The overlay method-row intestinal suture

 

(57) Abstract:

The invention relates to medicine, namely to surgery, and can be used during operations on the gastrointestinal tract. The objective is to reduce the frequency of insolvency intestinal suture. Carry out the imposition of double-row intestinal suture by holding the thread first through serous-muscular-polizistin layers with one and other sides, then carried out through the puncture inside, then tie in a knot through the seam, then serous-muscular-submucosal. The method reduces the number of complications intestinal suture.

The invention relates to medicine, namely to surgery.

There is a method of blending two-row intestinal suture. The method is as follows. The anastomosis is formed in two rows, the first row anchor sutures with knots in the lumen of the anastomosis impose on submucosal layer and the base of the mucosal layer at the edges of the incision, and when applying the second row of stitches, the thread is carried out through the serous, muscular and submucosal layers with Vicolo on the surface of the submucosal layer one side of the anastomosis and Mykola from the surface of the submucosal layer through the submucosa, muscular and serosal layers of the other side of the anastomosis.

< / the intestinal wall due to the presence of loose parts which come into contact area between the first and second row of stitches. The disadvantage is also a lack of physical integrity in the event of the insolvency of the first or second row of stitches.

There is a method of blending two-row intestinal suture, which consists in imposing knobby joints and mapping anastomosing intestinal walls, the first row of stitches through all layers and fastened in the bowel lumen, and a second row of stitches passing through serous-muscular-submucosal layers.

The disadvantage of this method is poor healing due to inaccurate mapping of homogeneous layers of the intestinal wall. Possible violation of intestinal permeability due to the presence of loose parts which come into contact area between the first and second row of stitches, which results in the formation of the anastomosis is immersed in the thick section of the anastomosis, thus reducing the lumen of the intestine. In addition, in case of insolvency of the first row of stitches is a severe disturbance associated homogeneous layers of the intestinal wall, resulting in impaired physical integrity.

The aim of the invention is to improve healing through accurate mapping of homogeneous layers of the intestinal wall, increasing the patency of the lumen of the intestine due to a resolve not pretpostavljena goal is achieved by that double row of intestinal seam is formed by holding the thread in the beginning through the serous, muscular and submucosal layers on the edges of the bowel wall with one hand and submucosal, muscle, serous layer on the other side. Then closer to the edge of the wound impose end-to-end suture, which is tied in a knot in the gut, then tied serous-muscular-submucosal site outside.

Thus, we believe new signs significant because only with their introduction of achieving the goal - the improvement of healing, improving the patency of the lumen of the intestine, improving physical integrity.

The method is as follows: first thread with a needle, departing 0.4-0.6 cm from the edge of the wound ulcer, stitch serous-muscular-submucosal layers of one side of the incision, then the same needle and thread stitch podlesice-muscle-serous layers of the other side of the incision, with Vicolo 0.4-0.6 cm from the wound edges. Another needle and thread to produce end-to-end vcol some distance of 0.2 cm from one and the other end inside. Fasten through the seam in a site in the lumen of the intestine, tying end-to-end suture is an accurate mapping of the regions and layers of the colonic wall. Then tie serous-muscular-submucosal site, sredstv the tight parts which come into contact area of the intestinal wall between the first and second row of stitches.

P R I m m e R. a Dog weighing 6 kg under morphine-geksenalovy anesthesia median laparotomy cut in layers opened the abdominal cavity. The wound took a loop of the small intestine, has made its resection and put anastomosis type "end to end" with the application of the proposed two-row intestinal suture. Edge intestinal wounds are well adapted, the process technically was not a problem. As suture material used chrome catgut N 2. The abdominal cavity was tighten up her layers tightly. The postoperative period was uneventful. After 21 days the animal felt good. The wound healed by first intention Macroscopically: the epithelium in the anastomosis fully restored, is determined by the tender scar.

Patient M., 38, East. disease N 5731, received 2.VI.89, OBSE, Karaganda with a diagnosis of penetrating stab wounds of the anterior abdominal wall with damage to the small intestine. Local peritonitis. Under General anesthesia median laparotomy cut in layers opened the abdominal cavity. The wound took a loop of the small intestine with stab wounds dimensions 3 x 0.5 cm, 2 x 0.5 cm, 2.5 x 0.5 cm Wound left the house taking with the application of the proposed two-row intestinal suture. Edge kiseon the instrumental condition. The wound healed by first intention.

The method worked on corpses, in experiments on 8 dogs, 3 patients.

The proposed method provides the most correct mapping of homogeneous layers stitched bodies that allows you to improve healing, eliminates loose parts which come into contact sections of the bowel wall between the first and second row of stitches, which improves the patency of the lumen of the intestine. The method allows to preserve the physical integrity in the event of the insolvency of the first row of stitches.

The OVERLAY METHOD-ROW INTESTINAL SUTURE, including flashing when the first number of a seam all layers of the colonic wall by tying knots in the gut, then flashing when the second row suture serous-muscular-submucosal layers with tying knots on the outside, characterized in that, with the aim of reducing the incidence of insolvency intestinal suture, nodes delay after application of the ranks of the seam, in this first form the second seam number, then the first, and the delay of the nodes starting from the first row intestinal suture.

 

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FIELD: medical engineering.

SUBSTANCE: device has elongated body having operation end engageable with ligature loop, lateral slit for ligature to exit and movable rod, mounted in the device body, having operation end for holding the ligature. The elongated body has special purpose design to match endosurgical port or trocar lumen. The rod is spring-loaded and has nonworking end projecting from the device body as handle. The rod operation end is hook arranged in front of the lateral slit for ligature to exit and making displacement at a distance minimum equal to distance from operation body end to end face of slit for ligature to exit, oriented towards the handle.

EFFECT: improved tissue and organ engagement conditions; simplified maintenance procedure; accelerated operation process.

3 cl, 2 dwg

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