METHOD OF LAPAROSCOPIC TREATMENT OF EXTENDED STRICTURE OF UPPER URETER WITH FORMATION OF ILEOCOLIC ANASTOMOSIS Russian patent published in 2020 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to abdominal surgery and urology. Trocars are placed to visualize the region of the right or left kidney, an ascending or descending segment of the colon for the right or left kidney, respectively, and a small pelvis. Ascending or descending portion of the large intestine is mobilized for the right or left kidney, respectively, with visualizing the fascia renalis and the anterior kidney surface. It is followed by Kocher duodenum mobilization for the right kidney, mobilization of the renal pedicle, mobilization of the inferior vena cava for the right kidney or aorta - for the left kidney. Renal artery and a vein of an operated kidney are separated. Lower segment of the operated kidney is mobilized from all sides. Dye is introduced into the cavity of the pelvic-pelvis system of the operated kidney. Lower pole of the operated kidney is resected and excised until the expanded lower group of cups or an inferior calyx is opened, and the dye is introduced into the abdominal cavity, followed by the haemostatic precision sutures on the parenchyma vessels of the resected kidney. Distance from the lower segment of the kidney to the bladder is measured with subsequent resection of the segment of the small intestine with a preserved mesentery length corresponding to the measured distance, with an indentation from the ileocecal angle of 35–40 cm. Enteroenteric anastomosis is formed as "side-to-side". Mesentery of resected segment of intestine is mobilized at angle of 90°. Tunnel is formed in the mesentery of the ascending or descending colonic segment closer to the hepatic right angle or the splenic left angle for the right or left kidney, respectively, followed by conducting a resected intestinal segment through a mesenteric mesentery in a retroperitoneal space to a lower segment of the kidney. Ileocolic anastomosis is formed between an intestinal segment and an enlarged lower calyx of an operated kidney by two continuous rows of sutures. First row of sutures is performed with a step of not more than 2 mm with engorgement of the intestinal wall and mucous membrane of the kidney. Second line of sutures is formed between the wall of the intestinal segment and the parenchyma with the renal capsule starting from the intestinal wall capture at distance of 5–10 mm from the previous suture, followed by parenchyma capture with kidney capsule and reinforcement of suture with plastic clips with lock on each needle piercing from kidney with suture interval of not more than 5 mm. Ileocolic anastomosis is formed through all layers of urinary bladder and intestinal segment by continuous suture. Trocars are removed with subsequent closing of ports.

EFFECT: method enables reducing the risk of inadequacy of ileocolic anastomosis and, as a result, developing its stenosis and forming hydronephrosis transformation leading to decreased kidney function, as well as development of such complications as urinary leakage, retroperitoneal phlegmon, peritonitis.

1 cl, 1 ex, 5 dwg