Method optimization midline laparotomy

 

(57) Abstract:

The invention relates to medicine, in particular to abdominal surgery. Essence: cut the skin paraumbilical area with underlying subcutaneous fat cut from the scar tissue of the umbilical ring diamond cut within paraumbilical area or umbilical fossa, the largest axis of symmetry of the diamond-shaped incision feature perpendicular to the median line of the abdomen, then cut the umbilical ring diamond cut from the remaining presechenie tissues anterolateral abdominal wall, while a large axis of symmetry of the diamond-shaped cut feature in the midline of the abdomen and at the same time perform the distal resection of the round ligament of the liver at a distance of 2.0-3.0 cm from the inner loop of the umbilical ring, which creates optimal conditions for performing operations on the organs of the cavity and the abdominal wall.

The invention relates to medicine, in particular to surgery.

The known method midline laparotomy, including layer-by-layer dissection of the abdominal wall in the midline of the abdomen around the navel to the left 1-2 cm (Littmann I. Abdominal surgery. - Budapest: Publishing house of Academy of Sciences of Hungary, 1970. - Swanee known way, is that in the known method has the following disadvantages.

1. Is in most cases the injury of the anterior and posterior vaginal wall left of the rectus abdominis muscle, and sometimes the left of the rectus abdominis muscle, which leads to various complications.

2. Not quite justified in cases requiring the removal of the navel when performing a midline laparotomy.

The closest way to the same destination to the claimed invention on the totality of symptoms is the way midline laparotomy, including dissection of the abdominal wall with a cut in the skin paraumbilical area in the midline of the abdomen (see author's certificate of the Russian Federation N 1732938, class. And 61 In 17/00, 1992), adopted for the prototype.

For reasons that impede the achievement of specified following technical result when using the known method, taken as a prototype, is that in the known method:

1. He excludes any damage to the round ligament of the liver and vascular lesions with the appearance of complications.

2. The probability of damage to the organs in the abdomen with umbilical hernias of the abdomen with the development of complications, especially in adults, when neupravenych the navel of the gain is as follows. The task of the invention is to improve the efficiency and quality of execution midline laparotomy. The technical result - improving the efficiency and quality of execution midline laparotomy. This technical result in the implementation of the invention is achieved by the fact that cut the skin paraumbilical area with underlying subcutaneous fat cut from the scar tissue of the umbilical ring diamond cut within paraumbilical area or umbilical fossa, the largest axis of symmetry of the diamond-shaped incision feature perpendicular to the median line of the abdomen, then cut the umbilical ring diamond cut from the remaining presechenie tissues anterolateral abdominal wall, while a large axis of symmetry of the diamond-shaped cut feature in the midline of the abdomen and at the same time perform the distal resection of the round ligament of the liver at a distance of 2.0-3.0 cm from the inner loop of the umbilical ring.

This improves the efficiency and quality of execution midline laparotomy.

Thus it is essential that the method is:

1. Quite simple and easy to use.

2. Reliable and available in practical isolational availability manipulation in the abdominal cavity due to the structure of animals umbilical ring and the distal portion of the round ligament of the liver. There is a navel - there are problems, there is no navel - no problem.

5. Provides the rationale for surgical access to the abdomen and creates optimal conditions for performing operations on them, as the method of choice abdominal access.

6. Provides a higher degree of compliance with all the requirements of accesses when performing operations on the abdominal organs.

7. Provides cosmetic surgery at the expense of the suturing skin paraumbilical area in the transverse direction and create plastic navel.

8. Provides selection of the operational benefits of umbilical hernias of the abdomen.

9. Provides choice of operational manuals for the prevention of umbilical hernias of the abdomen with dilated umbilical ring.

10. Ensures the prevention of injuries abdominal surgery umbilical hernias of the abdomen, especially in adults, when neupravenych umbilical hernias celebrated intimate fusion of the bottom of the hernial SAC with scar tissue navel and difficulty in the selection of the hernial SAC from the surrounding tissues.

11. Provides strengthening the place of the structure of animals navel by cross-clicks the Oia midline laparotomy.

Conducted by the applicant's analysis of the prior art, including searching by the patent and scientific and technical information sources, and identify sources that contain information about the equivalents of the claimed invention, has allowed to establish that the applicant had not found the source, which is characterized by signs, identical to all the essential features of the claimed invention. The definition from the list of identified unique prototype, as the most similar set of features analogue, has allowed to establish the essential towards perceived by the applicant to the technical result of the distinctive features in the proposed method, set forth in the claims.

Therefore, the claimed invention meets the condition of “novelty.”

To verify compliance of the claimed invention the term “inventive step”, the applicant conducted an additional search of the known solutions to identify signs that match the distinctive features of the prototype of the characteristics of the claimed method. The search results showed that the claimed invention not apparent to the expert in the obvious way from the prior art because the prior art Alenia transformations to achieve a technical result.

In particular, the claimed invention does not provide for the following conversions:

- addition of known means of any known part (s), attached (connected) to it according to certain rules, to achieve a technical result, in respect of which it is the effect of such additions;

- replacement of any part (s) of the other known means known part to achieve a technical result, in respect of which it is the effect of such a change;

- the exclusion of any part (element, action) means while the exclusion of its functions and the achievement of a result of such exclusion (simplification, reduction of weight, dimensions, material consumption, increase reliability, reduce process time, etc);

- increase the number of homogeneous elements of actions for enhancing the technical result due to the presence in the vehicle of such elements, actions;

- execution of a known drug or its part (s) of a known material to achieve a technical result due to the reinforcement of the matrix and the relationship between them is carried out on the basis of known rules, recommendations and achievable technical result is due only to the known properties of the parts of this tool and the relationships between them.

The described invention is not based on the change of the quantitative characteristic (s), the submission of such evidence in the relationship or change its appearance. This refers to the case when the known fact of the influence of each of these features on the technical result, and the new values for these characteristics or their relationship could be obtained from the known dependency relationships.

Therefore, the claimed invention meets the condition of “inventive step”.

Information confirming the ability of the invention to provide the above technical result: cut the skin paraumbilical area with underlying subcutaneous fat cut from the scar tissue of the umbilical ring diamond cut within paraumbilical area or umbilical fossa, the largest axis of symmetry of the diamond-shaped incision feature perpendicular to the median line of the abdomen, then cut the umbilical ring diamond cut from the remaining presechenie tissues anterolateral savremena perform distal resection of the round ligament of the liver at a distance of 2.0-3.0 cm from the inner loop of the umbilical ring.

Example 1. Patient P., 72 years. Was admitted to the surgical Department with the clinic of acute cholecystitis. After conservative therapy, the patient's condition has not improved in the context of ineffective conservative treatment, appeared clinic destructive cholecystitis. The patient was doobsledovanie and was exhibited indications for surgery due to the presence of destructive cholecystitis and was discovered napravila umbilical hernia.

The patient was operated on an emergency basis. Performed laparotomy was proposed method was rassechena skin paraumbilical area with underlying subcutaneous fat, which was separated from the scar tissue of the umbilical ring diamond cut within the umbilical fossa. Great symmetry axis of this diamond-shaped section arranged perpendicular to the median line of the abdomen. Then carved the umbilical ring diamond cut from the remaining presechenie tissues anterolateral abdominal wall, while a large axis of symmetry of the diamond-shaped incision is placed in the midline of the abdomen and at the same time fulfilled the distal resection of the round ligament of the liver at a distance of 2.0 cm from the inner loop of the umbilical ring. During operatorname incision with resection of the strands of the greater omentum in Grajewo bag. Made was cholecystectomy, abdominal drainage, suturing laparotomic wound. Laparotomic wound, with the exception of the skin and subcutaneous fatty tissue was sutured in the midline of the abdomen hub Mylar seams. Skin and subcutaneous fatty tissue in the paraumbilical region were sutured transversely to the median line of the abdomen.

The postoperative period was uneventful. The patient was discharged from hospital in satisfactory condition for 12 hours from the operation.

Example 2. Patient X., 68 years. Was admitted to the surgical Department with the clinic of acute cholecystitis. After conservative therapy, the patient's condition has not improved in the context of ineffective conservative treatment, appeared clinic destructive cholecystitis. The patient was doobsledovanie and was exhibited indications for surgery due to the presence of destructive cholecystitis and was discovered pravima epigastric and napravila umbilical hernia.

The patient was operated on an emergency basis. Performed laparotomy was proposed method was rassechena skin paraumbilical area with underlying subcutaneous fat, which was cut off from scar diamond-shaped section arranged perpendicular to the median line of the abdomen. Then carved the umbilical ring diamond cut from the remaining presechenie tissues anterolateral abdominal wall, while a large axis of symmetry of the diamond-shaped incision is placed in the midline of the abdomen and at the same time fulfilled the distal resection of the round ligament of the liver at a distance of 3.0 cm from the inner loop of the umbilical ring. During the operation, the hernia SAC upravenou epigastric hernia was isseen to the border edges laparotomic incision, and the hernia SAC nevprawima umbilical hernia with umbilical ring was also isseen to the border edges laparotomic incision with resection of the strands of the greater omentum in Grajewo bag. Made was cholecystectomy, abdominal drainage, suturing laparotomic wound. Laparotomic wound, with the exception of the skin and subcutaneous fatty tissue was sutured in the midline of the abdomen hub Mylar seams. Skin and subcutaneous fatty tissue in the paraumbilical region were sutured transversely to the median line of the abdomen.

The postoperative period was uneventful. The patient was discharged from hospital in satisfactory condition on the 11th day from the operation.

When conducting operations presents the pain is from the scar for 2 years.

The expediency of application of the method is not in doubt.

Thus, the presented data suggest the implementation of the use of the claimed invention (method) the following cumulative conditions:

the tool embodying the claimed method in its implementation, is intended for use in industry, namely, in medicine, in particular in surgery;

for the inventive method, it is described in the independent clause sets out the claims, confirmed the possibility of its implementation using the steps described in the application or known before the priority date tools and methods.

Therefore, the claimed invention meets the condition of “industrial applicability”.

Method optimization midline laparotomy, including dissection of the abdominal wall with a cut in the skin paraumbilical area in the midline of the abdomen, characterized in that the dissected skin paraumbilical area with underlying subcutaneous fat cut from the scar tissue of the umbilical ring diamond cut within paraumbilical area or umbilical fossa, the largest axis of symmetry of the diamond-shaped incision R. the remaining presechenie tissues anterolateral abdominal wall, the largest axis of symmetry of the diamond-shaped cut feature in the midline of the abdomen and at the same time perform the distal resection of the round ligament of the liver at a distance of 2.0-3.0 cm from the inner loop of the umbilical ring.



 

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