METHOD OF FORMATION OF SINGLE-ROW TRANSVERSE END-TO-SIDE INVAGINATING SMALL-TO-LARGE INTESTINE ANASTOMOSIS Russian patent published in 2014 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery. A single-row transverse end-to-side invaginating small-to-large intestine anastomosis is formed. After the right side hemicolectomy an end of the ileum is submerged into the lumen of the large intestine. The end of the ileum is mobilised along 3.5-4 cm by ligation of 2-3 terminal vasa recta. A sero-muscular layer of the small intestine is circularly dissected at a distance of 0.5-0.7 cm from the mesentery in the distal direction with isolation of the mucous-submucous layer along 3.0-3.5 cm. The sero-muscular layer is ablated to staple sutures. The ileum mucosa is turned outside and fixed with four sutures to the submucous layer of the intestine. A 0.5-0.6 cm wide strip of subcutaneous layer is left to the sero-muscular layer. The prepared small intestine is placed on the anterior surface of the transverse colon in the transverse direction. The sero-muscular layer of the transverse colon is dissected in the transverse direction for the width of the small intestine. Two terminal interrupted sutures are applied between the posterior wall of the small intestine and the anterior wall of the large intestine. The posterior semi-circle of the anastomosis id formed by an application of interrupted sutures. A puncture-in of a needle from the side of the small intestine is performed through its submucous-muscular-serous layers with the width of 0.3 cm. A puncture-out of the needle from the side of the large intestine is performed through its sero-muscular-submucous layer with the width of 0.3 cm. The distance between the interrupted sutures is 0.4-0.5 cm. The applied sutures without tightening are taken on clips. After formation of an entire posterior semi-circle of the anastomosis all the applied sutures are tightened. The lumen of the large intestine is opened. An invaginate is submerged into the lumen of the large intestine. The anterior semi-circle of the anastomosis is formed in the way analogous to the formation of the posterior semi-circle. The sutures are tightened after the formation of the entire anterior semi-circle of the anastomosis with knots into the intestine lumen, with the last suture knot outside. The method makes it possible to protect the anastomosis zone against inflammatory-cicatricial changes, from aggression of contents of the large intestine, and prevents ischemic changes in the anastomosis zone.

EFFECT: invention provides conditions for rhythmic-portion evacuation of the intestine contents after ablation of the right half of the large intestine with the ileocecal valve.

5 dwg, 2 ex