) to begin the earlier functioning of the disconnected intestine, which reduces the preparation time for the operation to eliminate the double intestinal stoma by 2-3 times;
b) reduce the time of surgery by 2 times compared with the prototype;
c) reduce the likelihood of failure of the anastomosis and thus reduce the possibility of purulent complications in the abdominal cavity.

Claims (1)

 METHOD FOR OPERATIVE TREATMENT OF DOUBLE INTESTINAL FISTALS, including the formation of a magnetic compression anastomosis by introducing magnets into the lead and outlet loops of the intestine carrying the fistula, comparing them at the first stage and closing the fistula at the second stage, characterized in that, in order to ensure anatomical and functional viability of the anastomosis when restoring patency of the intestine, at the second stage, a resection of the adducting and abduction loops with a fistula and part of the previously formed anastomosis is performed, and then sutured efekt double-row suture.

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