rectal instruments

VARIANT OF OPERATION FOR ILEORECTAL ANASTOMOSIS USING THE MECHANICAL SUTURE APPLIED BY THE КЦ-28 APPARATUS


By • Дек 18th, 2010 • Category: Rectum

In those cases when the rectum is cut off in the pel­vis below the promontory level, the ileorectal end-to-end anastomosis may be conducted more conveniently and rapidly using the КД-28 apparatus (see Part One, p. 50). The initial steps of this operation are identical with tho­se just described for the ileorectal anastomosis.

The rectum is clamped transversely with right-angled Fyodorov’s forceps and is painted per anum with iodine as far as the forceps level. A stout purse-string suture of closely placed stitches (No. 6 silk) is applied 0.5 cm below (distal to) the forceps (Fig. 184,1). A si­milar purse-string suture is then applied to the end of mobilized ileum just under the straight forceps that clo­ses the lumen (Fig. 184,2).

The next step is resection of the sigmoid colon. First, its proximal part is divided in the abdominal cavity bet­ween two straight forceps, the proximal sigmoid stump is ligated (as shown on p. 254( Fig. 166.13 and 14) and covered with a rubber cap. The distal part is divided in the pelvis with a sharp scalpel just under (distal to) the right-angled forceps, taking care to avoid damage to the purse-string suture. The rectum is opened with Al-lis forceps and is painted with iodine from the pelvic side.

The second assistant who stands between the separa­ted legs of the patient introduces per anu/n the body of КЦ-28 apparatus with its mushroom-shaped head screwed onto it. The apparatus is passed to the pel­vis throught the open rectal stump (Fig. 184,3) and its protruding head (mushroom) is painted with iodine. By rotating the apparatus screw from the outside the second assistant moves its head 5—7 cm (as required) into the pelvis. The open end of the ileac stump is now pulled on to the apparatus head oiled with vaseline (Fig. 184.4). Next both purse-string sutures are tightly tied with three knots on the apparatus rod (first the lower suture on the rectum and then the proximal one on the ileum), and the suture ends are cut off (Fig. 184.5).

Now the second assistant rotates the apparatus screw anticlockwise to approach the apparatus head to its body thereby bringing in contact the ends of bowel to be uni­ted (Fig. 184,6), with the surgeon seeing to it that no pieces of tissue, gauze, etc. penetrate into the gap bet­ween the bowel ends being approximated. Having adjus­ted the required distance between the bowel ends to be

Operation for total colectomy in multiple polyposis

Fig. 183. Operation for total colectomy in multiple polyposis:

10. Uniting skin edges with the peritoneal incision margins without cutting off the suture ends.

11. Suturing the stump of exteriorized sigmoid to the peritoneal wound edges.

Fig. 184. Ileorectal anastomosis using mechanical suture:

1. Establishment of purse-string sutures on the rec­tal stump under the clamp.

2. Establishment of purse-string sutures on the ileac stump.

lleorectal anastomosis using mechanical suture

Fig. 184. lleorectal anastomosis using mechanical suture:

3. Body of the КЦ-28 apparatus has been introduced into the pelvis through the rectal stump.

4. The ileac stump has been put on to the apparatus head («mushroom»).

5. The purse-string sutures have been tightened on the apparatus rod.

6. The stumps have been closely approximate



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